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Consequences of TNF inhibition (3.18.2022)

Jack Cush, MD

This week we're going to talk about the downside of TNF inhibitors, a few interesting observations in gout, and yes, kids do get COVID. We're also going to preview what's coming in April (hint: it's about PsA). This and more as Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.

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uveitis eye iritis

New Insights into Uveitis in Spondyloarthritis

Antoni Chan, MD, PhD

Uveitis is the most frequent extra-musculoskeletal manifestation (EAM) in Axial Spondyloarthritis (axSpA). The prevalence of uveitis in axSpA is between 25-30%. Up to 50% of patients with an acute episode of uveitis develop recurrent anterior uveitis or iritis.

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uveitis eye iritis

New Insights into Uveitis in Spondyloarthritis

Antoni Chan, MD, PhD

Uveitis is the most frequent extra-musculoskeletal manifestation (EAM) in Axial Spondyloarthritis (axSpA). The prevalence of uveitis in axSpA is between 25-30%. Up to 50% of patients with an acute episode of uveitis develop recurrent anterior uveitis or iritis.

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ACR Best

ACR21 Best Abstracts - Day 2

Jack Cush, MD

The RheumNow faculty reporters have been scouring and reporting on the best abstracts from the ACR. Here is a sampling of their choice abstract presentations reported during ACR 2020 Day 2 (#ACRbest).

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Multinational recs. on Rx of JIA assoc. Uveitis: - Topical steroids are 1st line Rx - Systemic Rx if above fails or w/ poor prognosis or persistence - Options MTX, MMF then Humira EOW, then weekly ADA - Consider non-ETN TNFi's, then TCZ, ABA, JAKi or RTX https://t.co/ZfVeWf5sVg https://t.co/yu3to0LdEd

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Dr. John Cush RheumNow ( View Tweet)
#EULAR2022 ASAS/EULAR AxSpA Recs ⭐️Last: 2016 ▶️All: education, exercise, 🚭 ▶️❌csDMARD for axial disease ▶️TNF/IL17 (or JAK) with high disease: ASDAS>/=2.1 ▶️Monoclonal TNF for uveitis/IBD, high PsO: IL-17 ▶️Sustained remission: tapering of bDMARD "can be considered" @RheumNow https://t.co/3yYU0Vb37r
Eric Dein ericdeinmd ( View Tweet)
2021 approved Efgartigimod (Vyvgart) for myasthenia gravis: (binds neonatal Fc receptor, stops Ig recirculation): pts w/ AChR Abs respond best (68% vs 30%). Common AEs include URI, UTI, HA; other AE: eyelid swelling, rash, and SOB. https://t.co/wQKZuAlXoR

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Dr. John Cush RheumNow ( View Tweet)

Genes and Obesity Tied to Higher Gout Risk in Women Excess adiposity and genetic predisposition both contributed to risk of gout among U.S. women, with the risks being highest when both factors are present, a large prospective study found. https://t.co/vLR8GJC9qf https://t.co/6Scc5c0dUU

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Dr. John Cush RheumNow ( View Tweet)
Uveitis and Prevalence of Psoriasis in axSpA: Dr. Robert Chao ( @doctorRBC) discusses the best SpA abstracts he saw at the #ACR21 annual meeting: abstracts #1324 and #1311. https://t.co/6zARkjsoCg

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Dr. John Cush RheumNow ( View Tweet)

Fr AQUILA study: #Uveitis status in AS or PsA pts given SEC 👁‍🗨3 pts w/o uveitis at BL developed new onset uveitis during study 👁‍🗨Most pts w/uveitis at BL - status remained unchanged or improved 👁‍🗨SEC did not ⬆ risk of uveitis @RheumNow #ACR21 abs1738 https://t.co/IGUpgXBLvt
sheila RHEUMarampa ( View Tweet)
Adults with #JIA #uveitis are still affected into adulthood. @Mara_Becker discusses visual outcomes #ACR21 https://t.co/ZBjw1CfSmv
Sheila Angeles-Han STHanMD ( View Tweet)
#Uveitis is the most ⬆ freq xtra-articular manifestation in axSpA. What factors are assoc'd w/AAU attacks? 👁‍🗨Active disease 👁‍🗨History of AAU Bottomline: Treat axSpA, treat uveitis = better outcomes. @RheumNow #ACR21 abs1314 https://t.co/O0kHulwJoP
sheila RHEUMarampa ( View Tweet)
axSpA and Uveitis Uveitis 🔼 in HLA-B27; Disease duration; Latin American pts 🔽 in Psoriasis ⭐️Uveitis was not significantly different in axSpA vs pSpA Recurrent Uveitis 🔼disease duration and body mass index (BMI) Abst #1307 #ACR21 @Rheumnow https://t.co/QDg8tOPgir
swethaann23 swethaann23 ( View Tweet)
Knowledge Bowl at #ACR21 ⭐️Which HLA allele confers an increased risk for anterior uveitis and inflammatory sacroillitis? ➡️HLA-B27 @RheumNow

Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)

Low incidence of GI-related serious AE in pooled 1 year data from VOY1&2 and DISC1&2 trials of Guselkumab for PsA/PsO treatment ⭐️no new onset IBD or exacerbation of IBD ⭐️no uveitis, infections, TB Abs#1342 #ACR21 @RheumNow https://t.co/x3OmLgInV0

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Robert B Chao, MD doctorRBC ( View Tweet)

Image of Takayasu's retinopathy (compared to normal) presented by John Stone #ACR21 . I'm no eye doctor, but this cannot be good. @RheumNow https://t.co/rjoQZ8TGDz
Richard Conway RichardPAConway ( View Tweet)
⭐️Imaging of the SIJ in psoriatic axSpA is similar to axSpA associated with iritis or colitis! Abst#0902 (https://t.co/f55Vfi1LSS) #ACR21 @RheumNow https://t.co/UCXrwPiyhh

Links:

Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ClinicalPearl Leflunomide for chronic CMV retinitis failing antiviral Rx? Suppresses inflammation & Arava May have antiviral properties. Didn’t know it. Kolfenbach & Palestine 6S117 eye opening experiences #ACR21 @RheumNow

Janet Pope Janetbirdope ( View Tweet)

#ClinicalPearl Joint clinic btwn ophthalmology & #rheumatology helps make dx & Rx work. #ACRBest #ACR21 see work up of inflammatory eyes disease. All are allowed one acute ant uveitis- ? dogma maybe work up all. 6S117 https://t.co/Wwdv3N66HS
Janet Pope Janetbirdope ( View Tweet)
#ClinicalPearl. ‘my eye hurts-what’s going on!’ Dr Palestine says Ophthalmologists don’t agree on uveitis naming/ethology & worse - Rheums & eye specialists don’t speak language. Need to know infections are r/o (syphillis, CXR) & if active uveitis to ⬆️Rx #ACR21 @RheumNow https://t.co/7LkhJnUKXK
Janet Pope Janetbirdope ( View Tweet)
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