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Allergic Drug-Induced Arthritis (5.19.2023)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. This week we delve into some odd associations, repeat drug warnings and the consequences of antirheumatic therapies.
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Microbiome of Hip and Knee Osteoarthritis is not "Sterile"
EurekAlert!
Next-generation DNA sequencing (NGS) techniques show the presence of bacterial DNA in surgical specimens of hip and knee arthritis, from patients undergoing first-time total joint arthroplasty, reports a study in The Journal of Bone & Joint Surgery.
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Dr. Anisha Dua on Imaging in PMR:
- US of shoulders to eval for bursitis can increase specificity
- MRI better for pelvic girdle, but expensive
- Consider PET if lack of response to steroids, r/o malignancy
#RNL2023 @RheumNow https://t.co/tjhGlJPDWZ https://t.co/9h1FwfM0CP
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Dr. Langford's take home for GPA. Remember to consider disease severity (will determine tx,) maintenance tx, and non-medical management including vaccination options for pts. #RNL2023 @RheumNow https://t.co/R6nrz7YXZr https://t.co/UVY0jDUGJ2
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Avacopan in GPA
- non-inferior to prednisone for induction remission
- received FDA approval for treatment of severe active GPA in combo with standard therapy and steroids
- should be used in newly diagnosed active or relapsing disease
@rheumnow #RNL2023 https://t.co/My6M5MGBl1 https://t.co/0aPFUeE55Q
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How to long for maintenance of GPA?
Continue for 24 months, then consider:
Relapse history? Organ damage? Toxicity? Patient wishes? Compliance? Family planning?
Dr. Langford @RheumNow #RNL2023 https://t.co/tFn2p5DfJV https://t.co/Uu4Fmans40
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U.S. FDA Approves RINVOQ® (upadacitinib) as a Once-Daily Pill for Moderately to Severely Active Crohn's Disease in Adults based on induction studies, U-EXCEED, U-EXCEL,& U-ENDURE maintenance study. This is 7th FDA approval for RINVOQ https://t.co/FypYaTMJxU https://t.co/yilppBv6Ka
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Dr. Carol Langford on GPA treatment
Duration of remission maintenance therapy?
- at least 2 years, after 2 years, maintenance appropriate in many cases
- consider RTX, and other cDMARDs (MTX, MMF, AZA)
@RheumNow #RNL2023 https://t.co/gAEo6SudES https://t.co/RGSzXy0vE5
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Dr. Langford #RNL2023
When to use CYC over RTX for severe GPA induction?
- Severe disease with RTX intolerance
- Worsening disease despite RTX
- RGPN Cr > 4.0, mechanical ventilation? (these were excluded from RAVE trial)
@RheumNow https://t.co/AnSAnGP6Oa https://t.co/iHF6tiFvj2
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Carol Langford #RNL2023
Use of CYC + RTX:
Not routine upfront, but may be needed for escalating disease
Limited data to support initial usage
Higher risk of hypogammaglobulinemia, infection, and death
@RheumNow https://t.co/DRLf1Zl5bN https://t.co/fSv5ciAklI
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Carol Langford #RNL2023 @RheumNow
Rx options for GPA showed by targeted to patient's disease characteristics of severe vs non-severe disease
CYC not for non-severe due to toxicity
MTX, MMF not for severe disease https://t.co/jw3wq2k7gb https://t.co/y3ck6KuCDj
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"Highest pre-test probability for GCA is actually:
1) Limb claudication
2) Jaw claudication
#RNL2023 @RheumNow https://t.co/Ed52fIcVaI" https://t.co/dA1FlCEU3i
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GCA biopsy: When and How
Early is best, rec'd in first 2 weeks. Findings can be present at 8 weeks but be less prominent
@anisha_dua rec's unilateral imaging in most pts, especially w scalp tenderness on one side
>1 cm length
#RNL2023 @RheumNow https://t.co/Pn25Qt0WL4 https://t.co/5qROaTbD2w
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Dr. Spiera's approach to PMR treatment
- prefers methylprednisolone
- rapid taper over 16 weeks
- consider GC sparing therapy (MTX, IL-6i)
@Rheumnow #RNL2023 https://t.co/LR9e0aXkeN https://t.co/qXUBkz5vfe
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SAPHYR, presented at #ACR22, unpublished
Robert Spiera at #RNL2023
Phase 3 study for refractory PMR
Sustained remission of disease, less steroids usage, steroid toxicity, and improved PROs
@RheumNow https://t.co/oQJV7gUV3W https://t.co/S1LRBT55Qn
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IL-6 for PMR
SPARE and SEMAPORE (Toci), SAPHYR (Sari)
2/2023: FDA approves sarilumab for PMR for inadequate response to corticosteroids or unable to taper off
Robert Spiera @RheumNow #RNL2023 https://t.co/VtzW01Ez7D https://t.co/P6oUQvmDXH
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Swedish registry review of #MTX initiation in early #PsA vs #RA (n 3642each). 2 years after MTX start, 71% of PsA vs 76% of patients with RA remained on MTX & the majority (66%/60%) had not started another DMARD, or a biologic (77%/74%) https://t.co/nTJO04sn65 https://t.co/gLjKzj2c74
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Evidence-Based Guidelines for EGPA
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, affecting between 10 and 14 cases per million globally.
https://t.co/VixECcPv4R https://t.co/XgEHRgDiPj
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RELIEF Trial: Sublingual Cyclobenzaprine in Fibromyalgia
https://t.co/a6KUPcfmxM https://t.co/ToRJQVsZSu
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RCT of 122 active plaque Psoriasis pts (38F, 55M) with low vitamin D (~15). Rx w/ either PBO or Vit D (100K IU, followed by 20K IU/wk x 4 mos). Vitamin D supplementation had no effect on psoriasis severity (but pts had mild PSO). https://t.co/JXtEBaop3c https://t.co/ScGtBUIrm0
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