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Cancer Risk in Systemic Lupus Erythematosus

d Jack Cush, MD

Bernatsky and colleagues have shown cancer risk factors in incident systemic lupus erythematosus (SLE).

Researchers analyzed an SLE cohort of 1,668 patients, over an average of 9 years follow-up and found 65 cancers: 15 breast; 10 nonmelanoma skin; 7 lung; 6 hematologic; 6 prostate; 5 melanoma; 3 cervical; 3 renal; 2 each gastric, head and neck, and thyroid; and, 1 each rectal, sarcoma, thymoma, and uterine cancers.

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Psoriasis, arms, PsA

Abatacept After Ustekinumab Withdrawal in Active Plaque Psoriasis

d Jack Cush, MD

A randomized controlled trial has shown that treatment of plaque psoriasis via costimulatory blockade ( CD28/B7) with abatacept did not prevent psoriasis relapse after withdrawal of ustekinumab.

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TNF Dose Reduction Succeeds in PsA, Axial Spondyloarthritis

d MedPage Today

Patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA) who were doing well on treatment with tumor necrosis factor (TNF) inhibitors were able to successfully taper the therapy when guided by disease activity, a retrospective cohort study found.

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Hepatitis B Reactivation with Rituximab and Abatacept

d Jack Cush, MD

Hepatitis B reactivation is an uncommon complication of biologic therapy use. Now, a serologic study of  rheumatoid arthritis patients shows that HBV reactivation is seen with rituximab, and less so with abatacept, especially in patients without hepatitis B antibody (HBsAb) positiv

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A case of reactive arthritis following COVID-19 infection; manifest as dactylitis, psoriatic skin/nail lesions, painful oral & vaginal ulcers, subungual hyperkeratosis, but no oligoarthritis, or lumbar pain. https://t.co/nobMHGgKfZ

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A randomized controlled trial has shown that treatment of plaque psoriasis via costimulatory blockade ( CD28/B7) with abatacept did not prevent psoriasis relapse after withdrawal of ustekinumab. Read the full story on #RheumNow. https://t.co/8qgxYFW7EE https://t.co/8hi7JmR59a

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NICE issued a positive final appraisal recommending upadacitinib in previously treated moderate active rheumatoid arthritis (RA). This will expand UPA use to nearly 27,000 RA patients in the UK. Final pub date is Nov 10, 2021 https://t.co/A8OuzNlrAz

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Could Auranofin work in COVID-19 infection? it may do so by inhibiting IL-6 production, as auranofin inhibits TLR3/TLR4, STAT3/JAK1 and thioredoxin reductase that regulates NF-kB (later IL-6); and may inhibit viral replication too. https://t.co/efLG4tzpTZ

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Catastrophic Still's dz occurs early; compares 20 AOSD w/ organ failure vs 40 AOSD without. CAT-AOSD had shorter Dz duration, earlier Rx need; risks: younger; splenomegaly, liver, cardiac,lung involvement; ferritin level, no arthralgia https://t.co/8WIMd0JxZr

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498 axSpA (62%M: 38% F): Compared to men, women had higher Dz activity, joint counts, enthesitis scores (all P ≤ 0.01), more pain, worse fatigue and Functional scores; all P < 0.05), less full time work, More DMARDs/pred, Depression & FM https://t.co/kPY9YDpA9J

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Costs of #JIA are substantial, total costs up to 44,832 USD annually. Direct costs up to $32,446 USD, accounting for 55-98 % of total. $$$ mostly related to meds; cost go up 3 fold after biologic initiation. (JIA Indirect costs are underrepresented) https://t.co/rukJPWqD0y

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Are you registered on the #RheumNow site? With registration, you’ll receive new daily content first and can sign up for topic specific emails. https://t.co/riyAnrRHhX

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Start #MTX & escalate 5mg q2wk (usual) or 5mg q4wk (fast): open RCT 178 #RA pts - equal EULAR resp (28 v 23%), DAS28-CRP (-1.3 v -1.3) - same at wk8 & 24. No diff in MTX polygluts., cell #s, LFTs, D/C - but more GI sx w/ fast wk8 (40 vs 27%) https://t.co/MbuFoA5HFp

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Metanalysis of NSAIDs & opioids in Knee/Hip #OA - 192 RCTs (102829 pts). AE dropouts & adverse events were ZERO w/ topical NSAIDs; highest w/ opioids (83% & 90%). Pronounced Rx benefit more likely w/ oral & topical NSAIDs (99 & 93% probability) https://t.co/376uAzMcpH

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US Preventive ServTask Force has advised that adults >60 yrs should NOT take daily preventative aspirin without a no hx of MI/CVD risk (the GI risks outweigh CV benefit). If 40-59 yrs, discuss w/ their MD if ASA would be beneficial https://t.co/jfqnBjwLLn

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FDA Approves Avacopan for ANCA-Associated Vasculitis https://t.co/L7UwhYBaVY #RheumNow https://t.co/0cGN5eyfCl

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Triple DMARD Rx - MSH vs MLH (Lef). 136 active #RA pts given OL MTX/SSZ/HCQ vs MTX/HCQ/LEF. Equal efficacy (EULAR-Good) was seen at wk 12 (54% vs 59%) and wk 24 (65% vs 62%) - hence LEF substitution was noninferior. https://t.co/F5CGj0w7Bh

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RETRO - Taper or Not: You Decide A prospective, phase 3 trial of RA patients in sustained remission has shown more than half will flare if DMARD therapy is tapered or discontinued and that remission is best maintained by continued DMARD therapy. https://t.co/KDqGrujGMT https://t.co/8HqSS74PqL

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Anakinra appears to lower mortality risk (OR 0·32 vs historic controls) in hospitalized severe COVID-19 pneumonia (esp w/ hyperinflammation, CRP >100 mg/L). Metanalysis of nearly 2000 pts; better resp if given w/ dexamethasone (OR 0·23) https://t.co/7nFAkLgpGK

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Diagnositic Imaging comparison in 36 acute Gout vs CPPD pts: - Better: MSK US sensitivity/specificity for gout 92%/83% & 91%/92% for CPPD - Less: DECT sensitivity/specificity for gout 63%/92% & 55%/92% for acute CPPD https://t.co/Ee2MFb8qyl

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