RheumNow Podcast – Believe in Vitamin D or Rituximab? (9.20.19)

Jack Cush, MD

Sep 20, 2019 6:49 am

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

Prospective ankylosing spondylitis cohort - 628 without HTN followed for12 mos; 200 treated with NSAIDs; of these 129 developed incident HTN. NSAID use associated with increased risk of HTN (HR 1.12; CI, 1.04‐1.20), not effected by age, biologics, dz activity https://t.co/T6y5OcCgMM
Southern Sweden study of ANCA Assoc Vasculitis (GPA, MPA, EGPA) 195 pts followed x8 yrs: found all cancers increased (SIR=2.8). SIR for squamous cell CA=12.9; 4.3 bladder cancer, & 7.0 for pancreatic CA. CYC total <10g were not associated w/ higher CA risk https://t.co/wqRKaFYWGb
Metanalysis of 16 studies- Systemic Sclerosis pregnancies have a higher risk of miscarriages (OR 1.6), IUGR (OR 3.2), preterm births (OR 2.4) and low birth weight (OR 3.8). SSc pts have 2.8 fold higher rate of gestational HTN & 2.3x more C- sections. https://t.co/FuM0DZFR4k
Statin use was associated with reduced risk of radiographic knee osteoarthritis joint space narrowing progression in patients with nodal osteoarthritis. Data from the Osteoarthritis Initiative, 832 knees of 602 participants (statin initiators vs nonusers) https://t.co/lRR4MG1il7
Administrative data from British Columbia examined the role of NSAIDs in OA and their risk of cardiovascular dz. Overall OA patient have a higher risk of CVD than do matched controls (adj HR 1.23) & 41% of that CVD risk was mediated through NSAID use. https://t.co/32ThTWkMkh
Despite several Vitamin D intervention RCTs in SLE failing; a metanalysis shows Vit D levels low in SLE, especially in pts with SLEDAI >10. Deficiency of Vit D incr SLE risk (OR=4.37) and Vit D levels were inversely correlated with SLEDAI (correlation coefficient = −0.50) https://t.co/M39lzISw09
Despite RCTs showing RTX doesnt work in SLE - rheums still use it. Review of 147 SLE pts on RTX shows better outcomes in those with a low # prior DMARDs & low C4 levels. >1/2 had prior MMF, AZA, HCQ; 1/3 CTX or MTX. Lesser responses seen with Joint disease. https://t.co/XlGGulpLDW
Risk of HCQ/CQ Retinal toxicity was 5.5% in 326 SLE pts F/U x 12.8 yrs. None occurred in 1st 5 yrs; earliest 8 yrs (max =33 years). Retinal toxicity cases tended to have more renal disease (22% vs 15%) and were slightly less likely to be Caucasian https://buff.ly/32NgZdJ
90 SLE patients (SLEDAI<6) on immunosuppressives were given PBO or the live virus zostavax - Vax pts had significantly higher anti-VZV IgG by Wk 6; also more injection site reactions (31% vs 7%). 3 pts flared (1PBO; 2 Zostavax) and no one developed zoster postvaccination https://buff.ly/309Xj77
ACR Survey Shows Half of Patients Cannot Afford Treatments