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RheumNow Podcast – Coconspirators: RA and Lung Disease

Apr 23, 2021 10:06 am

Dr. Jack Cush reviews the news and journal articles from the past week on

  1. BC, Canada study of Lupus mortality: 6,092 SLE pts followed for 17 yrs, there were 451 deaths. Compared to population, all cause mortality was nearly 2 fold higher (HR 1.85; 1.66-2.06); excess deaths from renal (HR 3.04), INFX (2.74) & CVD (2.05)
  2. Diary study of 79 FM, 86 RA, 33 w/ both FM/RA shows that compared to RA, pts with FM have worse daily well-being, negative affect, more isolation, inability to complete plans. FM had more perceived stigma and lower well-being.
  3. When DOACs (Xarelto, Eliquis) used for Afib or VTE, concomitant aspirin also given (without indication) in 34%. There was no additional anti-thrombotic effect, PLUS ASA use adds 20% increased risk of non-major bleeding. Registry cohort study of 3280 pts.
  4. 37 RA, 28 PsA & 20 AS pts in remission/LDA x 6 mos enrolled in DMARD spacing. Joint flares seen in 13.5% RA, 21.4% PsA & 20% axSpA pts but 5 more PsA patients had skin flare. PsA had lower persistence 61% (vs RA 87% & 80% AS) due to skin flares
  5. 55 pts w/ Multi-joint osteonecrosis (>2 jts).(SLE 29%, ALL 11%, HIV 9%, EtOH 4%). Mean cumulative steroid dose >30 g over 5 yrs. Predictors of MJON was cumulative oral steroid dose (3.2% incr per 1000 mg. MJON risk incr 12 fold w/ 2nd risk factor.
  6. Study of 207 Pediatric pts treated w/ Rituxan (for Rheum, Cancer, CNS, Renal dz) and 40% developed hypogammaglobulinemia post-RTX; hypo-IgG Pre-RTX 28.7% to Post RTX 42.6%, p=0.009; low IgG levels had higher risk of serious infx (OR 2.3)
  7. Broadalumab Efficacy in Axial Spondyloarthritis Broadalumab, an anti-interleukin-17 receptor A monoclonal antibody, is FDA- approved for use in adults with plaque psoriasis; but a recent trial shows it to be effective in patients with axSpA.
  8. Sonelokimab is a novel trivalent nanobody aimed at IL-17A & IL-17F; tested at multiple doses vs Placebo or secukinumab in 383 plaque psoriasis pts: SON at doses 60-120 mg had efficacy similar to SEC; but SON had more Candida infx (17·4% vs 1.9% SEC)
  9. Randomized trial of 206 adults with knee OA found that a web-based exercise intervention supported by text messaging improved knee pain and function at 24 weeks vs web-based information alone. (MCID pain 72.1% vs 42%)
  10. Not in the US, but biosimilar infliximab (CT-P13) is being used subcutaneously in the EU and Canada. Analysis of 2 RCTs shows (compared to IV inflectra or remicade) SC CT-P13 greater DAS28-CRP, CDAI and SDAI response rates.
  11. Dual seropositivity with RF/ACPA autoantibody higher titers were strongly associated with prevalent RA-ILD (OR 2.90; developed in 3.7%). ILD more likely with high titer RF (HR 3.4) than high titer CCP (HR 1.9).
  12. Increased Risk of COPD in ACPA+ Pre-RA Patients 
  13. Increased Methotrexate Liver Disease in Psoriasis 
The author has received compensation as an advisor or consultant on this subject

Rheumatologists’ Comments

Dr M Nazibur Rahman

| Apr 23, 2021 2:07 pm


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