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MTX Fails Knee OA (6.6.2025)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com
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HLA-B27 Testing in Practice
Analysis of testing for human leukocyte antigen B27 (HLA-B27) in a teaching center shows HLA-B27 testing was frequently performed by rheumatologists and nonrheumatologists for a broad spectrum of indications and primarily as a screening test.
Metanalysis of 12 trials, 12 902 adults hospitalized w/ COVID betw May, 2020 & March, 2022 (7 Bari, 3 Tofa, 2 Ruxo). Fewer deaths in those on JAKi (11·7% vs 13·2%; aOR 0·67 [95% CI 0·55–0·82]; high-certainty evidence); 39 fewer deaths/1000. JAKs had less mechanical ventilation https://t.co/QSMRo3RcRr
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Systematic review of JAK inhibitor use in systemic sclerosis - 18 articles/87 SSc pts (80%F; ages 13–78 yrs). JAKi (83% tofa) mostly used for ILD & Skin Dz (45%) or GI+Skin Dz (39%). 87.5% improved, w/ 6% relapsed. Adverse events in 50% (20% infx). We need RCTs! This could be a https://t.co/lNFEX08Vn3
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Blau syndrome -a rare autoinflammatory Dz w/ triad of granulomatous dermatitis, arthritis, & uveitis (may cause blindness); from a NOD2 gain-of-function mutations. Onset age 2-4 yrs. Early biologics (esp TNFi) may prevent joint complications; but metanalysis shows no preferred https://t.co/wYTNv50tqM
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IL-40 is elevated in systemic sclerosis (SSc). Study of serum (90 SSc vs controls/HCs), Skin Bx (5 SSc v 5 HCs). IL-40 signific. upregulated in the skin & correl. w/ ESSG (r = 0.37), GI dz; also w/ serum IL-8, TGF-β1. IL-40 functionally linked to activated B cells, PMNs, T https://t.co/XsSFXgBxuD
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PETRI-isms: "The patient is always right (even when they are wrong)." - Dr. Michelle Petri
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Methotrexate Fails in Knee Osteoarthritis
We'll be blunt: methotrexate flopped in a randomized placebo-controlled trial among patients with osteoarthritis (OA) of the knee.
https://t.co/Y9elFXTkhN https://t.co/oqDDVPGbh7
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135 pts w/ neurologic autoimmune dz (MS, GBS, myasthenia gravis) who had cancer & Rx w/ checkpoint inhibitors (ICI) showed exacerbations in SOME - 18% of MS pts, but 67%of MG, latter often w/ hospitalization (50%) or death (17%). GBS faired well w/ ICI Rx. https://t.co/RksC6QXce0 https://t.co/HbwYDVrIAt
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In 2019 there was an estimated 273,000 coccidioidomycosis cases in the USA; 23,000 hospitalizations and 900 coccidioidomycosis-associated deaths. Mostly from endemic states California & Arizona. https://t.co/JXPs8B4Dwb https://t.co/90e1TYxGoW
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Positive results from Phase 2b RENOIR RCT of Rosnilimab, an agonist targeting PD-1+ T cells. 432 RA pts on MTX or csDMARDs, Rx w/ 6 mos of PBO vs ROS (100 or 200 mg q4wk or 600 mg q2wk). All 3 doses of rosnilimab achieved significant reductions DAS-28 CRP at Wk 12 https://t.co/6nF8KPRK2f
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Systematic review of fibromyalgia & sleep quality - 47 RCTs, 11094 pts showed CBT for insomnia had a significant improvement in sleep quality; but CBT for pain had no impact. Only moderate improvement w/ pregabalin, sodium oxybate; but no effect w/ amitriptyline, milnacipran, https://t.co/AEqbShRh6e
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UK Natl Early Inflammatory Arthritis Audit (5/18-11/19) compared 2120 PsA & RA (1:1). PsA had longer Sx to referral wait (112 v 89 days; HR 0.87), longer delay in Dx (HR 0.8), PsA less DMARD use at baseline (54% v 69%) & higher DAS28 results at 3 mos (+0.27) https://t.co/ObssKGcomq
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Single-centre retrospec study of 39 Juvenile Dermatomyositis pts Rx w/ JAKi. Partial/complete Clin inactive Dz achieved in 32/39 w/in 6 months w/ steroid reduction and W/D of other DMARDs. Only TIF1γ) Ab (+) was assoc w/ nonresponse to JAKi (P < 0.001). 5 w/ H. Zoster
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Psychological Bulletin has published that invalidating (gaslighting) pts Sxs can have harmful consequences. Includes pts dx w/ Ehlers-Danlos, endometriosis, fibromyalgia, ME/CFS, POTS, Gulf War, IBS, long Covid, multiple chemical sensitivity, SLE, and vulvodynia.
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Sacroiliitis is a rare adverse reaction of isotretinoin. Review of 67 pts finds median age 21 yrs, onset median 2.5 mos (0-24) post isotretinoin. Sxs: LBP 70%) & hip pain 45%. Dx by MRI (73%) w BME. Full recovery 81% isoretinoin D/C & NSAIDs (< 10% biologics)
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PPACMAN Consensus Recs. for CV risk in PSO/PSA published for Rheums/Derms/PCPs
- check BP, Wt, Lipids, Cr.
- Look for HTN, DM, smoking, obesity, metabolic synd.
- Risk stratify w/ hsCRP, Lipids
- Lifestyle management https://t.co/MkgYopTNAX https://t.co/fplKbua9Z2
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Review of ARF & Post-streptococcal reactive arthritis (PSRA) following Group A strept infxn. Early Dx & Rx of Strept can prevent ARF & PSRA. PSRA is a sterile arthritis, bimodal age onset, lower extrem arthritis, usually resolves without lasting sequelae https://t.co/ld208yf0Zk
Links:
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Target trial emulation study data from British Dermatologists Biologics & Immunomodulators Register, compared 231 PSO Rx w/ MTX + Adalimumab against 1553 PSO on ADA. @1Yr MTX did not augment ADA only responses based on Rx survival (79% vs 78%) or PASI75 (49% vs 52%). https://t.co/DSYNd9P5Om
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Denosumab and Osteoporosis - A JAMA Review
An overview of denosumab use in osteoporosis (OP) by Bauer and Ensrud was published in JAMA
https://t.co/3d7Q61nVKM https://t.co/PdI235k9jh
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