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ICYMI: New GRAPPA 2021 PsO and PsA Treatment Recommendations

d Rachel Tate, DO

The evidence-based recommendations from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis were presented at #EULAR2021. The goal (as per 2009 recommendations) was “To develop recommendations, based upon the best scientific evidence, for the optimal treatment of patients with PsA” Dr. Laura Coates, Oxford detailed in abstract #OP0229. Since the last update in 2015, there have been multiple changes, which are highlighted here.

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ICYMI: EULAR Guidelines on Intraarticular Therapy

d Jack Cush, MD

EULAR has published evidence-based recommendations on the use of intra-articular therapies (IAT) based on the literature review and recommendations of a multidisciplinary international task force. These IAT recommendations apply to adult patients with peripheral arthropathies.

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ICYMI: Rheumatologists Rank 2nd in Physician Burnout

d Jack Cush, MD

The 2021 Medscape Survey on Physician burnout ranks rheumatology second, just behind Critical Care medicine.

The survey included over 12,000 physcians from 20 specialties. While 42% of MDs claimed to be burnt-out, Rheumatologists claimed this 50% of the time. The top 3 this year were Critical care (51%), Rheumatology (50%) and infectious disease (49%).

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ICYMI: Actemra FDA Approved for Systemic Sclerosis Interstitial Lung Disease

d Jack Cush, MD

Genentech announced Thursday that the US Food and Drug Administration approved tocilizumab (Actemra) for the treatment of Systemic Sclerosis-associated Interstitial Lung Disease (SSc-ILD), specifically indicated for slowing the rate of decline in pulmonary function in adul

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ICYMI: Cardiac and Cancer Signals Tofacitinib Safety Alert from FDA

d Jack Cush, MD

The FDA has notified healthcare professionals of a safety alert concerning tofacitinib (Xeljanz), noting that preliminary results from a long-term safety clinical trial show an increased risk of serious heart-related problems and cancer with tofacitinib (compared to adalimumab) when given to at-risk rheumatoid arthritis patients. These findings are in addition to the thrombotic risks (added to the label), potential risks including blood clots in the lungs and death.

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ICYMI: JAK Inhibitor Misses Endpoint in Safety Study. Now What?

d MedPage Today

Pfizer announced results Wednesday from its FDA-mandated postmarketing safety study of tofacitinib (Xeljanz), and they don't bode well for the drug and possibly others in its class.

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Textbooks say fever is common in lupus ("36%–86%") BUT IT IS NOT! Lupus is cause of FUO in 5%; Fever is seen in a minority of SLE onsets; Fever occurs w/ SLE complications - vasculitis, pneumonitis/serositis/alveolar hem, CNS, & INFECTION! https://t.co/KvZeo6Q1WY

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Dr. John Cush RheumNow ( View Tweet)

Hands-Down Rheumatology - Gout doesnt get to the hands until its done its damage below (MTP, ankle, knee) and usually only in those with severe tophaceous gout Can also present as dactylitis or Carpal tunnel. Women on diuretics w/ CKD can get gout in Nodal OA joints https://t.co/Ri5taWpR0p
Dr. John Cush RheumNow ( View Tweet)
WATCH: Is blindness with Tocilizumab in GCA a worry? Dr. David Liew ( @drdavidliew) weighs in. #EULAR2021 https://t.co/eFrmbkW9Gy https://t.co/imMaEIczb8

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Rituximab Tops Mycophenolate Mofetil for Pemphigus Vulgaris. One year study of 135 moderate-to-severe pemphigus patients saw complete remission in 40% of RTX vs 10% of MMF patients. https://t.co/yAauFRjHCe https://t.co/xhf85kQHq4

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Dr. John Cush RheumNow ( View Tweet)
Metanalysis of 9 studies, and 1132 lupus pregnancies shows that hydroxychloroquine treatment significantly reduced the risk of preeclampsia (OR 0.35), pregnancy hypertension (OR0.41)and prematurity (OR 0.55), but no effect on rates of HELLP, DM, Ab https://t.co/P9MXjDpuiO https://t.co/DxVWiUAPpe

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Dr. John Cush RheumNow ( View Tweet)
VEXAS is a new somatic mutation disorder with overlap with relapsing polychondritis. Thus older makes with ear/nose defects, MCV >100, Plt<200 could have the VEXAS-RP overlap @RWCSmtg https://t.co/Pqh6rYD96C
Dr. John Cush RheumNow ( View Tweet)
ProDERM Study: IVIG in Dermatomyositis--The ProDERM study show that IVIg is safe, effective and superior to placebo in patients with dermatomyositis (DM). https://t.co/HOB8CYn9yc https://t.co/4nNRRhzHVO

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Dr. John Cush RheumNow ( View Tweet)
Is Q-DAPSA the answer to disease activity scoring in PsA? Dr. Rachel Tate ( @uptotate) provides some insight. https://t.co/fbi3Kbd2GS https://t.co/vBhWsbQYlg

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Dr. John Cush RheumNow ( View Tweet)
"Arthritis Mutilans" - worse outcome to chronic inflammatory arthritis is due to 5 disorders: 1) RA 2) Psoriatic arthritis 3) Tophaceous gout 4) polyarticular JIA 5) Multicentric reticulohistiocytosis (Ive never seen this!!) https://t.co/XYmBEW1F0R https://t.co/010QYkOO7E

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Dr. John Cush RheumNow ( View Tweet)
Serious problem! Pulmonologists believe that MTX causes and/or worsens ILD. MTX causes hypersensitivity pneumonitis, not ILD. RA, lupus DM, PSS cause ILD and they may need MTX to manage their disease. Do your own research, look at this paper to start. https://t.co/vUyCxJP2Mh

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Dr. John Cush RheumNow ( View Tweet)

Protective Effects of Colchicine in Non-Hospitalized COVID-19 A press release from the Montreal Heart Institute has announced that the COLCORONA clinical trial has provided evidence of the protective effect of colchicine. Read more: https://t.co/xW5SchMUeK https://t.co/tUoDTJKbVG

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Dr. John Cush RheumNow ( View Tweet)
Psoriasis has greatest risk of MTX liver dz - a Danish Population study of PsO, PsA & RA pts taking MTX. Risk of liver Dz was most in PsO, followed by PsA, then RA. PsO had 1.6-3.4 fold risk (mild-severe) liver dz (vs RA). PsA was 1.3-1.6x higher) https://t.co/pAo9KFr5fO

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1/3 of patients with rheumatoid arthritis had unacceptably high levels of pain 5 years after diagnosis, often despite low levels of inflammation, Swedish researchers found. Read more: https://t.co/K8zf1pE9jM https://t.co/eu2Byo6dx4

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Dr. John Cush RheumNow ( View Tweet)
The ACR has a new position on patient safety and site of service for biologics— it strongly believes infusions should be given in a monitored health care setting with onsite supervision by a provider w/ training in biologic infusions. https://t.co/NONozoIIq6 https://t.co/PQMvUZqnMW

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Dr. John Cush RheumNow ( View Tweet)
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