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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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Oligoarticular vs. Polyarticular Psoriatic Arthritis https://t.co/lQVNdmWgMc https://t.co/ZjyDeYTLe2

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Dr. John Cush RheumNow ( View Tweet)
We've got a new podcast up for you, focusing on all of this week's top stories on RheumNow. https://t.co/xYzkw3zGRt https://t.co/A75Cl3WYno

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Cochrane review finds only 2 studies showing tocilizumab to be beneficial in GCA (sustained remission, relapse-free survival, need for escape therapy). https://t.co/sQjIBAiWKN

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Swedish study of 287 SLE pts shows rare risk of autoimmune liver disease. While 14% had persistent LFTs, only 2.8% dx w/ autoimmune hepatitis. 1.4-2.1% met criteria for primary biliary cholangitis. Both AIH & PBC AIH are overrepresented in SLE https://t.co/oc5SLJtycf

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Metanalysis of 36 studies, 608 RA-Bronchiectasis among 8569 RA pts; pooled bronchiectasis prevalence in RA was 18.7% (range 15.5% to 20.7%). Risk factors: older age, longer RA duration, genetics (CFTR & HLA), undetectable MBL biomarker https://t.co/SSRoTCYkHf

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ACR Guidance on Timing of 3rd Dose Booster with Immunomodulatory Drugs https://t.co/XO4DPXwGQi https://t.co/S9E3yENfDF

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Dr. John Cush RheumNow ( View Tweet)
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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Dr. John Cush RheumNow ( View Tweet)
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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Dr. John Cush RheumNow ( View Tweet)

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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