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Tocilizumab Works Best in Non-Mechanical Ventilated COVID-19 Patients
JAMA has published a meta-analysis of 15 studies of hospitalized patients with COVID-19 treated with tocilizumab and corticosteroids, showing that a clinically meaningful mortality benefit from tocilizumab (and steroids) was best seen in those not requiring invasive mechanical ventilation (IMV).
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When Less (Drug) is More (Activity) (3.4.2022)
Dr Jack Cush reviews the news and journal reports from the past week on RheumNow.com.
This podcast is sponsored by RheumNow.live. The great future of rheumatology education is at RNL 2022.
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2021 Top Articles from Arthritis & Rheumatology
https://t.co/nxKWrkdGX3 https://t.co/iZx5MOUyA7
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Dr. John Cush RheumNow ( View Tweet)
CORVITAS RA registry shows poor biologic responses in Severe obesity (BMI >35) & underweight (<18.5) w/ no diff between 2891 TNFi vs 3010 non-TNFi users. Severe obesity lower odds of LDA, MCID, CDAI ~10-20% UnderWt ~50-70% https://t.co/iMvlyo4UKx https://t.co/JTQ6aRVTpH
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Dr. John Cush RheumNow ( View Tweet)
ICYMI: Spondyloarthritis in Early Crohn's Disease
Analysis of a German Crohn's disease cohort finds that in patients with early CD, SpA was present in nearly one out of five patients and was associated with HLA-B27 positivity and a highly active CD.
https://t.co/ExAHSCw5v2 https://t.co/UDZHbg9ySY
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Dr. John Cush RheumNow ( View Tweet)
ICYMI: Increased SLE Flares with HCQ Reduction
Concerns about the long-term safety of HCQ often results in dose reduction or drug discontinuation; study shows that, for those in remission, HCQ taper/discontinuation resulted in a higher rate of SLE flares.
https://t.co/l0Xh1oQzQA https://t.co/HyDbqKrEFp
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Dr. John Cush RheumNow ( View Tweet)
ICYMI: 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/gJ922ToXe9 https://t.co/vyuxLA5SkL
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Dr. John Cush RheumNow ( View Tweet)
ICYMI: 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/1h2recxnqn https://t.co/d930Xij3Zv
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Dr. John Cush RheumNow ( View Tweet)
ICYMI: FDA approved 2/28/22
IV (intravenous) Actemra for GCA: dose 6mg/kg q4 weeks (don't exceed 600 mg/dose)
https://t.co/QhIq6dHGSf
TheDaoIndex KDAO2011 ( View Tweet)
ICYMI: 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/5K8L5WKQXs https://t.co/InDPhLrIUK
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Dr. John Cush RheumNow ( View Tweet)
Download this week’s podcast titled “When Less (Drug) is More (Activity) “
https://t.co/FESVNenri9 https://t.co/PVGGjkgcTV
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Dr. John Cush RheumNow ( View Tweet)
French GAZEL study of 20,625 pts showed a confirmed RA Dx was significantly assoc w/ increased CV risk (HR 3.03; 1.13–8.11) independent of usual CV risk factors. RF or ACPA (+) without RA was not associated with CV events https://t.co/DG8o5d9hHE https://t.co/5n9uDAhSrF
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Dr. John Cush RheumNow ( View Tweet)
When Labs and Exam are Discordant
A patient whose labs are way scary but her exam is not
QD Clinic is sponsored by https://t.co/4UQlqwujiR (March 19 & 20, 2022 in Las Colinas, Texas)
https://t.co/zUNcCn2CMi https://t.co/jsCGdwn5SH
Dr. John Cush RheumNow ( View Tweet)
Spondyloarthritis in Early Crohn's Disease
Analysis of a German Crohn's disease cohort finds that in patients with early CD, SpA was present in nearly one out of five patients and was associated with HLA-B27 positivity and a highly active CD.
https://t.co/q3w0hy0mzw https://t.co/P6EdggUxM8
Links:
Dr. John Cush RheumNow ( View Tweet)
An odd association - Swedish Registry analysis matched incident gout (1:5) w/ non-gout & looked for birth associations. Future gout risk was assoc w/ maternal diabetes ( https://t.co/Tsz72SeTC8 3.1), congenital malformation (OR 1.33), $ small gestational (OR 1.75) https://t.co/r9dGMzBopK
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Dr. John Cush RheumNow ( View Tweet)
Postpartum maternal outcomes Study compared 202 RA pts to 596 non-RA controls. There was no difference in infection rates or transfusions, but RA was assoc w/ more preterm births (OR = 2.11). Steroids (41%) were associated with lower birthweight https://t.co/F8DKmEHh0M https://t.co/d4Jkb3huMy
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Dr. John Cush RheumNow ( View Tweet)
Increased SLE Flares with HCQ Reduction
Concerns about the long-term safety of HCQ often results in dose reduction or drug discontinuation; yet a study shows that, for those in remission, HCQ taper/discontinuation resulted in a higher rate of SLE flares.
https://t.co/BROdm7zLaw https://t.co/2cEDEc2eOn
Links:
Dr. John Cush RheumNow ( View Tweet)
OP is worse w/ Inflammation; would biologics reduce OP and Fx risk? Swedish study of 24,678 RA pts, 4265 on biologics - Over time, the OP Fx rates were 12.1 vs 13.0 per 1000PY with and without biologics (HR 0.97; 0.78-1.20); Thus no Fx benefit https://t.co/d2zGd0WWoa https://t.co/Z9HVMUQd5U
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Dr. John Cush RheumNow ( View Tweet)
2/28, was “Rare Disease Day” in the USA, w/many tributes to the patients, doctors & researchers dedicated to these disorders. Moreover, it was a great opportunity to shout about the many rare conditions that don’t get enough press, praise or funding.
https://t.co/ft8Y8Mmdnz https://t.co/WqhRGzNRtS
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Dr. John Cush RheumNow ( View Tweet)
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
Links:
Dr. John Cush RheumNow ( View Tweet)
