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Is Pre-Clinical Spondyloarthritis a Real Risk?

d Jack Cush, MD

A study of first-degree relatives (FDRs) of HLA-B27-positive axial spondyloarthritis (axSpA) patients shows clinical or imaging features of spondyloarthritis in up to 32% subjects, regardless of HLA-B27 status.

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Rare Myocarditis Risk following COVID-19 Vaccine

d CDC/MMWR

MMWR review of the risk of myocarditis and pericarditis reports a June 23, 2021 recommendation by the Advisory Committee on Immunization Practices that the benefits of COVID-19 vaccination clearly outweighed the risks of myocarditis after vaccination. 

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ICYMI: RheumNow Podcast – Tofacitinib Safety Concerns

d Jack Cush, MD

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

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Modest IL-6 mAb benefit w/ COVID. Metanalysis 27 RCTs & 10 930 hosp COVID pts shows 28D all-cause mortality lower w/ IL-6i (vs usual care.PBO) (OR 0.86), better w/ steroids (OR 0.78). Mortality 22% w/ IL-6i vs 25% usual care. https://t.co/rTLjGMMe2g https://t.co/nz1sbKlk2E

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How should anti-IL-6 mAb therapy be used in COVID-19 infection? 1. w/ corticosteroids 2. Early/severe pts: 3. Hospitalized on O2, but not ventilated https://t.co/S6DT0Fsjow https://t.co/oeM8EgZk8n

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Lit review shows there are few good studies patients on the management of hospitalised gout pts. No studies have tested strategies designed to prevent gout re-admissions/flares. Better prospective studies of ULT use by hosp gout is needed https://t.co/OVkMTepa5y

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HCQ prolongs SLE survival. Case–control study 6241 incident SLE pts compared 290 SLE dead to 502 alive controls. HCQ reduced all-cause mortality by 50% (aOR 0.50; .30–0.82) but HCQ stoppers had incr mortality (aOR 2.47) - sick stopper effect? https://t.co/JIeTJaDVPk

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185 Lupus pts undergoing renal transplant for ESKD saw good outcomes. Pt survival = 88%, 82%, 78% & 67% (@ 1,3,5,10 yrs). Graft survival was 93%, 89%, 87% & 89% (@ 1,3,5,10 yrs). Immunosuppressive use was protective & only 2 cases of recurrent LN seen https://t.co/xgFYskeX0a

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Metanalysis of 33 clinical trials show that corticosteroids are anaglesic, especially in 1st 3 mos (mean drop VAS pain -12mm); after that benefit wanes to -8mm @3-6 mos and -6mm (95% CI, -10mm, -2mm) after  6 mos. https://t.co/IKZhqqwhPO

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Top June Tweet: Pain Persists in RA, Even Without Inflammation One-third of patients with rheumatoid arthritis had unacceptably high levels of pain 5 years after diagnosis, often despite low levels of inflammation, Swedish researchers found. https://t.co/K8zf1pE9jM https://t.co/XwdCXnktQN

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ICYMI: RheumNow Podcast – Tofacitinib Safety Concerns https://t.co/3Q5OvHRht5 https://t.co/JLFuj5tETw

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Are you subscribed to RheumNow? Benefits include delivery of new articles right to your inbox, access to downloads and more. Register today. https://t.co/riyAnrRHhX

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Tofacitinib shown to work very well in ankylosing spondylitis. @RWCSmtg @JointMD https://t.co/bx5FS9BSDZ
Dr. John Cush RheumNow ( View Tweet)
Throwback Tweet: Hello 2021 and new drug price hikes - on average a 4.2% hike in over 500 drugs (past years saw an avg hike ~5%). Increases include Cosentyx 7%, Humira & Rinvoq 7.4%, Orencia 4.5%, Taltz 5%, Actemra 3%, Benlysta 5%, Xeljanz 4.9% & Cimzia 4%

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Great Gout Teaching points. Here's my 2 cards on how to Stop #gouta https://t.co/R3EhYFusKf
Dr. John Cush RheumNow ( View Tweet)
Septic arthritis MIMICs (all presenting as acute monoarthritis) - consider: cellulitis, bursitis, abscess, osteonecrosis, gout, pseudogout, Lyme, Osteomyelitis, reactive arthritis, Lyme disease,, Rheumatoid arthritis, & Transient synovitis (kids) https://t.co/uNirAcoBds

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Comparison of MSU crystal ID, DECT scanning and US to Dx gout - study of 147 pts. Compared to the gold standard (MSU ID), Feet/ankles (87% sensitivity; 100% specificity) or knees DECT (91%; 87%) alone had best Dx accuracy. US was inferior to DECT. https://t.co/2Hiu7YhLo8

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Hands-Down Rheumatology - Sarcoidosis usually presents as a monarthritis or oligoarthritis. Late sarcoid arthritis affects knees, ankles, fingers (dactylitis). Bony lesions show honeycomb trabecular pattern). https://t.co/lmXBbJz6ts https://t.co/oDYrBiPuIX

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Pirfenidone, studied in 127 pts w/ CVD/CTD ILD, fibrotic interstitial pneumonia, chr hypersensitivity pneumonitis, & asbestoslung fibrosis. Pirefenidone had significantly less FVC% decline compared with placebo (p=0·043) https://t.co/H1s6ut4NhG

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263 RA patients with ILD were treated w/ Abatacept (ABA mono, ABA+MTX or ABA+nonMTX) - all improved their DAS28, stablized their FVC, DLCO, CHest CT; Only difference was that steroid sparing best when ABA used in combo. https://t.co/1dGufcKsha

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