RheumNow Podcast – Tricked Up Lupus Criteria (8.9.19) Save

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com, including new SLE criteria, ULT in gout and MSU reductions, IVIG in ANCA vasculitis and non-TNF biologics outperform the TNF inhibitors. 

1. Internet based study by Choi et al - looked at 517 gout patients and examined if gout flares were associated with vaccination. They found a twofold higher odds of gout flare (adjusted OR 1.99; 95% CI 1.01 to 3.89 in those who were vaccinated (any vaccine). https://buff.ly/2ZOhVO4
2. Patients with pain, fatigue & myalgias should be FM; but rarely could be Macrophagic myofasciitis – a rare myopathy manifest as "algias", weakness, fatigue, fever, & muscle tenderness. Dx by biopsy of vaccinated muscle shows PAS+ macrophages w/ aluminum deposits https://t.co/9Ll4pE3wXJ
3.  IL-16 studied in Scleroderma: finds increased perivascular IL-16 lymphocyte expression with  more IL-16+ cells in dcSSc vs lcSSc (44% vs 29%, P<0.05). Serum IL-16 levels elevated in SSc patients (297 vs 195 pg/ml) & IL-16 correlated with dcSSc, skin score, erythema & pigmentation. https://buff.ly/2YPsMtQ
4. Prospective study of 83 gout patients; 77 on urate lowering therapy; 6 discontinued Rx. The D/C group had no change in MSU deposits or SUA levels, In the ULT group MSU burden significantly decreased (MSU volume: p=0.007) and sUA dropped from 7.2 to 5.8 mg/dl. https://t.co/YfXjTKz1va
5. Metanalysis of 9 studies shows that use of IVIG in ANCA-Associated vasculitis is associated with significant and rapid improvement in BVAS (SMD –1.7), ANCA (SMD –0.72) and CRP (SMD –0.92) within 2-24 weeks. https://t.co/aw3VjBWCcf
6. Claims analysis of 88,463 #RA pts (2006-2015) finds no greater risk of cardiovascular events with tocilizumab (11.8/1000 PY) compared to TNF inhibitors (15/1000PY) or abatacept; suggesting no net increase in CVD w/ occ hyperlipidemia seen w/ TCZ https://t.co/6L8aKlLGta
7. Claims analysis of 45,208 TNFi +MTX initiators and 1,387 triple DMARD (MSH) initiators showed no significant difference in the risk of serious infections (2.46 TNFi+MTX vs 2.03 triple DMARD/100PY) (HR 1.23; 0.87‐1.74) https://t.co/pe52p8Xtrv
8. Oral candidiasis (OC) is a significant predictor of severe infections during immunosuppressive Rx in ANCA-associated vasculitis. 71 AAV patient cohort study; Predictors of severe infection: low albumin, pulse methylprednisolone (adj HR = 5.44), & OC (adjHR  5.31) https://t.co/BSZzWxDU4k
9. Periodontal Disease and P. gingivalis Increased in CCP+ Pre-Clinical RA
10. Are Non-TNF Biologics Superior to TNF inhibitors? 
11. New EULAR/ACR Classification Criteria for SLE