RheumNow Podcast – To Needle or Not to Needle (11.30.18)

Jack Cush, MD

Nov 30, 2018 1:35 pm

Dr. Jack Cush updates the news and reports from the past week at RheumNow.com:

The Next Best Meeting in Rheumatology is coming - RHEUMNOW LIVE - March 22-24 2019 in beautiful downtown Fort Worth. Short Lectures, interactive sessions, Q&A panels, TED (like) Talks, digital, streaming and much more. You dont want to miss this meeting! https://t.co/5TVg0Frsbf
Study of 2053 RA patients from VA medical centers found 27% with chronic lung disease that confered a 51% increased mortality risk that was not altered by MTX or biologic therapy. https://t.co/nYFnScSXQ4
Amongst 192 patients w/ ANCA Assoc. vasculitis there were 95 severe infections (25%; 26/100PYs). TMP/SMX prophylaxis lowered risk of severe infections by 70% (HR 0.30). Risk was higher w/ age, bronchiectasis, endobronchial dz, COPD. https://t.co/aDEGNuwsEH
Could routine use of hydroxychloroquine reduce the rate of serious infections in immunosuppressed patients? A modest to moderate risk reduction noted in two large SLE cohort studies. https://t.co/pssLrteRRq
A systematic literature review shows that triple positivity for ACPAs, RF, and anti‐CarP antibodies yields a higher specificity for RA (98–100%), accompanied by a lower sensitivity (11–39%). https://t.co/TKAZd7CP1M
Bisphosphonate safety review - risk of Atypical Femoral Fracture is 1/1000 and risk of osteonecrosis of the jaw is 1/10,000. One-third of IV zolendronic acid pts will have arthralgia/myalgias or flu like sxs. https://t.co/80xBkZlKgn
TB Testing 2 - Note: <10% of pts initially PPD/IGRA neg may be positive later (either they were anergic or have a new TB infx). I Recommend repeat TB testing 3 mos after starting or changing from 1st to 2nd biologic - Repeat testing indicated if newly EXPOSED or when Risk Changes
TB Testing - Do PPD or IGRA before TNFi or biologic - If negative, start therapy - If Positive, Eval for active TB (Sxs, CXR, C/S); if neg --> LTBI Rx BEFORE biologic - If "Indeterminate", repeat or change test. If same or neg--> start biologic - Do not do annual TST or IGRA
Metanalysis shows DMARDs (6 studies) and biologics (5 studies) offer NO clinically significant benefit compared with placebo in Osteoarthritis. https://t.co/fNGVzuNQNo
2018 NRMP report shows Rheumatology as one of the most competitive fellowships with 313 applicants for 221 positions - 147 filled by US grads and 69 by FMGs. https://t.co/xRmMyA2yCy
There are SIX FDA approved TNF inhibitor biosimilars in the USA - 3 infliximab (Ixifi, Renflexis, Inflectra), 2 of adalimumab (Amjevita, Cyltezo) and 1 etanercept biosimilar (Erelzi). https://t.co/xxwgvVeEXy https://t.co/ALESYJf0Zi
80 overweight & obese pts w/ mild to moderate Knee OA Rx in RDBPCT showing garlic 1000 mg/D significantly lowers pain scores, resistin levels (but not TNF). Garlic may work by effects on MMPs, cytokines? shown to lower CRP levels https://t.co/bg5nwzUpJe https://t.co/us0uBLdCau
Steroid Injection Superior to Splinting in Carpal Tunnel Syndrome
AURA-LV Trial - Voclosporin Effective in Lupus Nephritis