All in the Family (8.23.2024) Save

Jack Cush, MD

Aug 23, 2024 7:00 am

Dr. Jack Cush picks highlight reports from the past week on RheumNow.com, with reports on the challenge of lupus nephritis, perplexing skin issues, you don't know JAK (about Tyk) and the value of a good family history.

Retrospective study of 919 RTX-treated GPA pts shows TMP-SMX prophylaxis (given to 31%) assoc w/ reduced serious infections (adj HR 0.5) and less outpatient infections (aHR 0.8). All 13 pneumocystis infx (PJP) occured in those not Rx w/ TMP-SMX. https://t.co/ww4jPmNC8r
Predictors of Pregnancy Outcomes in SLE A review of preconception predictors of pregnancy outcomes in women with SLE highlighted -- lupus nephritis,chronic hypertension, SLE disease activity and secondary antiphospholipid syndrome as predictors of APO. https://t.co/vA445kSe5t
Metanalysis of 50 RCTs (3,231 pts w/ lupus nephritis (LN) related starting pred dose to rates of complete response (CR), serious infections, & death. PO pred 25 mg/D assoc w/ 20%, 3.2% & 0.2%, respectively. Pred 60 mg/day incr rates to 35%, 12% & 2.7% https://t.co/6FH9BWsmaz
Systematic review of anti-Sm Abs (17 studies) shows Sm Abs to have 90% specificity for SLE. Although Smith Abs assoc w/ higher SLE activity, they are not predictive of lupus nephritis. Anti-Sm is more common in Black patients https://t.co/LpTn3kxE09
Cohort of 112 VEXAS pts: skin involvement common (83%), esp early w/ LCV (36%), neutrophilic (34%) or perivascular dermatitis (30%). p.Met41Leu variant w/ PMN (Sweets?) dermatitis (82%); p.Met41Val variant w/ vasculitic lesions (55%). 92% respond to pred https://t.co/JJSfpEyZRp0
Severe Alopecia Areata or Universalis - if you stop the JAK inhibitor, Hair loss occurs quickly, but can be recaptured. Severe Alopecia Areata. Substudy of the baricitinib BRAVE-AA1 RCT, 80% of those who D/C vs 8% of those continuing, lost BARI benefits https://t.co/YcfmegdvK6
Tobacco is a risk factor for hidradenitis suppurativa (HS). Korean population study finds 3761 HS out of 6 million. Those who quit smoking developed less HS (adj HR 0.68; 95% CI, 0.56-0.83) https://buff.ly/4cDQACw
JAKi an option for Still's Dz, especially refractory AOSD? Metanlysis of 9 studies (35 pts), Rx w/ either Tofa (17), Bari (14), Ruxo (4), Upa 1. Half had complete remission, 1/3 partial remission, 1/5 loss effect. Ruxolitinib 100% effective in AOSD w/ MAS https://t.co/3TKFNsj4v9
Biologic Rx may be less effective in psoriasis pts who are older, smokers, w/ Hi BMI & prior biologic use. Metanalysis of 40 studies, 21 438 PSO pts, and PASI90 responses. Decr Response w/ age (OR 0.99), Biologics (0.44), BMI 30+ (0.57), smoking (0.81) https://buff.ly/3XeRaSZ
Tyk2 inhibitor/Zasocitinib (TAK-279) effective in Psoriasis. Ph II RDBPCT of 259 pts w/ mod- severe plaque PsO showed 12 week PASI 75 success in 68% & 67% on 15 - 30 mg zasocitinib qd vs Placebo (18%). https://buff.ly/4dyFIaw
HBV reactivation w/ Anti-IL17, IL12/23, IL23 & JAKi. Metanalysis of pts w/ chronic HBV infection (HBsAg+ or detectable HBV-DNA) and prior HBV infection (HBcAb+, HBsAg neg) shows more reactiv w/ chronic HBV (14% vs 5%), similar betw classes (0-4%) https://t.co/5Jgehb5gNg
Longitudinal US RA Registry of 31129 #RA pts (148K Pt-Yrs F/U) shows Higher RA Dz activity assoc w/ eGFR decline & renal dysfunction. Compared to remission, pts in Hi Dz activity had HR 1.27 risk for CKD G3a (<60cc) & HR 1.93 for CKD 3b (<45cc/min) https://buff.ly/3WX4JVF
A Family History of Arthritis?