RheumNow Podcast – A Tofa Two-fer (4.12.19) Save

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

1. 71-80% of primary care diagnosed gout patients meet criteria for a gout diagnosis. https://buff.ly/2G98dhx 
2. 36 studies of 6662 depression patients shows the addition of antiinflammatory drugs (NSAIDs, steriods, statins, cytokine inhib, minocycline) improved antidepressant effects in Major Depression pts without increasing the risk of side‐effects. https://t.co/RdRNtVCfjh 
3. MMWR reports that for the 8th yr in a row the US TB rate dropped 1.3% to 2.8 per 100,000. In 2018 there were 9029 TB cases (69% in non–U.S.-born). TB risk in non-US born was >14 times that of U.S.-born persons. https://t.co/qdzvyavNVX
4. A downward trend in Rheumatology fellowship positions reversed after 2013 andsince (2014-17) there has been a 44% increase in fellowship positions (230-332), more than other subspecialties. More applicants per position, more US grads, higher salaries. https://t.co/STbmG4QnSA 
5. US Veterans Study examined 17,415 patients starting MTX - only 20.6% started a biologic w/in 2-yrs. Biologic use was significantly lower in elderly [aHR 0.20 ≥ 80 vs < 50], pts w/ comorbidities [aHR 0.79], CHF [0.68], cancer [0.78] & nonwhites [0.79]      2005-2016  JREUM https://t.co/3LcPVQAgcp 
6. 151 pts w/ myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) were treated with either rituximab or PBO showing no effect of RTX!! Really? someone, somewhere believes ME/CFS or FM is an immunologic dz? Do NOT use biologics, DMARDS in such pts. https://t.co/1xXG94QEnP   
7. Analysis of CareRA, early RA 330 pt trial shows long term outcomes linked to initial response type rather than regimen. Best PROMs in the 42% with early persistent response. 9% were primary NR, 28% secondary NR, 21% delayed responders. https://t.co/ZDqYD3krtb 
8. Long term tofacitinib in RA shows lymphocyte #s dropped ~24% by 48 mos. Monitor ALC at baseline & q3 mos; ALC <500 seen in 1.2% of 2983 pts and was assoc w/ higher risk of SIE & Zoster. ALC <500 more likely with low ALC, age, higher dose Tofa & MTX https://t.co/5CHMmoGWJw 
9. Long term safety study of 4481 tofacitinib pts w/ 9.5yrs exposure (16,291PYs). 52% discontinued Rx (4% insufficient response; 24% adverse events). AE incidence rates were 3.4/100PY for H zoster, 2.4/100Py SIE, 0.8 cancer, 0.4 MACE, 0.3 Mortality. https://t.co/Qv5keuKXr3 
10. 41 study Metanalysis on H zoster drug risk in psoriasis and PsA - finds an increased risk w/ steroids, tofacitinib, biologic +DMARD Combination Rx. But no risk with monotherapy. Insufficient evidence for IL-12/23, -7, -23 inhibitors or apremilast https://t.co/KRrTqIw7Ko
11. Dietary Supplements Fail to Reduce Mortality Risks  
12. FDA Approves Romosuzumab (Evenity) for High Risk Osteoporosis   
13. Increasing Prevalence and Consequences of Interstitial Lung Disease in RA