Anti-Rheumatic Rx

Dr. Jack Cush reviews recent news, regulatory and guideline updates from the past week on RheumNow.com.  Studies on methotrexate use, COVID vaccination, Supplements and vitamins, and arthrocentesis despite anticoagulation are discussed.

A new way of inhibiting tumor necrosis factor (TNF) for treating rheumatoid arthritis showed strong results in a phase II/III clinical trial, researchers said.

Analysis of two large clinical trial datasets shows that placebo response rates in randomised controlled trials (RCTs) of patients with rheumatoid arthritis are better when the patient continued background methotrexate (MTX). 

The GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) treatment recommendations have been updated and the 2021 evidence-based guidance is rich in treatment recommendations based on the key disease "domains" - peripheral arthritis, axial disease, enthesitis, dactylitis, skin and nail psoriasis; with new PsA related domains uveitis and inflammatory bowel disease.

Hydroxychloroquine (HCQ) appeared less safe from a cardiovascular standpoint than methotrexate in older patients with rheumatoid arthritis (RA), analysis of Medicare data indicated.

The US Preventive Services Task Force (USPSTF) has updated its recommendations regarding the efficacy of supplements or multivitamins for reducing the risk of cardiovascular disease, cancer, and mortality in the general adult population.

Pooled data from two large ixekizumab (IXE) trials show that male patients had greater clinical responses than did female patients with psoriatic arthritis are largely unexplored. Reasons for this differential treatment responses to an interleukin-17A inhibitor (IXE) between male and female patients is unexplained.

A cohort study of rheumatoid arthritis (RA) patients evaluated immunogenicity of COVID vaccination with and without holding methotrexate (MTX) for and 2-weeks and showed better immunogenicity, but more RA flares with the second MTX withdrawal. 

A pooled analyses of data from eight, phase 2 and 3 randomized clinical trials shows bimekizumab, a dual IL-17A/F inhibitor, to be effective in plaque psoriasis and was well tolerated aside from an increased incidence of mild to moderate oral candidiasis. 

Aside from cost, there are significant concerns regarding efficacy and safety outcomes and recovery time. These issues are compounded with the need for bilateral TKR, wherein the patient and surgeon need to decide whether to have both TKRs done simultaneously or staged (single TKR one after another with a recovery period in between).

Whether exposure to ultraviolet (UV) radiation from the sun can cause new-onset systemic lupus erythematosus (SLE) wasn't settled by data from a large, long-running epidemiologic study, but the trends indicated that it could.

A EULAR taskforce systematically reviewd the literature on the effects of diet and lifestyle behaviors in rheumatic and musculoskeletal diseases (RMDs), and found little evidence suggesting dietary factors can substantially affect the outcomes in people with RMDs.

There is a shortage of rheumatologists in Canada and the recent 2020 Canadian Rheumatology Association (CRA) Workforce and Wellness study shows that the shortage may be compounded by rheumatologist burnout, especially among young and female physicians. 

During the COVID-19 pandemic, a new COVID-related syndrome in children, the "Multisystem inflammatory syndrome in children" (MIS), was described as being similar to but distinctly different than childhood Kawasaki's disease (KD). A new epidemiologic report shows that while MIS-C cases rose, KD cases fell and remained low during the period of masking and school closure.

Dr. Jack Cush does a 2-week review of RheumNow Tweets on news and journal citations worth noting, along with some opinions on Telehealth, manpower, monkeypox and the price of drugs. Although Rheumatology currently ranks 2nd or 3rd in specialty use of telemedicine - the vast majority of rheums have given up on telehealth (<15%) https://t.co/iDNesBkOnN