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MTX + Pegloticase Combo FDA Approved
Horizon has announced that the U.S. Food and Drug Administration (FDA) has approved the expanded labeling of pegloticase (Krystexxa) injection to be co-administered with methotrexate (MTX), to improve response rates in patients with uncontrolled gout.
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N.Zealand adult registry of ~1million without CV disease, amongst whom 32K had gout. Having gout increased risk of CV events in women (adj HR 1.34;1.23-1.45) and men (1.18). CV risk in men was increased if not on ULT & not at target (~15%) https://t.co/AgHF45kY2c https://t.co/KzRvtMjS9p
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Study of 420 active #AS patients not responding to bDMARDs (TNFi, IL-17i) randomised to upadacitinib 15 mg/d or placebo. By wk14, UPA was superior by ASAS40 (45 vs 18%; p<0.0001)& other secondary endpoints (p<0.0001). https://t.co/nfOLlxgP5d https://t.co/fROMep8tbT
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JAMA full read on wt loss and type 2 diabetes.
- Diet, physical activity, & behavioral therapy
- high frequency counseling (≥16 sessions/6 mos)
- Wt medications effective as adjuncts to diet etc
- Rec surgery if BMI >40, unable to lose # or comorbidity
https://t.co/lgbNVPr8tz https://t.co/bzmdOvnxC7
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Dr. John Cush RheumNow ( View Tweet)
GLORIA trial presented by Martin Boxers. 2 yr RCT, 5mg Pred vs. PBO shows DAS28 benefit (-0.37 to -0.62) & -1.7 better X-ray (vs PBO) at 2yrs. BUT signif more harm (AE) RR 1.24; mostly infx. Is this a good trade off? Abst# OP0263 #EULAR2022 https://t.co/sjuOqDSjrM https://t.co/vniyDI77qE
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Dr. John Cush RheumNow ( View Tweet)
#AOSD cause is unknown, but matched case control study suggests signif link to Stressful life events (OR 2.56) & nonsignificant risk trending towards coal dust exposure (OR 3.0), allergy prior to onset (OR 2.67) & oral contraceptive use (OR 2.0) https://t.co/Saa4gEbzKS https://t.co/87RKgojmGZ
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Dr. John Cush RheumNow ( View Tweet)
Proposed investigations (findings) in the diagnosis of Stills disease:
- CRP, ESR, Ferritin (high)
- W/U for infection, cancer (negative)
- Serologies (negative)
- consider Imaging (CXR, CT, US, PET)
https://t.co/l3yqAx6PA0 https://t.co/Sg7okwKHaw
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Dr. John Cush RheumNow ( View Tweet)
Guidelines for MAS complicating Systemic JIA: Dx is based on:
- Fever in sJIA with ^ ferritin > 684, plus
- Any 2 of these: elevated PLTs, AST, Triglycerides or low Fibrinogen
https://t.co/aIEvxRYZca https://t.co/DYpLHxRCzI
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Dr. John Cush RheumNow ( View Tweet)
Cyclic GMP–AMP synthase (cGAS) engages stimulator of interferon genes (STING) to trigger inflammatory cytokines & type I interferons. cGAS–STING activation by genomic or mitochondrial self DNA implicated in autoinflammatory & autoimmune dz https://t.co/7CEFt9wLrl https://t.co/HpHhjJOATd
Dr. John Cush RheumNow ( View Tweet)
Five Mistakes When Diagnosing Still’s Disease
AOSD is likely to be the adult continuum of systemic-onset juvenile arthritis (sJIA) and hence, frequently affects young men and women below the age of 35 years.
https://t.co/C9kUOpFIlc https://t.co/82GIA7hSJl
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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)
Li et al. Orelabrutinib in SLE. 60 patient phase 2 RCT. Week 12 SRI(4) 50.0%/61.5%/64.3% in orelabrutinib groups vs 35.7% PBO. @RheumNow #EULAR2022 LB0005 https://t.co/wWJhlY5IYW
cc: @RichardPAConway : https://t.co/2IAURdfAOB
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#EULAR2022 Prof Schulze-Koops highlighted a mechanistic study that baricitinib therapy ex vivo suppressed autophagy, increased apoptosis, and reduced expression of adhesion molecules in #sjogren salivary glands. Next step should be randomised controlled trial cc: @Yuz6Yusof https://t.co/1tDBNzTuwQ
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)
#OP0004 #EULAR2022 In line with EULAR President’s preech to go Digital, Prof Mosca highlighted a study which showed assessment of joints in RA could be done by taking photos and analysed their dorsal skin folds using convolutional neural network
cc: @Yuz6Yusof : https://t.co/mn48vXtGad
Dr. John Cush RheumNow ( View Tweet)
Bimekizumab: IL-17A and F inhibitor for tx of PsA - BE OPTIMAL trial reached primary endpoint: ACR50 44% vs. placebo
Efficacy as early as 2 weeks
No MACE, uveitis, IBD, deaths
@RheumNow #EULAR2022 ABST#LB0001 cc:@doctorRBC : https://t.co/wgeBsfdQcL
Dr. John Cush RheumNow ( View Tweet)
Prof Hoi @alberta_hoi Anti-Sm in SLE. Present in 17%. Assoc severe disease activity, "classic" SLE manifestations, specific serologic and proteomic profile. Argues for Sm+ SLE being a specific subset (or even a "different" disease?)
#EULAR2022 POS0774. cc: @RichardPAConway https://t.co/cwp6q4kouz
Dr. John Cush RheumNow ( View Tweet)
#Bestinclass Recurrent #PMR RCT of #sarilumab v placebo. Nearly doubles sustained remission but maybe attenuating effect - flare difference over time? N=118. 🤷♀️ Dunno who I would use it in yet. LB0006 @RheumNow @eular_org #EULAR2022
@Janetbirdope
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)
Solving Still’s Disease
Still's disease is the most common rheumatic cause of unknown fever in adults. This series covers the definition, history, epidemiology, key manifestations and labs, diagnostic criteria, and more.
https://t.co/YqpSW6T3El https://t.co/vwehTCm4aN
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Dr. John Cush RheumNow ( View Tweet)