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Prolonging the Controversy of Hydroxychloroquine

Kathryn H. Dao, M.D.

Since the start of the pandemic, hydroxychloroquine (HCQ) was forced into the limelight for the prevention/treatment of COVID-19.

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Treat-to-Target Works in Gout With No Cardiac Toxicity

ACR

New research presented this week at ACR Convergence, the American College of Rheumatology’s annual meeting, shows that allopurinol and febuxostat may effectively lower urate levels when used in a treat-to-target approach. Importantly, both urate-lowering therapies were very effective with 90% of patients reaching target urate levels. Additionally, both appeared safe, with no evidence of increased cardiovascular toxicity (Abstract #1900).

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RheumNow Podcast – Like Father, Like Daughter (10.29.2021)

Jack Cush, MD

Bad things happen when our patients go into the ICU and it's not always due to the disease. Good things happen when we rise from sitting. And guess what? Rheumatologists are setting cardiology straight about hydroxychloroquine and chloroquine. This, and a special recognition of parent-child rheumatologists, along with the news and articles from this week on RheumNow.

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Rheumatoid Arthritis Thrombotic Risk Influenced by DMARD Choice

Jack Cush, MD

RA patients have an increased risk of venous thromboembolism (VTE) related to disease activity and inflammation, yet a large real-world study of older RA patients shows methotrexate to be associated with a 2-fold increased VTE risk (compared to hydroxychloroquine).

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Smoking Impairs Methotrexate Efficacy

Jack Cush, MD

The Journal of Rheumatology reports that current smoking significantly reduces the clinical efficacy of methotrexate (MTX)-based therapy, as studied in an early rheumatoid arthritis (RA) cohort.

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Heart Failure in RA: Inflammation Matters

MedPage Today

Patients with rheumatoid arthritis (RA) who had high levels of inflammation at baseline were at increased risk for later heart failure, a large cohort study found.

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It's what's below the surface that's most scary. see: RA & the heart - why do RA pts without cardiovasc dx/Sx get LV remodelling over time - why is it worse with worse RA control? RA goes deeper than the joints & our pts need to hear that! @Columbia #ACR21 ABST0272 @RheumNow https://t.co/NDHLZwoEjy
David Liew drdavidliew ( View Tweet)
Despite >20y of bDMARDs, our patients still have a 50% greater risk of cardiovascular issues (similar to family history or abdominal obesity) Cardiovascular disease in RA is not historic, it's today's reality we too often ignore. 2020 data @VUamsterdam #ACR21 ABST0286 @RheumNow https://t.co/Az4wHNUOGe
David Liew drdavidliew ( View Tweet)
Diabetes puts you at risk of cardiovascular disease, right? What about RA? Look at this graph and compare the pair. "already it was impossible to say which was which” - George Orwell, Animal Farm #ACR21 ABST0287 @RheumNow https://t.co/r0yaeC530l https://t.co/mKJhoyJ2Cn

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David Liew drdavidliew ( View Tweet)
#ACR21 Abst#0271. ⬆️ Risk of carotid atherosclerosis in first few years of RA diagnosis. Authors recommend routine carotid screening in pts at time of diagnosis. Q: would you routinely screen all patients at time of diagnosis? @Rheumnow https://t.co/A9akqyVRGF https://t.co/SYGkJHQzWf

Links:

Eric Dein ericdeinmd ( View Tweet)
Abst#0276: Pulse Pressure (PP) can predict carotid plaque in RA! ➡️PP (SBP – DBP) assoc w/ subclinical CVD in gen populat. How about in RA? ⭐︎ RA pts had higher PP than controls ⭐︎ PP = only independent RF for subclinical athero #ACR21 @Rheumnow https://t.co/esLDW8iggf https://t.co/6d2D9hXC1i

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Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Nintedanib open-label extension study in PF-ILD (progressive fibrosing) - active arm continuing: similar rate of change as RCT (78 v 77) - placebo arm initiating: similar as well Missing data (COVID-19) but effect appears related to exposure INBUILD-ON #ACR21 ABST0186 @RheumNow https://t.co/hWe7ypbex6
David Liew drdavidliew ( View Tweet)
Abst#0269: Autoabs confer risk of incident CVD in US ⚦ veterans w/ RA ⭐︎ MACE risk: ↑ concentrations of RF (HR 1.15) & malondialdehyde acetaldehyde (anti-MAA) (HR 1.2) ⭐︎ CVD Death: ↑ concentrations of CCP (HR 1.27) & anti-MAA #ACR21 @Rheumnow https://t.co/UeOz91Bh3P https://t.co/PJwP1H4eNk

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Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR21 Abst#0269 ⭐️TCZ: ⬆️cholesterol, LDL, TG. ⬇️ hsCRP compared to TNFi. No ⬆️ risk of Reynold risk score (RRS) Take-away: good data on TCZ effect on lipids, but I wouldn't use RRS to calculate CVD risk on med that ⬇️ CRP @Rheumnow https://t.co/zMltktfHkS https://t.co/bwKXiGIi8a

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Eric Dein ericdeinmd ( View Tweet)
Abst#0268 ➡️Do lipids change w/ some bDMARDs in RA? YES! ⭐︎ TCZ: ↑ TC, LDL, TG & ↓ in hsCRP relative to initiating TNFi. ➡️Does this lipid ↑ confer risk for CVD? Not necessarily as it may not be atherogenic per Reynolds Risk Score! #ACR21 @Rheumnow https://t.co/Gy62mg6GhZ https://t.co/5uC8Zy0Lbr

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Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR21 Abst #0269: VA study of AutoAbs and CVD risk ⭐️Anti-malondialdehyde acetaldehyde (anti-MAA) shown to associate w/ CVD risk in non-RA pt Findings: RF, CCP, anti-IgG anti-MAA, anti-IgM anti-MAA (not IgA) associated with ⬆️ CVD death https://t.co/WRBh673u8T @Rheumnow #ACRbest

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Eric Dein ericdeinmd ( View Tweet)

ICYMI: ACR publishes a "White paper on Antimalarial Cardiac Toxicity"- reviewing drug hx,indications, effects & rare risk of arrhythmias, conduction abnormalities, cardiomyopathy, QTc prolongation. torsade de pointes. No evidence for routine ECG monitoring https://t.co/2aemSKzk3T https://t.co/4CrqO0OKlz

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Dr. John Cush RheumNow ( View Tweet)
"ECG monitoring is not part of the current standard practice when HCQ or CQ is prescribed for...rheumatologic or dermatologic conditions." -pub 10/26/21 ACR White Paper on Antimalarial Cardiac Toxicity https://t.co/uBqm5LBsob

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TheDaoIndex KDAO2011 ( View Tweet)

Rheumatic pts admitted to ICU, #SLE is most common & Sepsis most common reason. 80 ARD pts adm to ICU: Dx were SLE (42%), RA (26%), vasculitis (12%) FOR Sepsis (31%), (10%) CHF (10%). 20% died in ICU, 5% 30d after ICU, 7.5% w/in 1 yr https://t.co/lX0m3vOukI

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Dr. John Cush RheumNow ( View Tweet)

Smoking worsens adult-onset Still’s disease. 185 AOSD pts, found 45 smokers who had higher risk of pericarditis (36 vs 16%), pleuritis (33 vs 14%), abd pain (18% vs 6%), higher systemic score (6.4 vs 5.4 ), More MAS (29% vs 6%), lung disease (18% vs 13%) https://t.co/ZKKhw1EbnD

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Dr. John Cush RheumNow ( View Tweet)

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