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Rheum Manpower Needs - More Programs! (12.2.2022)
Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.
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Just Can’t Get Enough of Hydroxychloroquine
When it comes to hydroxychloroquine dosing, issues on efficacy, toxicity and therapeutic thresholds may affect the optimal use of this important drug.
Following are three abstracts presented during the meeting that address these topics.
ACR22 Takeaways: Pre-RA, Lupus, PsA and AS
ACR22 Convergence left us bountiful with information from all over the world. Here are a few of my personal highlights and key takeaways.
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Cancer Screening Recommendations in Idiopathic Inflammatory Myopathy
Idiopathic inflammatory myopathy (IIM) is associated with increased risk of lung, ovarian, colorectal, lymphoma, breast, and naso-pharyngeal cancers, often within three years of disease onset. At ACR22, plenary abstract 0002, Oldroyd, et al, reviewed the 18 recommendations provided by the International Myositis Assessment and Clinical Studies Group (IMACS) steering committee.
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Will a vegetarian diet and exercise actually help RA disease activity?
The exact role of diet, physical activity, and stress management in the management of RA has long been debated. While reasonable evidence has supported the importance of physical activity in patients with RA, its capacity to reduce disease activity via conventional measures such as DAS28 was less well delineated.
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Practical Guidance for the Clinical Rheumatologist in Unplanned Pregnancies
Discussions regarding family planning, contraception, and pregnancy should be approached at each clinic visit to ensure providers understand patients’ personal goals. These conversations have the potential to decrease the risk of unplanned pregnancies. However, rheumatologists may need to manage unplanned pregnancies and the impacts of accidental teratogenic exposure.
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Tight control of proteinuria in newly diagnosed lupus nephritis
Since reduced proteinuria at one year is the best predictor of improved long-term renal outcomes in lupus nephritis, is there rationale to set a tighter treatment target?
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Pain in Psoriatic Arthritis
The prioritisation of pain, and its evaluation, is important in those with psoriatic arthritis, when the already incredibly heterogenous nature of the condition can complicate assessment. Whilst we lean towards all pain in PsA being nociceptive in nature, evidence suggests that a significant proportion of patients with PsA also have nociplastic pain, characterised by fibromyalgia.
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Was this a Mistake? HCQ Dose Reductions per AAOS Guidelines
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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Rheumatology Roundup: ACR22
On Thursday, November 21, 2022, Dr. Arthur Kavanaugh and Dr. Jack Cush reviewed the best and most interesting data and sessions presented at ACR22 in Philadelphia, PA. These are the research abstracts discussed:
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Why treatment of pre-RA isn't ready for prime time
The ACR Great Debate was on "To treat or not to treat in pre-RA?". What is the clinician to do?
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Imaging in PMR
Despite the fact that polymyalgia rheumatica is the most prevalent inflammatory rheumatic disease in those over 65 years of age, progress in its diagnosis, monitoring and management have failed to garner momentum in decades past.
However, ACR22 has fostered significant promise for its future.
ACR 2022 Appraisal, Praise & Critique (11.18.2022)
It was great to be back at an ACR annual meeting, this one in Philadelphia - Philly was great. A walking town, rich in culture, history and good places to meet and mingle.
I loved the city, but not the convention center (not easy to navigate).
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