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The Great Unknowns (8.5.2022)

Jack Cush, MD

Dr. Jack Cush reviews the news, FDA approvals, journal articles from the past week on RheumNow; plus viewer questions. This week great hopes for vitamin D, the great unknows of CSA and the great big mess that is the gout.

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ACR guidance

ACR Updated Guideline on Vaccinations for Rheumatic Patients

Jack Cush, MD

The ACR has posted a new ACR Clinical Practice Guideline Summary providing recommendations on the use of vaccinations for children and adults with rheumatic and musculoskeletal diseases (RMDs).

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Upadacitinib in non-radiographic Axial Spondyloarthritis

Jack Cush, MD

The janus kinase inhibitor, upadacitinib, has been shown to significantly improve the signs and symptoms of non-radiographic axial spondyloarthritis (nr-AxSpA), extending the efficacy of UPA beyond classic ankylosing spondylitis.

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Spinal Findings on MRI May Not Signify Spondyloarthritis

Jack Cush, MD

For about one in six people considered healthy with no reports of back pain, lesions were visible on MRI in the lower spinal column and sacroiliac joint, researchers said -- a sign that rheumatologists should be cautious about diagnosing spondyloarthritis (SpA) on the basis of imaging.

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Achilles,ankle,heel

Steroid Injection for Chronic Achilles Tendinopathy

MedPage Today

Adding a corticosteroid shot to exercise therapy significantly improved symptoms of chronic Achilles tendinopathy, a 100-person randomized trial found.

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ICYMI: 2021 Rheumatology Year in Review

Jack Cush, MD

For 2022, let's look our top 10 list of advances, game-changers, worries and those better medical practices that evolved during 2021.

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Axial Spondyloarthritis

ICYMI: Update on Axial SpA at EULAR 2022

Antoni Chan, MD, PhD

This year at EULAR 2022, there were important and interesting topics in Axial Spondyloarthritis (AxSpA). These are my picks of abstracts from the conference.

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Upadacitinib (Rinvoq) Approved by European Commission for use in adults with active Non-Radiographic Axial Spondyloarthritis - 15 mg qd p.o. Approval based on Phase 3 SELECT-AXIS 2 nr-axSpA trial published in Lancet https://t.co/n3Pci5GyoA https://t.co/4aoSOc7xHd

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Dr. John Cush RheumNow ( View Tweet)
THe microbiome differs between #AS (n 33) and AS-IBD(59) compared to IBD (105) patients. Study comparing feces & intesting Bx. Microbiome composition correlated with BASDAI and faecal calprotectin (FCP) levels. https://t.co/D4QCVVDK7G https://t.co/OJkeisycg0

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Dr. John Cush RheumNow ( View Tweet)
Have you checked out our new sister-site, Still's Now? A new site for Still's disease, autoinflammatory & febrile disorders. https://t.co/oWEugnOB6k https://t.co/5jwiP2Xqrz

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Dr. John Cush RheumNow ( View Tweet)
JAMA patient (resource) handout on Lumbar Spinal Stenosis! https://t.co/fl5K5Ve6fY https://t.co/aLHs6sKE1o

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Dr. John Cush RheumNow ( View Tweet)
Spinal Findings on MRI May Not Signify SpA Research indicates that rheumatologists should be cautious about diagnosing SpA on the basis of imaging alone. https://t.co/Z4gox4cx9N https://t.co/PI9BCty8Bx

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Dr. John Cush RheumNow ( View Tweet)
Rheums: Got a Rheumatology question or case for Jack Cush? Record it here and we'll feature it on an upcoming podcast. Tell us your name and where you practice rheumatology. https://t.co/QUTIbK3r89 https://t.co/FZcTLREida

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Dr. John Cush RheumNow ( View Tweet)
Rheumatologist Survey: What do you rely on MOST in diagnosing Still’s disease? Sxs? Labs? Both? Criteria? Fever? Vote here: https://t.co/oANKpKqJA5 https://t.co/LIjRSBHNBi

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Dr. John Cush RheumNow ( View Tweet)
French registry of IBD due to IL-17 inhib revealed 32 pts- risk of new IBD was low & decreased 2016 to 2019, w/ good outcome in 24/31. IBD more common w/ AS (27) vs PsO (4), IBD onse after 4 (1.5–7.5) mos; all cases w/ secukinumab https://t.co/FJAvhmzPkc https://t.co/WSIut9mAEq

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Dr. John Cush RheumNow ( View Tweet)
Tofacitinib had faster and larger impact on improvement of fatigue compared to placebo in treatment of ankylosing spondylitis pts. Note 100% fatigue resolution roughly same vs. placebo @RheumNow #EULAR2022 ABST#POS0305 cc: @doctorRBC : https://t.co/sodp75Nblw
Dr. John Cush RheumNow ( View Tweet)
In vitro study shows Upadacitinib inhibits enthesis T cell derived TNFa and IL-17A, disrupting the prominent IL-23/IL-17/TNFa axis driving SpA. @RheumNow #EULAR2022 ABST#POS0331 cc: @doctorRBC https://t.co/M8YYAOBVat
Dr. John Cush RheumNow ( View Tweet)
SELECT-AXIS 1 trial of upadacitinib in active #AS with an inadequate resp to prior biologic - pivotal phase 2/3 RCT of 420 AS pts (Dz dur 7.7 yrs; 83% B27+) showed better ASAS40 at wk 14 w/ UPA vs PBO (45% vs 18%; P<0.0001) #EULAR2022 POS0306 https://t.co/JmreAOqnqh https://t.co/pTFeAzWUYU

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Dr. John Cush RheumNow ( View Tweet)
The EMA's CHMP has positively recommended upadacitinib for use in Non-radiographic axial spondyloarthritis (nr-axSpA) based on Phase 3 SELECT-AXIS 2 study showing superior ASAS40 responses at week 14 https://t.co/uc7oOKglLX https://t.co/yz7M8U3rkk

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Dr. John Cush RheumNow ( View Tweet)
No science to F/U visit scheduling. Study of 114 outpt SpA visits, 34% considered unnecessary (fewer Rx change 15 v 52%) & clinical actions (23 v 63%) visits) vs. "necessary" visits (predict by ASDAS ≥2.1 & PtGA ≥3 >80%). Remote monitoring role? https://t.co/J8TIQRb0LG https://t.co/TCSN0NaeC8

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