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RheumNow Podcast – World Going to Pot (7.23.2021)

d Jack Cush, MD

Bicycles, Tramadol, biologics - these are but a few of my favorites things in today's broadcast. Join me as I review the news and journal articles from this past week on RheumNow.com.

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Vertbral,Fracture,spine,compression

Fracture Risk with Low Dose Steroid

d Jack Cush, MD

A large RA cohort analysis shows that low-dose glucocorticoid therapy in rheumatoid arthritis (RA) patients may carry an increased risk of vertebral osteoporotic (OP) fractures. 

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SI AS SpA ACR

Tofacitinib Efficacy in Ankylosing Spondylitis

d Jack Cush, MD

Deodhar and colleagues have published the results of a study showing that in adult patients with active ankylosing spondylitis (AS), oral tofacitinib was effective (versus placebo) and is safe. 

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smoke.cannabis.hookah.weed_.jpg

Growing Cannabis Use in Arthritis Patients

d Jack Cush, MD

The National Databank for Rheumatic Diseases reports a significant increased in cannabis use amongst arthritis patients between 2014-2019, suggesting patients are more frequently engaged in self-management of pain and the unmet need for a pain relieving, opioid-sparing alternative.

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New-Onset IBD and IL-17 Inhibitors: What Is the Risk?

d MedPage Today

Patients with inflammatory/autoimmune diseases who initiated treatment with interleukin (IL)-17 inhibitors did not have a higher risk for the development of inflammatory bowel disease (IBD), but only after taking into account the severity of their underlying disease, French investigators reported

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ICYMI: New-Onset IBD & IL-17 Inhibitors: What’s the Risk? https://t.co/zXDQotDiWV Patients w/ inflammatory/autoimmune diseases who initiated treatment w/ IL-17 inhibitors didnt have a higher risk for development of IBD, but only based on the severity of their underlying disease https://t.co/w3IpQkzmn7

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ICYMI: FDA Approves IVIG in Dermatomyositis https://t.co/BZsl8a6ArW The FDA has approved Octagam 10% [Immune Globulin Intravenous (Human)], as the first and only intravenous immunoglobulin (IVIg) formulation to be approved for adult dermatomyositis (DM). https://t.co/VFF0QMqbin

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Fracture Risk with Low Dose Steroid https://t.co/HcYpx8IDcB A large RA cohort analysis shows that low-dose glucocorticoid therapy in rheumatoid arthritis (RA) patients may carry an increased risk of vertebral osteoporotic (OP) fractures. https://t.co/1bc5nyZUzG

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Tofacitinib Efficacy in Ankylosing Spondylitis https://t.co/SEKa5OnB50 Deodhar and colleagues have published the results of a study showing that in adult patients with active ankylosing spondylitis (AS), oral tofacitinib was effective (versus placebo) and safe. https://t.co/Wb19EJQZHN

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Growing Cannabis Use in Arthritis Patients The National Databank for Rheumatic Diseases reports a significant increased in cannabis use amongst arthritis patients between 2014-2019. https://t.co/9YyYB75GuN https://t.co/Xs24kBLmeg

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New-Onset IBD and IL-17 Inhibitors: What Is the Risk? https://t.co/zXDQotDiWV Patients w/ inflammatory/autoimmune diseases who initiated treatment w/ IL-17 inhibitors didnt have a higher risk for development of IBD, but only based on the severity of their underlying disease https://t.co/hbWf45pQWt

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Steroid (GC) withdrawal studied in T2T RA cohort of 207 RA pts (F/U 39 mos); Only 60% discontinued GC, w/ low risk of flare. BUT D/Cs were SLOW w/ only 9.7%, 26.6%, 48.0% & 58.6% at 6 mos, 1, 2 & 3 yrs - median time to cessation = 27 mos https://t.co/h02aueYKwN

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COAST-Y - an extension study of 155 spondyloarthritis pts in remission on ixekizumab; they either continue or had IXE withdrawn. After 40 weeks, 83% on IXE vs 55% of PBO (WD) pts remained flare free. Most flares >20 wks of IXE withdrawal https://t.co/DDzCoFxt0d https://t.co/jgTxFCgQIq

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Retrospective cohort study of 1719 Psoriasis only pts (F/U 14721 py) were Rx w/ topicals (81%), cDMARDs (13%), bDMARDs (6%). Overall, 239 patients (14%) developed PsA - Lower risk of PSA if Rx w/ biologics (IRR=0.26 vs topicals; not csDMARDs) https://t.co/BqJWPxG7xf

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Metanalysis of Tramadol efficacy & safety in knee or hip #OA. 6 RCTs (3,611 pts) showed little clinical benefit w/ 100/d or 200 mg/d; only 300mg/d was better vs PBO at pain & functional improvement. All doses had higher risk of GI, CNS AEs & W/D https://t.co/wDLHFQWFOe

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While myeloperoxidase (MPO) Abs are seen in idiopathic pulmonary fibrosis (IPF), only 7–23% develop vasculitis. Study of 58 pts w/ IPF & MPO Abs - UIP most frequent ILD pattern, 13 had rheumatic dz; MPO Abs did not change survival of UIP/IPF pts https://t.co/RXXIPUBMBT https://t.co/v3KhEaefZD

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Anti- neutrophil extracellular traps (NET) Abs were elevated in 328 COVID-19 pts, 27% IgG & 60% IgM. Net Abs assoc w/ circulating NETs, impaired O2 ventilation, high D-dimers. They likely impair NET clearance and may worsen thromboinflammation. https://t.co/xRNKqKjxzS

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NEJM Image: Salt-and-Pepper Skin Changes in Systemic Sclerosis. 68yoM with skin changes of chest and back and with shortness of breath. Exam:showed “salt-and-pepper” skin changes, w/ CT evidence of lung fibrosis. https://t.co/Pz7mKUD2Yx

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A study of 7459 adults with diabetes, shows that regular bicycling is associated with a 22-32% reduction in all cause mortality and CVD mortality - with a loss of benefit to those who stop. https://t.co/wjEJXAu0zx

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In a study of 15123 RA pts >50 yrs; 1640 osteoporotic fractures occurred. Low-dose glucocorticoids (≤7.5 mg/D) was not associated with overall risk of OP Fx (adj HR 1.14) but was assoc w/ increased risk of vertebral Fx (adj HR 1.59, 1.11–2.29) https://t.co/ZJtYAAQ3KW

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