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RheumNow Podcast – Vasculitis and Strange Bedfellows (12.14.18)

Dec 14, 2018 1:30 pm

Dr. Jack Cush reviews the news from the past week on 

  1. Comparison of pediatric (214) and adult (5348) GPA pts shows Pediatric GPA to have 30% more hospitalizations and 2-3 fold more leukopenia, neutropenia, hypogamma than adults. No diff in severe infections, major relapse, ESRD.
  2. No differences seen in the rates of major adverse CV events (MACE) between RA, axial SpA or PsA pts, suggesting inflammation, rather than a disease, drives CV risk. Data from a Swiss mixed retrospective/prospective cohort study
  3. 27yoF w/ chronic 4 mos b/l knee effusions (SF WBC=22K, -C/S), MRI synovitis only, Labs normal but with +ANA 1:160, neg Parvo, B27, RF, CCP, RPR, HCV/HBV, ESR and CRP. No resp to NSAIDs or IA steroids. DX?  
  4. Statin Safety review from the American Heart Assn says 1 in 4 adults > 40yrs takes a statin; lowering LDL by 55-60%. Statin-induced rhabdomyolysis is
  5. Vasculitis may complicate autoinflammatory Dz - in FMF (IgA vasculitis, PAN), vasculitis may occur w/ CAPS, TRAPS, HIDS, DIRA, PAPA & Behcets syndromes. Vasculitis is part of DAD2 deficiency (STING-assoc vasculopathy w/ onset in infancy-SAVI (PAN-like)
  6. Systematic review of 41 papers shows that polymyalgia rheumatica is associated with comorbidities - CVA, CAD, peripheral arterial disease, diverticular disease, hypothyroidism, but there is disagreement as to an association betw PMR and cancer.
  7. Registry studies of systemic sclerosis shows that early severe GI involvement (9% at 2yrs) is associated with increase risk of inflammatory myositis (OR 4.68), telangiectasias (OR 2.45), skin progression and a >2-fold risk of death (HR 2.27)
  8. Psoriatic Arthritis Does Not Add to Pregnancy Problems
  9. No End in Sight for the Shingrix Vaccine Shortage
  10. Genetic Diagnosis for Previously Undiagnosed Disorders  
  11. Patients Don't Always Tell the Truth
  12. Too often doctors think their job is to know the answer and fix the problem. All too often, strangely and surprisingly, that isnt what the patient wants or needs. They need someone who cares, doesnt judge behaviors and displays a pulse and personality 
  13. RNL 3/22-24 2019 in Ft Worth, 16hrs CME, all the big names, all the big companies


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