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RheumNow Podcast – COVID Marching Amidst the Madness (8.27.2021)

d Jack Cush, MD

We have a lot of news, information and approvals to review and discuss, though I need to begin with what's weighing heavily on my mind. After, we'll dive into what we learned this week.

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Rare Risks Associated with BNT162b2 mRNA Covid-19 Vaccine

d Jack Cush, MD

The current NEJM reports that the use of the Pfizer mRNA vaccine (BNT162b2) demonstrated a very low risk for certain serious adverse events, including the risk of myocarditis (1 to 5 events per 100,000 persons). 

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Mediterranean Diet Benefits Spondyloarthritis

d Jack Cush, MD

Can an antiinflammatory diet impact axial spondyloarthritis (axSpA)? A 6-month dietary intervention shows that adherence to a Mediterranean diet lowers disease activity in axSpA; but dietary adherence is often incomplete.

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ACR Guidance on Timing of 3rd Dose Booster with Immunomodulatory Drugs

d ACR Press Release

The American College of Rheumatology has issued an updated version of its COVID-19 Vaccine Clinical Guidance for Patients with Rheumatic and Musculoskeletal Diseases following recent recommendations from the CDC that certain immunocompromised patients receive a third dose of an availabl

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The Predictive Value of Morning Stiffness

d Jack Cush, MD

A prospective study evaluated the value and associations with morning stiffness in patients with clinically suspect arthralgia, and found that the presence of morning stiffness increases the odds of inflammation (as detected by CRP and MRI synovitis).

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Brazilian national study of 319 SLE & 251,800 nonSLE pts hospitalized with COVID-19 showed that SLE increases risk of death (RR 1.74) & poor outcomeS (RR 1.39). Having lupus doubled (RR 2.2) the risk of risk of death. https://t.co/8VJjdOEuzS

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A prospective study evaluated the value and associations with morning stiffness (MS) in patients with clinically suspect arthralgia (CSA), and found that the presence of MS increases the odds of inflammation (as detected by CRP and MRI synovitis). https://t.co/4j5Zshn48a https://t.co/2UUguqpckF

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2021–22 influenza season coincides with continued COVID infx & Sxs may be confused betw both. ACIP Influenza vaccination guidelines: 1. Annual flu vaccine rec to all >6mos; 2. COVID Vax can be given w/ Flu Vax; 3. give before Nov 2021 https://t.co/oIkl50GI0W

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Comparing COVID vaccines in rheum dz pts - 45 took J&J vax compared to 994 on mRNA vaccines. Detectable Ab responses lower w/ J&J (80% vs 92%, p=0.03) than mRNA vax. RTX, MMF & steroids significantly depressed Ab responses https://t.co/6ZJU8EVF5n

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Arthritis clinic referrals divided into 2 cohorts: (A) 163 w/ MSK US before visit; (B) 109 without initial MSK US. MSK-US at 1st visit reduced time to Dx from mean 31 to 12 days (p< 0.01), # of clinic visits, & increased odds of inflamm Dx (47% vs 27%) https://t.co/FaXLBlRlxy

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MTX impairs COVID Vax responses in IMID pts from Ehrlangen & NYU. BNT162b2 mRNA COVID-19 vaccination in rheumatic pts (82) & 206 controls. Adequate immunogenicity seen in IMID & TNFi Rx >90%, but less (50-72%) w/ MTX (45) https://t.co/EvxZSAD6ve

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#ClinicalPearl My pt’s rheumatoid nodules ⬇️ when she continued off her #methotrexate post #CovidVaccine. She restarted her JAKi + #plaquenil https://t.co/FqNX9k7FUN
Janet Pope Janetbirdope ( View Tweet)
Why do they always say larger RCTs are needed? RCT was >1000 and superiority of Bimekizumab to Secukinumab was shown. Maybe it is better to inhibit more than IL17A with added value of IL17F @RheumNow https://t.co/DAwZKxxinM

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Janet Pope Janetbirdope ( View Tweet)

In the land of a surfeit of free vaccines, this is the dark day when we crossed the line of over 100,000 hospitalizations, more than 25,000 patients in the ICU (highest for the pandemic), over 1300 deaths, and over 186,000 new cases. https://t.co/A8KNIClCwX
Eric Topol EricTopol ( View Tweet)
Cognitive impairment (CI) is not a consequence of having rheumatoid arthritis (OR = 1.12, 0.80–1.58). Population survey study of 4262 adults >50 yrs. 63% of RA had normal cognition , 25% w/ CI, 12% dementia (similar to non-RA- 66%, 22%, 12%) https://t.co/7RFOk8Nrkm

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A current report in Arthritis & Rheumatology examined the Nurses Health Study II data set and shows that parental smoking, and passive exposure to children, can later lead to an increased risk of adult-onset incident seropositive RA. https://t.co/szl5L7DGJG https://t.co/ScV51iJsA9

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European Commission approves upadacitinib (Rinvoq)-first JAK Inhibitor for use in adults & adolescents with Moderate to Severe Atopic Dermatitis. UPA is approved for atopic dermatitis in other nations, Russia, Saudi Arabia; pending review in US https://t.co/hiPkJoJCex

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Rheumatic Events With Checkpoint Inhibitors: Tumor Type Matters https://t.co/vT6185ycoG https://t.co/ImEejSrOPW

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Given the DELTA breakthrough surge how do you feel about live medical meetings (n> 50) in the next 6 weeks @Janetbirdope @KDAO2011 @psufka @AngusWorthing @RonanTKavanagh @RheumNow @MattieRheumMD @rheum_cat @jeffsparks @hausmannMD @CCalabreseDO @DrSwamyV

Leonard Calabrese LCalabreseDO ( View Tweet)

Among pregnant women, receipt of the BNT162b2 vaccine was associated with a 78% lower risk of incident SARS-CoV-2 infection. Cohort study tincluded 15 060 pregnant women in Israel. No adverse pregnancy outcome difference in Vax Pts https://t.co/jXUjaKIfUV

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