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Linger on the Fingers (9.6.2024)
Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. This week with a focus on fingers and better prescriptive follow through.
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CAR-T Like Effects with Bispecific Teclistamab
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MedPage Today
A new chapter may have begun in the exciting story of "immune reset" therapy for difficult-to-treat autoimmune diseases, with a patient with severe refractory lupus obtaining drug-free remission after treatment with an antibody product normally used in multiple myeloma.
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Does Rheumatoid Factor Influence Anti-TNF Responses in RA?
Smolen and colleagues have published a subanalysis of the EXXELERATE study that showed while certolizumab pegol [CZP] concentrations and efficacy was unaffected by high titers of rheumatoid factor (RF), patients treated with adalimumab had a blunted response in the face of high RF titers.
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While Raynaud's phenomenon severity is worst at very cold temperatures, it may also worsen during very warm temperatures, presumably due to air conditioning. Based on q3mos assessments of 2243 RP pts (88% female, 82% White, mean 55 yrs https://t.co/4c0XzqHYjB https://t.co/TOn4DJP4Xi
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Urticarial Vasculitis Overview
Urticarial vasculitis is rare and the causes often go undiagnosed. A Medscape recent overview highlights key features in the diagnosis and management of this rare disorder.
https://t.co/TUlCw76asZ https://t.co/HwDQpsAtws
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EMA Updated overview of leflunomide (Arava) https://t.co/LbuqzDdTvf https://t.co/npfsRDdFiP
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Good Clinical Practice Recommendations on Glucocorticoid Withdrawal and Adrenal Insufficiency
The European Society of Endocrinology and Endocrine Society have jointly published a clinical guideline on the diagnosis and treatment of glucocorticoid-induced adrenal insufficiency,… https://t.co/GmQ5ypvqWP https://t.co/oab9qHpxSa
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Sustained Hydroxychloroquine and Cardiovascular Outcomes
A national cohort study shows that continuous use of hydroxychloroquine (HCQ) protects against cardiovascular (CV) events in patients with systemic lupus erythematosus (SLE).
https://t.co/xqB2tyzzYQ https://t.co/dlFjbgbsep
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Dactylitis is seen in 50% of PsA patients. Dactylitis is frequently associated with more severe PsA phenotype, often representing the initial feature of the disease. Many agents are effective but no b/tsDMARD is distinguished as being superior in dactylitis.… https://t.co/NKOXReiZYd https://t.co/Ake2fixZ40
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"Vanishing Fingers" Acro-osteolysis in a patient with Scleroderma and renal failure and bilateral hand pain. Causes of AO include Scleroderma, PsA, hypertrophic osteoarthropathy, skeletal dysplasias, frostbite, Hyperparathyroidism, genetic disorders https://t.co/UwXcw3r6LD https://t.co/bnGiY0i0ot
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Difficult to treat RA Approach
https://t.co/2rmlv0kspP https://t.co/6yb5xj8jrn
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Norwegian Registry study compared risk of stroke in 2750 RA vs 158 879 w/o RA pts. 7.3 vs 5% (HR 1.36; 1.13, 1.62). RA pts with atrial fibrillation was also elevated (HR 1.25; 1.05, 1.5). RA pts less likely to Rx w/ oral anticoagulants (adj OR 0.88) than non-RA… https://t.co/s20wTKafR8 https://t.co/FPxc5VP4Xh
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Study of 4821 pts (age 52 yrs) undergoig EGD - H. pylori infx seen in 2262, w/ long-lasting H Pylori (LLHp) infx in 1043 (21.6%). 6.3% dx w/ aCVD & 4.3% w/ RA. LLHp infection incr risk of aCVS (HR 1.57) & RA (HR 2.63) In RA, LLHp up risk for aCVD (7.89) https://t.co/FNOsEHKVIf https://t.co/dSeJuuuUMQ
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Is it possible that Helicobacter pylori (Gm neg) can exacerbate or cause RA? Infx of gastric epithelial cell line w/ H. pylori upregulated the expression of PAD4 and increased PAD4 activity, leading to Helicobacter pylori-induced citrullination? https://t.co/QeE3SmWLLp https://t.co/ZG2tYmdJNx
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Singapore study of Autoimmune (AIRD) risk w/ COVID infx compared 104 179 DELTA + pts vs 666 575 PCR neg controls (~80+% Vax) & 375 903 Omicron+ vs 619 379 controls (~75% boosted). Found no signif incr risk of AIRD w/ COVID infx. https://t.co/gXzWdotzvL https://t.co/UsQpwgsyTD
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Immunomodulatory Prevention of Uveitis Relapse in Behçet's
The results of a randomised, open-label, head-to-head trial shows that adalimumab was superior to ciclosporin in preventing uveitis relapses in patients with severe Behçet's disease.
https://t.co/12fpuIZFmA https://t.co/iDJJq29JMA
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Study of 4370 RA pts (26534 PYs) saw 362 MACE (CV) events. RA activity & inflammatory markers assoc w/ MACE risk in bDMARD non-users (not those on bDMARDs). 515 bDMARD vs 3855 non-users (n=3855). Each DAS28-CRP unit incr MACE risk (HR 1.21)https://t.co/lRaHxTHzqe https://t.co/usEiJctVYk
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Claims analysis, shows <0.5% of IBD or RA pts developed an invasive fungal infx within 1 year of TNF therapy initiation (. Histoplasmosis was the most common
IBD = 3.3 IFI/100PY
RA = 2.8 IFF/100PY https://t.co/ER9YCxecJT https://t.co/T0UNgB4h6R
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Prospective Nurses' Health Study (n 204,175) included 212 w/ incident SLE; ultraprocessed food intake was assoc w/ >50% increased SLE risk & doubled risk for anti-dsDNA Abs. Sugar-/artificially sweetened drinks assoc w/ lupus risk (HR 1.45) https://t.co/jesfsgNvUY https://t.co/KQupBkEcKg
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Metanalysis of Social determinants of health and lupus nephritis (31 studies) showed poor LN outcomes were 1.47-fold higher w/ any adverse SDoH. Also multiplicative impact of having two or more adverse SDoH on LN outcomes. https://t.co/4oEuAEgBx1 https://t.co/OkeRzrCXzQ
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