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RheumNow Week in Review – ACR Preview Edition (10.19.18)

Oct 19, 2018 3:00 am

Dr. Jack Cush summarizes the news and reports from RheumNow.Com this past week and previews RheumNow activities at the upcoming ACR 2018 meeting in Chicago. This week we cover info on antimalarial cardiomyopathy, TNF inhibitors causing neuropathy or treating sarcoid, diabetes fractures, bisphosphonate holidays and marijuana for chronic pain.

  1. Drug-induced interstitial lung Dz accounts for 3⁻5% of ILD. Most common causes include Cancer drugs, followed by rheumatology drugs, amiodarone and antibiotics, - there is no typical radiological pattern specific to DIILD. Mortality rates as high as 50%.
  2. Federal register publishes new Trump admin plans to require drugmakers include list prices in direct-to-consumer television ads. This is subject to a 60-day comment period. 25 companies run ~300 DTC ads, TV ad spending >$2.8 billion in 1st 9 mos of 2018.
  3. 8 pts from the Toronto Lupus clinic dx w/ antimalarial cardiomyopathy by endomyocardial Bx. They were older 62.5 yrs, Dz duration 35 yrs, HCQ use 22 yrs, half w/ abnl cMRI; look for cardiac troponin I, high CPK. 1 died, other improved w/ HCQ d/c
  4. Claims data study of 61,570 patients with rheumatic diseases from PharMetrics database shows 1358 cases of peripheral neuropathy.  Risk of PN was only high with past TNFi or multiple TNFi users (RR 2.77 to 3.49), but not with current TNFi users.
  5. TNFi in Sarcoid? Metanalysis of 65 studies, 5 RCTs, 1525 pts shows no good data for ETN, GOL, CZP. But LIMITED Limited evidence of efficacy for infliximab in PULM, Skin, Ocular, CNS & multisystem Dz & adalimumab for Skin & ocular sarcoidosis
  6. Diabetics known to have a higher risk of hip Fracture; Metanalysis of nearly 5 million people & over 50k Fractures shows diabetics w/ a 30% increased risk of ankle Fx (RR 1.30) & 15% decrease in wrist Fx (RR 0.85). Same pattern of Fx seen w/ obesity.
  7. ASBMR study of 150K women in S. Calif finds after 3-5 yrs of bisphospholate, a drug holiday resulted in 44% reduction in atypical femoral Fx in the 1st Yr.& 80% lower in yrs 1-4. Also found that higher BMD levels before bisphosphonate incr risk AFF.
  8. NEJM Debate on Medical Marijuana for Chronic Pain 
  9. Update on Immune Checkpoint Inhibitor Toxicity
  10. RheumNow coverage of ACR 2018


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