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New ACR Rheumatoid Arthritis Guideline: Emphasis on Methotrexate

d MedPage Today

The American College of Rheumatology (ACR) has issued new guidelines on the treatment of rheumatoid arthritis, addressing questions about initial treatment with methotrexate and minimizing reliance on glucocorticoids.

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The Potential of Rituximab Efficacy in Systemic Sclerosis

d Jack Cush, MD

Rituximab (RTX) has been in the news a lot lately; more surprisingly for its potential benefits in progressive systemic sclerosis (SSc).

Ebata and colleagues have published the results of a double-blind, randomised, placebo-controlled trial comparing intravenous RTX to placebo in 56 SSc patients. Patients had to have a modified Rodnan Skin Score (mRSS) of 10 or more. The primary endpoint was the change in mRSS at 24 weeks. 

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ACR Stands Against Insurer Mandated Infusion Locations

d ACR

The American College of Rheumatology (ACR) has released an updated position statement on patient safety and site of service for biologics outlining several reasons why the ACR strongly believes infusions should be administered in a monitored health care setting with onsite supervision by a provid

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RheumNow Podcast – Modern Treatment of RA Pregnancy (6.25.2021)

d Jack Cush, MD

Dr. Jack Cush reviews this week’s news and journal reports featured on RheumNow.com.

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Stroke risk is increased in arthritis (RR 1.36, 95% CI: 1.27–1.46); esp for RA (RR 1.38), AS (RR 1.49), PsA (1.33) & gout (1.40); but NOT osteoarthritis (RR=1.03). Apparently Inflammation drives this risk. https://t.co/Snb6OrtZJH

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Global metanalysis of 67 studies of T2T in gout shows only 34% on ULT achieve a serum urate target. Thus only a minority of gout receive T2T care worldwide. Thos on ULT, have low rates of continuous Rx, SUA testing, & achieving SUA target https://t.co/zpBRhRaek5

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BRAVE-AA1 - a Phase 2 trial of 110 pts w/ Alopecia areata Rx w/ either PBO or baricitinib (1, 2, 4 mg); showed significantly greater improvement with Bari 2-mg (33.3%, P = .016) and 4-mg (51.9%, P = .001) versus placebo (3.6%). https://t.co/tzDeb4l60H

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Retrospective study of 258 IBD patients, 17% had MRI sacroiliitis (73% w/ bone marrow edema. Sacroiliitis was significantly associated w/ Female gender, back pain, and later age of CD diagnosis. >two-thirds of these pts never seen a rheumatologist. https://t.co/HYhAU6aRIf

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GFR decline in 2269 RA pts (15 mos F/U) - Most RA had a GFR decline w/ age. Pts w/ higher DAS28-CRP had more GFR decline. Pts in remission/LDAS had a slower rate of eGFR loss (−0.817 vs −1.283 cc/min per year; P < 0.001) https://t.co/rnIc080xYb

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Analysis of Ph 3 data Tofacitinib in Ulcerative Colitis shows no increase in Cancer; rates equal to that seen w/ Tofa in RA, PsA & other biologics in UC. In 1124 pts (2576 PtYrs) there were 20 cancers, excluding NMSC (IR, 0.75; 0.46–1.16) https://t.co/xiTIKYAtyY

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Blindness with Tocilizumab in GCA: Is it a Worry? https://t.co/PJYap294jm https://t.co/q1izGlH68j

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EULAR 2021 Lupus Panel Drs. Cush, Dao, Pope, Dein and Yusof discuss a number of lupus presentations as well as abstracts presented at the virtual EULAR 2021 meeting. Lupus nephritis and treat-to-remission presentations were discussed by the panel. https://t.co/yUEXTOatpR

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Alcohol abuse worsens psoriasis. Prospective study of 266 Psoriasis pts (1/2 biologics; 1/2 ; conventional Rx). Poorer outcomes predicted by alcohol abuse (CAGE score) (regression co-efficient 1.40), obesity (1.84) & conventional Rx (4.39) https://t.co/CJGTT0HoV2

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Which patients with psoriasis are at risk to develop PsA? https://t.co/5sj5HSnke3 https://t.co/vxOHIUrevd

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FDA has granted emergency use authorization (EUA) for Actemra (tocilizumab) us in treating hospitalized COVID-19 (adults and kids) patients on steroids and who require, supplemental oxygen, mechanical ventilation, or ECMO https://t.co/YAVfbykcti https://t.co/d7pS1lUXpa

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The FDA has informed Abbvie that their supplemental application for new indications (PsA and AS) for upadacitinib (Rinvoq) has been delayed; the FDA citing its ongoing review of tofacitinibs safety concerns stemming from the ORAL Surveillance RA study https://t.co/sSJyVtQNYu

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Danish population study shows that all cause mortality in GCA is increased 49%,(RR 1.49; CI1.36-1.64) after 1 year but less so at 10 years (RR 1.03: 1.00-1.05). Deaths usually due to infectious, endocrine, cardiovascular, GI diseases https://t.co/p36zDskf6y

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RHEUMATOLOGIST SURVEY - on Osteoporosis, Osteomalacia and a Family Hx of recurrent Fractures - Answer a 4 question survey here >> https://t.co/TuY1fXAAk5

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Guidelines for the prevention, diagnosis and treatment of Lyme disease have been formulated by the ACR, Infectious Diseases Society of America and the American Academy of Neurology https://t.co/RgHzCLrtDM

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The Swedish Rheumatology Quality Register looked at risk of ant.uveitis (AU). From 4851 starting secukinumab (456) or TNFinhibitor (4395 ), there was higher AU risk w/ SEC (adj HR 2.32; 1.16-4.63) & ETN (1.82;1.13-2.93) (ADA as referent) https://t.co/j06MtKedYU

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