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RheumNow Podcast – What Not to Do (7.16.2021)

d Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com.

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hip, OA, AVN

Osteonecrosis in Lupus

d Jack Cush, MD

A single center analysis of systemic lupus erythematosus (SLE) patients found symptomatic osteonecrosis (ON) in nearly 10%.

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Arthritis as a Harbinger of Pediatric Cancer

d Jack Cush, MD

Lancet Rheumatology has published a cohort analysis showing that a small but significant subset of children presenting with arthralgia or arthritis may have a pediatric malignancy.

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ANCA, vasculitis, test

ACR/Vasculitis Foundation 2021 Guidelines for ANCA–Associated Vasculitis

d Jack Cush, MD

Chung et al have published the 2021 treatment guielines for the management of antineutrophil cytoplasmic antibody–associated vasculitis, including granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis. These guidelines are put forth by the ACR and the Vasculitis Foundation as benchmark guidance to assist health care professionals in managing AAV.  

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Slow Steroid Tapering Succeeds in SLE

d MedPage Today

Gradual withdrawal of glucocorticoids was successful among patients with systemic lupus erythematosus (SLE) after 2 years of clinically quiescent disease, without an increased likelihood of flares, Canadian researchers reported.

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Knee corticosteroids injx within 4 wks of total joint arthroplasty may be assoc w/ a higher risk of postop infection (studies suggest a risk w/in 3 mos of TKA). Greatest risk seen w/in 2 wks of injx (OR 2.89), worse in <65 yrs & w/ comorbidities (RA) https://t.co/nZKTkv7ym5 https://t.co/4W6CNsrqpf

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NEJM posts images of the malar rash, typical of #SLE. https://t.co/YZsnAXyhVX

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Survey of women re: sex & reproduction (SRH) says women prefer 1) Rheums to initiate SRH discussions, 2) clear info on pregnancy & infertility risks w/ Dz & DMARDs, 3) holistic Rx approach, 4) not to be intermediaries betw Rheum & OB https://t.co/Orlh6gLO6P https://t.co/rS4r39Easx

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Of 100 newly diagnosed #RA patients, Foot Involvement was the 1st manifestation in 29%. Pattern: 59% w/ forefoot involvement, 27% hindfoot and 14% midfoot. Pts were 58-63% RF+/CCP+. https://t.co/OGS2Fzfgg3 https://t.co/AKCj4pipYG

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Very cool to see #RheumMadness in @ACRheum 🔥 #NephMadness —> #RheumMadness a “joint” venture Impressive work by @DavidLeverenz and entire team @LisaCriscione @GuyKatzMD @didemsayginmd @Allen06440733 RheumMadness: An Educational Tournament https://t.co/hHpm93C0yT https://t.co/ZPYxG6NUrl

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Matthew Sparks, MD, FASN, FAHA Nephro_Sparks ( View Tweet)
ACR/Vasculitis Foundation 2021 Guidelines for ANCA–Associated Vasculitis Chung et al have published the 2021 treatment guidelines for the management of antineutrophil cytoplasmic antibody–AAV, including GPA, MPA, and EGPA. https://t.co/234OQ7klRd https://t.co/33sWq1U55T

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Ann Int Med: 185 Hospitalized COVID-19 pts were treated with either PBO remdesivir or HCQ. Neither remdesivir nor HCQ affected viral clearance, Sxs duration, mortality or need for mechanical ventilation. https://t.co/NEFABDD4bK

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Todays NEJM: Ruxolitinib effective in glucocorticoid-refractory Chronic Graft-versus-Host Dz. Phase 3, 329 pts; wk 24 responses better w/ RUX (50 vs 26%; P<0.001). Important? as there is phase 2 data showing JAK efficacy in scleroderma https://t.co/ygLevqfuMW

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In 2016, 552,230 RA adults were hospitalized -1120 for influenza, 590 H zoster, & 785 for S. pneumoniae. These infections constituted 0.5% of RA hospitalizations at a cost of $124 million & 13,750 hosp stay days. https://t.co/7vtsWafGvv

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2020 saw record numbers of drug overdose deaths (93,331) a big increase (29.4%) over 2019, according to CDC & Natl Center Health Statistics (NCHS). Overdose deaths 69,710 primarily fentanyl, Rx pain meds and cocaine https://t.co/K9GlWAeALS

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Telehealth has declined but still much higher than pre-pandemic. CMS is proposing to extend Medicare coverage of certain telehealth services until the end of 2023. A -3.75% payment adjustment has been proposed & will be debated https://t.co/ETK74d9uGT

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Metanalysis shows that Ustekinumab (effective in IBD) may also control skin and joint extra-intestinal manifestations. Despite no effect on spondylitis, UST was effective at PSO, PsA, pyoderma gangrenosum, E nodosum stomatitis and uveitis https://t.co/NPxJdYUM7I

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Systematic review of muscle relaxants use in nonspecific low back pain shows uncertain, small, but not clinically important reductions in pain in the 1st 2weeks. Muscle relaxants are 3rd most common Rx for LBP (30 mill Rx in 2016)(49 trials >6505 pts) https://t.co/zN5rvBF1HO

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Norwegian pre-pregnancy registry studied 274 axial SpA and 317 RA women. Longer time to pregnancy (TTP) seen in 21% (32% TTP >12 mos). Longer TTP associated with older age, nulliparity, and longer disease duration. https://t.co/kT7fqnhTkw https://t.co/8qC1N2K7vI

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NHANES survey study shows adult psoriasis in the US was 3.0% (7.5 million adults). Psoriasis was most common in non-Hispanic White individuals, and the prevalence of psoriasis has not significantly changed since 2003 in the US. https://t.co/3yrlPu1GGi

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