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2022 Rheumatology Year in Review (1-6-2023)

Jack Cush, MD

Dr. Jack Cush reviews the best of 2022 in Rheumatology - highlights on new drug indications, breakthrough lupus therapies, new biosimilars and the multivitamin letdown.

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2022,wordle

2022 Rheumatology Year in Review

Jack Cush, MD

2022 was a year of recovery, discovery, and some losses.  While still dealing with the aftermath of COVID-19, rheumatologists were resilient as leaders for their patients and research in advancing rheumatologic care.

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Malar,rash,SLE, Lupus

Best of 2022: Emerging Therapeutics for Lupus

Kathryn H. Dao, M.D.

Impressive data on novel treatment for SLE were presented at the EULAR22 Congress. A disease that is difficult to study due to its pleomorphic presentation, unpredictable disease course, and high mortality rates, SLE is considered the dragon of all autoimmune diseases. Here are highlights of four exciting abstracts presented at the meeting with emerging therapeutics designed to slay the beast. 

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Best of 2022: Was this a Mistake? HCQ Dose Reductions per AAOS Guidelines

Michael Putman, MD, MSCI

In the wake of the 2016 AAOS Guidelines, rheumatologists dutifully reduced the dose HCQ take by patients with SLE to some number south of 5mg/kg per day. Though I believe the ophthalmologists correctly interpreted a 2014 paper in JAMA Ophthalmology that quoted a much-higher rate of HCQ associated retinopathy than had previously been appreciated, they and subsequent guidelines published in the field of rheumatology lacked a critical piece of information: what actually happens when you do this?

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Lungs ILD

Best of 2022: Approach to ILD in Myositis Syndromes

Jack Cush, MD

Mehta et al have published a full read review of managing interstitial lung disease (ILD) in patients with inflammatory myopathies, a heterogeneous group of syndromes connected by ILD and and increased morbidity and mortality risk.

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Hydroxychloroquine Update from ACR22 https://t.co/oqINHvpGLG https://t.co/si99jdDkSA

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Dr. John Cush RheumNow ( View Tweet)
Join us for RheumNow Live this March 18-19 in Dallas, TX! We're not like other meetings--we're answering the questions you want answered. RNL is a meeting to engage your mind and change your practice. Join us in-person or virtually! https://t.co/bMphD12Bie https://t.co/Hx0uHAIUWd

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Retrospective Claims analysis 1663 #SLE pts shows pts w/ lupus nephritis (LN, 2916) had higher Charlson Comorbidity scores ≥4 (72 vs 14%) & inpatient (41 vs 17%). LUPUS FLARES were more (61 vs 54%), more severe (11 vs 5%) & twice the cost https://t.co/tXI7SSalaV https://t.co/z0SorOQilb

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Dr. John Cush RheumNow ( View Tweet)
Best of 2022: Was this a Mistake? HCQ Dose Reductions per AAOS Guidelines https://t.co/Swf5kq6VtG https://t.co/UTIaCFpAX6

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Dr. John Cush RheumNow ( View Tweet)
Drug-Induced Lupus from Proton Pump Inhibitors A wide range of therapies have been implicated in causing drug-induced lupus erythematosus (DIL); now it appears that proton pump inhibitors (PPIs) can be added to the list of causative drugs. https://t.co/Jp3oNUhP6c https://t.co/AcC4mM0nLM

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Three (3) Worst Drugs to use in #Lupus patients who want to be pregnant (MTX, MMF, CTX) #UTSWSLE2022 https://t.co/nBBUlWXmhw
Dr. John Cush RheumNow ( View Tweet)
Challenges in Lupus: -Mortality greatest in 1st yr -Dx Delays 6.4 yrs -Long-term complications increased 50 fold -Steroids worsen long-term outcomes -Health care costs increased 3 to 5 years prior to Dx -Mean delay in drug starts after Dx =177 days https://t.co/NPxzluJJAV https://t.co/J2uLOfeijV

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Dr. John Cush RheumNow ( View Tweet)
Infection in lupus is suggested by very high CRP, PMN-lymph ratio (NLR) Plt-lymph ratio(PLR). Study of 104 hospitalized SLE found all very high w/ infx & Combined cutoffs of CRP >20 mg/L, NLR >3.5, PLR >151 had 87 sensitivity & 81% specificity for infx https://t.co/2ycSGhnHeK https://t.co/VZsGAK2hFs

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213 #SLE pts were screened for Cryoglobulinemia (2013 -2017); CG is frequent in SLE (66%), but mostly asymptomatic. Mean levels 40mg/L (0-228). Cryo Vasculitis in 15% w/ purpura, ulcers, digit ischemia, arthritis, GN (5%) or CNS (19%) https://t.co/rBNDHrb3sh #BestOf2022

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Study of 119 SLE pts (30 w CKD) shows urinary galectin-3 binding protein as a biomarker, increased w/ active LN, significantly (p<0.001)correlating w/ SLEDAI, SLICC RAS, histologic activity; higher in proliferative vs membranous LN (p=0.04) https://t.co/DlJzREdj0h https://t.co/peqZzpQrWk

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Dr. John Cush RheumNow ( View Tweet)
Leflunomide versus azathioprine in lupus nephritis? Study of 215 bx proven LN given either LEF or AZA - Renal flares were equal (15.7% v 17.8%), as was time to flare (16 mo vs AZA 14 mo); 24-hr proteinuria, creatinine, C3 and C4 improved similarly. https://t.co/fbzhuFT3lh

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From the Hopkins Lupus cohort - Just one month of Prednisone 40 mg/d yields a FOUR fold increase in avascular necrosis risk #UTSWSLE2022 https://t.co/Kae2PMVgl7 https://t.co/XuhbkBwlCw

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Dr. John Cush RheumNow ( View Tweet)
Practical Guidance for the Clinical Rheumatologist in Unplanned Pregnancies Women of reproductive age comprise an overwhelming majority of patients with rheumatic and musculoskeletal disease. https://t.co/x44GTLRtnT https://t.co/YlLgqeDRgP

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Dr. John Cush RheumNow ( View Tweet)
73-87% of autoimmune (RA, SLE, UCTD, APL) pts used HCQ during pregnancy. HCQ significantly reduced pre-eclampsia (20% vs 9%), early-onset pre-eclampsia (8% vs 2.5%), 2nd/3rd trimester pregnancy loss (3% vs. 0.6%) https://t.co/CF5ivHeCmY https://t.co/CYqaCCuZJz

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Dr. John Cush RheumNow ( View Tweet)

Review of the Rheumatic causes of Pericarditis and their management. Causes: SLE, RA, MCTD, Myositis, EGPA, GPA, IgG4-rel Dz, FMF, TRAPS, CAPS, AOSD, JIA, Sarcoidosis, Kawasakis, GCA, Takayasu's https://t.co/MQmkUe4Yey https://t.co/FSfrznoeBe

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