Anti-Rheumatic Rx

Tan and Buch have reviewed the approach to difficult to treat rheumatoid arthritis (D2T-RA), with a new EULAR definiation of D2T-RA to foster an approach rationale and concideration of treatment options.

NEJM has published study results showing that vitamin D3 supplementation does not significantly lower fracture risk (vs. placebo) when used in generally healthy adults.

Krill oil supplements in knee osteoarthritis (OA) was shown to be superior to placebo in reducing knee pain, stiffness and function while increasing the omega-3 index. Krill oil, rich in anti-inflammatory long-chain (LC) omega-3 ( ω–3) PUFAs and astaxanthin, is thought to be safe and now shown to be effective nutritional treatment for mild to moderate knee OA.

Litifilimab, a humanized monoclonal antibody against BDCA2, targets the BDCA2 receptor on plasmacytoid dendritic cells. When administered to patients with cutaneous lupus erythematosus (CLE) was shown reducing disease activity in CLE patients.

The janus kinase inhibitor, upadacitinib, has been shown to significantly improve the signs and symptoms of non-radiographic axial spondyloarthritis (nr-AxSpA), extending the efficacy of UPA beyond classic ankylosing spondylitis.

Dr. Jack Cush reviews the news, journal reports and rheumatologist cases from the past week on RheumNow.com. This podcast is brought to you by StillsNow.com - be sure to sign up for our monthly StillsNow email and Monthly StillsNow Podcast.

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. They divide myositis-ILD into three main prognostic groups with different treatment approaches:

There is no “test” (blood or other) that is solely diagnostic of Still’s disease, but labs can help make a diagnosis or manage disease, and affirm the safety of drugs in use. ​​​​​​​ 

Management of arthralgias before a certified rheumatoid arthritis (RA) diagnosis is challenging - should one use DMARD therapy before clinically evident synovitis in a preemptive effort to avoid or forestall the diagnosis or damage of RA?

Mitochondrial constituents and metabolic products may give rise to immune activation; this is especially true for mitochondrial DNA, which can function as damage-associated molecular patterns (DAMPs) leading to inflammasome activation. DAMPs and pathogen-associated molecular patterns (PAMPs) are primary drivers of inflammasome activity.

Are you treating “systemic” or “articular” (arthritis) Still’s disease? Most Still’s patients have a dominance of one or the other. With certainty, the right therapy for the right symptoms can be chosen. What about patients who have an incomplete or no response, or who become unresponsive to a drug that once worked well?

Dr. Jack Cush covers the news and journal reports from the past week on RheumNow.com. This week we have Insights NAFLD, overdose deaths, septic arthritis, refractory stills, & when MTX doesn’t work.

A large prospective psoriatic arthritis (PsA) study examined the enthesitis outcomes when PsA patients received conventional (cDMARDs) or targeted disease-modifying antirheumatic drugs (tDMARDs) and showed an overall 86% response rates, regardless of the medication used.

The concept of a “Still’s disease continuum” that encompasses both sJIA and AOSD is based on the many common clinical, genetic and laboratory features shared by both sJIA and AOSD.

Placebo responses are to be expected in rheumatoid arthritis (RA) clinical trials, but are such placebo responses affected by continuing background DMARDs like methotrexate (MTX) even though there was an inadequate response (IR) to MTX?