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Heavy Metal Rheumatology (9.23.2022)

Jack Cush, MD Sep 23, 2022

Below are this week’s highlights from RheumNow, as discussed by Dr. Jack Cush. Thanks to all of you for your kind comments and great reviews of our weekly podcast. Please let us know how we can improve by emailing me or recording your suggestion using the "Ask Cush Anything" link on our website.

IL-18 is a proinflammatory cytokine involved in innate &adaptive immune responses. IL-18 is a key mediator in autoinflammatory diseases, MAS, Still’s disease. Serum IL-18 levels may be useful in diagnosis and monitoring of disease activity https://t.co/IB9CwbILD9 https://t.co/TWNnjJyR2Z

https://bit.ly/3UE55yD

Medicare (1,654,862 pts) cohort matched study included 3.6% w/ rheumatic IMIDs w/ MI. Rheum IMIDs were younger, women, w/ non–STEMI, less angiography/Stent/CABG & have higher mortality (aHR 1.15), CHF (1.12) & recurrent MI (1.08) https://t.co/SxemjO7GA2 https://t.co/VKg1f4yd2M

https://bit.ly/3LIrE0Z

Cancer Risk with Scleroderma Spanish Scleroderma Registry examined a large cohort of systemic sclerosis (SSc) patients showing an increased cancer risk, especially breast, lung, hematologic and colorectal cancer. https://t.co/9w53NO3AsU https://t.co/bSkFhTN3v2

https://bit.ly/3dE6aWE

Is PMR the Next Indication for Tocilizumab? About half of patients with steroid-dependent PMR were able to get off steroids altogether when they were started on tocilizumab (Actemra) infusions, a randomized phase III trial showed. https://t.co/Ea7XIqViRj https://t.co/h65OSjoytg

https://bit.ly/3R9GRsX

Clinical Profiles Seen with NXP-2 Antibodies A recent review of the myositis associated autoantibody NXP-2 profiles its clinical associations with dermatomyositis (DM), calcinosis, severe myositis and, in some reports, with cancer. https://t.co/oCgb1f2Avw https://t.co/rnMa4jHhNy

https://bit.ly/3R88UJp

Yoga Fails to Benefit Knee Osteoarthritis The Annals of Internal Medicine has published a study showing online yoga education and an unsupervised yoga program may improve physical function did not improve knee pain after 12 weeks and 24 weeks. https://t.co/9n31mTpudX https://t.co/WettcMpBLi

https://bit.ly/3fjUcSw

IL-6i in Behcets? Lit Review finds 25 articles papers, 74 pts (31 TNFi naive, 45 TNFi prior Rx). Pts Rx w/ tocilizumab IV. TCZ given for vascular, CNS , ocular & mucocutaneous. TCZ was effective in 87% TNF naive & 80% in TNFi Experienced pts. https://t.co/u1jnR9gb1L https://t.co/Rkqch4MVWi

https://bit.ly/3fjUoRK

Is there link between PsA & autoinflammatory Dz? Study of 120 #PsA pts found 31% w/ AID gene variants (AP1S3, PLCG2, NOD2, NLRP12, all monoallelic variants adn 1/2 genes assoc w/ autosomal dominant disorders. https://t.co/1cVFErPV6o https://t.co/QtRHrZJLJI

https://bit.ly/3RaucWT

Hydroxychloroquine Dosing and SLE Flares JAMA cohort study examining HCQ dosing in patients with SLE suggests that HCQ doses of 5 mg/kg per day or less, was associated with a higher risk of lupus flares, including moderate or severe lupus flares. https://t.co/1krevZo64c https://t.co/XEybtcFvNR

https://bit.ly/3Suxc1m

STAR-RA study - real world claims data shows tofacitinib doesnt increase malignancy risk. Study of 83,295 pts (10,504 TOFA). Risk of malignancy w/ TOFA not increased (HR 1.01) w/ RWE or RCT-duplicate cohort (HR 1.1; 95% CI 0.85, 1.62) https://t.co/9YWmXBTkWf

https://bit.ly/3DM689x

RINOMAX Trial studied single dose of 500 mg rituximab IV in myasthenia gravis - 47 MG pts randomized to RTX or PBO, after 4 mos RTX response (71% vs 29%) superior to PBO. Further studies are needed https://t.co/ffko7uMpk7

https://bit.ly/3UAOiws

Colchicine vs cimetidine in PFAPA (Periodic fever, aphthous stomatitis, pharyngitis, adenitis) syndrome. 72 pts given COL vs CIM x 3 mos: # of febrile attacks was significantly decreased by both Rx (noninferior to each other) https://t.co/HkmzwGNwFC

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Heavy Metal Rheumatology 🤘 https://t.co/4fkwOsH2yf https://t.co/otQP9a6h6S

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USPSTF Recommends Screening for Anxiety and Depression The U.S. Preventive Services Task Force has recommended that general practitioners actively screen and identify anxiety and depression in all adult patients under 65 yrs. https://t.co/8qOHzV52d8 https://t.co/tOzZQDHR1M

https://bit.ly/3xP2dVE

Worldwide, IL-6 inhibitors are approved for RA, poly JIA, systemic JIA, AOSD, GCA, Takayasu arteritis, Castleman’s dz, CAR-T-cell-induced cytokine release syndrome, neuromyelitis optica spectrum disorder and severe COVID-19 https://t.co/SRPjerXnGS

https://bit.ly/3BDHwx4

Patients with incident gout have a 44% increased risk of 1st-time ACS, higher in women than in men. This risk is largely explained by the underlying comorbidities, Swedish study of 20,146 pts w/ incident gout. Risk decr in multivariate analysis (15-20%) https://t.co/KbjszXNFSQ

https://bit.ly/3LBEI8w

Italian study of Apremilast in 356 #PsA (age 60yrs) pts Followed ~17 mos, shows retention rate @ 12, 24 & 36 mos to be 85.6%, 73.6%, & 61.8%. D/C primarily for inefficacy (18-34%), GI Sx (24%). Best persistence w/ oligoarthritis https://t.co/iIy86cUHB5

https://bit.ly/3qT7isp

Open label, multicenter study of 70 Psoriasis pts treated w/ apremilast shows no change in aortic vascular inflammation (FDG-PET) at wks 16 & 52, but did decr. several cardiometabolic biomarkers (IL1b, ferritin) & 5-6% loss of SC fat https://t.co/iJOgZ5kHLb

https://bit.ly/3r3qi7j

Retrospective study of PFAPA < 18yrs, 336 pts, Boys=Girls, peak onset ~age 1 yrs (less w/ yrs); 90% 1st Sxs under 5 yrs & <3% after age 10 yrs, Common Sxs: pharyngitis w fever, Cx adenitis, aphthous stomatitis, atyp skin rash. Incidence 0.86/10K/Yr https://t.co/1Mrp9bMnuE

https://bit.ly/3C3sqTa

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Heavy Metal Rheumatology (9.23.2022)

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