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Linger on the Fingers (9.6.2024)
Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. This week with a focus on fingers and better prescriptive follow through.
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CAR-T Like Effects with Bispecific Teclistamab
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MedPage Today
A new chapter may have begun in the exciting story of "immune reset" therapy for difficult-to-treat autoimmune diseases, with a patient with severe refractory lupus obtaining drug-free remission after treatment with an antibody product normally used in multiple myeloma.
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Does Rheumatoid Factor Influence Anti-TNF Responses in RA?
Smolen and colleagues have published a subanalysis of the EXXELERATE study that showed while certolizumab pegol [CZP] concentrations and efficacy was unaffected by high titers of rheumatoid factor (RF), patients treated with adalimumab had a blunted response in the face of high RF titers.
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Urticarial Vasculitis Overview
Urticarial vasculitis is rare and the causes often go undiagnosed. A Medscape recent overview highlights key features in the diagnosis and management of this rare disorder.
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EMA Updated overview of leflunomide (Arava) https://t.co/LbuqzDdTvf https://t.co/npfsRDdFiP
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Good Clinical Practice Recommendations on Glucocorticoid Withdrawal and Adrenal Insufficiency
The European Society of Endocrinology and Endocrine Society have jointly published a clinical guideline on the diagnosis and treatment of glucocorticoid-induced adrenal insufficiency,… https://t.co/GmQ5ypvqWP https://t.co/oab9qHpxSa
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Sustained Hydroxychloroquine and Cardiovascular Outcomes
A national cohort study shows that continuous use of hydroxychloroquine (HCQ) protects against cardiovascular (CV) events in patients with systemic lupus erythematosus (SLE).
https://t.co/xqB2tyzzYQ https://t.co/dlFjbgbsep
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Dactylitis is seen in 50% of PsA patients. Dactylitis is frequently associated with more severe PsA phenotype, often representing the initial feature of the disease. Many agents are effective but no b/tsDMARD is distinguished as being superior in dactylitis.… https://t.co/NKOXReiZYd https://t.co/Ake2fixZ40
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"Vanishing Fingers" Acro-osteolysis in a patient with Scleroderma and renal failure and bilateral hand pain. Causes of AO include Scleroderma, PsA, hypertrophic osteoarthropathy, skeletal dysplasias, frostbite, Hyperparathyroidism, genetic disorders https://t.co/UwXcw3r6LD https://t.co/bnGiY0i0ot
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Difficult to treat RA Approach
https://t.co/2rmlv0kspP https://t.co/6yb5xj8jrn
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Norwegian Registry study compared risk of stroke in 2750 RA vs 158 879 w/o RA pts. 7.3 vs 5% (HR 1.36; 1.13, 1.62). RA pts with atrial fibrillation was also elevated (HR 1.25; 1.05, 1.5). RA pts less likely to Rx w/ oral anticoagulants (adj OR 0.88) than non-RA… https://t.co/s20wTKafR8 https://t.co/FPxc5VP4Xh
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Study of 4821 pts (age 52 yrs) undergoig EGD - H. pylori infx seen in 2262, w/ long-lasting H Pylori (LLHp) infx in 1043 (21.6%). 6.3% dx w/ aCVD & 4.3% w/ RA. LLHp infection incr risk of aCVS (HR 1.57) & RA (HR 2.63) In RA, LLHp up risk for aCVD (7.89) https://t.co/FNOsEHKVIf https://t.co/dSeJuuuUMQ
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Is it possible that Helicobacter pylori (Gm neg) can exacerbate or cause RA? Infx of gastric epithelial cell line w/ H. pylori upregulated the expression of PAD4 and increased PAD4 activity, leading to Helicobacter pylori-induced citrullination? https://t.co/QeE3SmWLLp https://t.co/ZG2tYmdJNx
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Singapore study of Autoimmune (AIRD) risk w/ COVID infx compared 104 179 DELTA + pts vs 666 575 PCR neg controls (~80+% Vax) & 375 903 Omicron+ vs 619 379 controls (~75% boosted). Found no signif incr risk of AIRD w/ COVID infx. https://t.co/gXzWdotzvL https://t.co/UsQpwgsyTD
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Immunomodulatory Prevention of Uveitis Relapse in Behçet's
The results of a randomised, open-label, head-to-head trial shows that adalimumab was superior to ciclosporin in preventing uveitis relapses in patients with severe Behçet's disease.
https://t.co/12fpuIZFmA https://t.co/iDJJq29JMA
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Study of 4370 RA pts (26534 PYs) saw 362 MACE (CV) events. RA activity & inflammatory markers assoc w/ MACE risk in bDMARD non-users (not those on bDMARDs). 515 bDMARD vs 3855 non-users (n=3855). Each DAS28-CRP unit incr MACE risk (HR 1.21)https://t.co/lRaHxTHzqe https://t.co/usEiJctVYk
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Claims analysis, shows <0.5% of IBD or RA pts developed an invasive fungal infx within 1 year of TNF therapy initiation (. Histoplasmosis was the most common
IBD = 3.3 IFI/100PY
RA = 2.8 IFF/100PY https://t.co/ER9YCxecJT https://t.co/T0UNgB4h6R
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Prospective Nurses' Health Study (n 204,175) included 212 w/ incident SLE; ultraprocessed food intake was assoc w/ >50% increased SLE risk & doubled risk for anti-dsDNA Abs. Sugar-/artificially sweetened drinks assoc w/ lupus risk (HR 1.45) https://t.co/jesfsgNvUY https://t.co/KQupBkEcKg
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Metanalysis of Social determinants of health and lupus nephritis (31 studies) showed poor LN outcomes were 1.47-fold higher w/ any adverse SDoH. Also multiplicative impact of having two or more adverse SDoH on LN outcomes. https://t.co/4oEuAEgBx1 https://t.co/OkeRzrCXzQ
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Points to Consider when Managing Inflammatory Arthritis with Cancer
https://t.co/qLMPwDNMiy https://t.co/sL87mp0gd4
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