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ACR Guidelines for the Treatment of Systemic Juvenile Idiopathic Arthritis

d Jack Cush, MD

The ACR has updated its clinical guidelines for the management of juvenile idiopathic arthritis (JIA), with this update focusing on oligoarthritis, TMJ arthritis, and systemic JIA (with and without macrophage activation syndrome); only the latter, systemic JIA recommendations are reported he

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Drug Survival Differences in RA, PsA, SpA and PsO

d Jack Cush, MD

Drug survival may be the best measure of efficacy and safety. A new study of novel therapy durability (survival) in patients with RA, axial spondyloarthritis, PsA, and psoriasis shows that while all these drugs are approved for said conditions, drug survival varies by condition, suggesting an ongoing need for individualized treatment.

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ACR Best

2021 Top Articles from Arthritis & Rheumatology

d ACR

The ACR journal, Arthritis & Rheumatology, has publish a listing of top articles in 2021 as measured by Altmetric, an online service that tracks what gets "clicked" and discussed.  Interestingly, this includes 4 guidelines and 5 COVID-related papers.

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Spondyloarthritis in Early Crohn's Disease

d Jack Cush, MD

Analysis of a German Crohn's disease cohort finds that in patients with early Crohn’s disease (CD), spondyloarthritis was present in nearly one out of five patients and was associated with HLA-B27 positivity and a highly active CD.

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NEJM case - Whats the diagnosis? 31yoM w/ 10yr hx of clubbing, arthralgias, nailfold hyperpigmentation, Tender DIPs, toes; xrays showed bony proliferation. Labs and PET were normal. Rx w/ NSAIDs and improved w/ specific Rx? https://t.co/kwkIsOgnW5 https://t.co/NsBqe3rxFP

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Top February Tweet: Positive Results from the DOA (Duloxetine in OsteoArthritis) Study https://t.co/Is56PBxpIr https://t.co/xEh6zbx9nr

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With H. Zoster on JAK inhib; you can continue JAKi @ low risk. Study of 416 RA pts on JAKi, 8% HZ reactivation (age 60 yrs, 42% Pred) after 11 mos. 72% cont JAKi during HZ, 15% temporarily D/C & resumed. Only 1 pt had HZ re-reactivation https://t.co/dJqhlhGEda

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Polarized microscopy of synovial fluid to identify uric acid crystals was shown to high utility and reliability in a study of 5 rheumatologists (4 consultants, 1 registrar). 50 SF samples - good agreement w/ κ = 0.71 for MSU, 0.88 for CPP https://t.co/5c7N7spc0t https://t.co/9wXsHuCY6D

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The worldwide Psoriatic arthritis treatment market is expected to grow from $7.89 billion in 2021 to $8.92 billion in 2022 https://t.co/5gdsUgM08y

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Pharma payments to rheums. Study of 4822 rheums in Medicare, 77% recv some pharma payment. For every $100 in food/beverage payments, prescribing increased 1.5-14%. For every $1000 in consulting, prescribing increased <5%. https://t.co/tKsRIBbFdt https://t.co/HN2yiTBkPh

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Phone Calls about Labs How to handle "labs" and expectations. QD Clinic is sponsored by RheumNow Live (March 19 & 20, 2022 in Las Colinas, Texas) https://t.co/WzIGihU1UR https://t.co/uvctRtbUEK

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INBUILD Study of 170 pts with autoimmune related ILD showed nintedanib signifi. slowed the rate of FVC decline in FVC decline over 52 wks (NIN -75.9 mL/yr vs PBO -178.6 mL/yr). AE's (mostly diarrhea) leading to D/C was NIN 17.1% vs PBO 10.2% https://t.co/VG5oPBU0VC https://t.co/vTkzcwskuJ

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Diabetes (HR 1.29), bad glycemic control (HR 1.41), and long-term diabetes (>5yrs HR 1.49) are potential risk factors of symptomatic knee OA, independent of age and BMI. Targeting blood glucose, in addition to obesity, may prevent knee OA. https://t.co/6XXVfLumqG https://t.co/ypz8avcjVs

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Retrospective study of juvenile dermatomyositis shows 1st line Rx w/ MTX is not effective, esp in MSA Ab+ pts. 45 JDM pts (2/3 severe) Rx w/ 6 mos MTX + steroids; inactive dz seen in 31%, with 42% muscle and 33% skin responses. MSA neg pts did better https://t.co/PDubjbcMe2 https://t.co/rGCSZ3ZT9U

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Referring Psoriasis with Joint Pain Psoriasis Patient with a Few Tender Joints - How to Refer to a Rheumatologist. QD Clinic is sponsored by RheumNow Live (March 19 & 20, 2022 in Las Colinas, Texas) https://t.co/kuDc6xi3NZ https://t.co/VCFFFqA040

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Psoriatic fingernail onycholysis and hyperkeratosis, rather than nail pitting, are significantly & independently assoc w/ PsA. Study of 1985 pts w/psoriasis, 11.5% were Dx w/ PsA. Only onycholysis (OR 2.34) and hyperkeratosis ) were assoc w/ PsA https://t.co/X3JHUFtGdD https://t.co/xu8erkOMSa

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Health Disparities in Rheumatology - a great lecture by Dr. Alvin Wells at RWCS 2022. https://t.co/aZXrKndenF

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Updated ACR/AAHKS Guidelines on Drug Use in Knee & Hip Arthroplasty Patients https://t.co/e6hSUJDrLK https://t.co/DzgCm47Qyh

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Downside of Holding MTX with COVID-19 Vax A recent clinical trial has shown that a 2 week hold of MTX following COVID-19 vax resulted in greater anti-SARS-CoV-2 immunogenicity; but there was an increase in flare rates after the second dose of vaccine. https://t.co/a7XfBxVkvJ https://t.co/h4VqsQYkaK

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Undifferentiated Arthritis +RF Arthralgias x 3 mos and a vague Family History of arthritis. How would you treat? QD Clinic is sponsored by https://t.co/4UQlqwujiR (March 19 & 20, 2022 in Las Colinas, Texas) https://t.co/O0KywLk5dd https://t.co/JV37SGk7ud

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