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3-4-5 Rule (5.26.2023)

Dr. Jack Cush reviews more than a dozen news, journal articles and RNL highlights from this past week on

  1. With all the new adalimumab biosimilars happening in 2023, where's the pen? Now the FDA has approved an ADA biosimilar, Cyltezo, Autoinjector Pen!

  2. Retrospective cross-sectional EMR study from Israel compared GI Dz in 18,598 FM pts vs 36,985 controls. FM significantly assoc w/ IBS (OR 4.61), GERD (OR 2.62), PUD (OR 2.13), celiac Dz(OR 2.08), IBD ; But not w/ GI malignancies

  3. SLE & dsDNA: 3,484 SLE pts (over 37,582 visits) - 29.5% had persistently dsDNA+ & 34% had fluctuating dsDNA.results & both assoc w/ SLE flares (HR 1.56 & 1.46). Doubling of dsDNA assoc w/ 33-36% increased risk of flare (p=0.009)

  4. 14 yr study #SLE (255 pts) & Lymphadenopathy. Causes: SLE (33.7%), lymphoma (0.8%) or TB (0.4%). LAD assoc w/ with fever (OR=3.3), pericarditis (4.1), membranous GN (3.6), leukopenia (2.6); NOT Wt loss, myocarditis, myositis. Bx needed to R/O lymphoma.

  5. BIOBADASER registry of 3,366 RA/AS/PsA pts on 1,2 bDMARDs saw Remission-related Biologic D/C by 80 pts (2.4%). D/C Factors: short Dz duration (OR: 0.95), no csDMARDs (OR:0.56), shorter use prior bDMARD. Less D/C w/ smoking & ACPA+

  6. INBUILD study was an all cause ILD nintedanib RCT (n=663). Subanalysis of 89 RA-ILD pts showed FVC decline (@ 52 wks) was −82.6 mL/yr on NIN vs −199.3 mL/yr on PBO (p=.037). NIN diarrhea in 62%; & AE discontinuation in 24%

  7. Dr. Deodhar reminds us of his "3,4,5 rule" for diagnosing AS. *Erosions in 3 or more SIJ quadrants *BME in 4 or more SIJ quadrants *Fat lesions in 5 of more SIJ quadrants #RNL2023 @RheumNow

  8. Medevil ruler Bermudo II ("The Gouty", in Spanish: "el Gotoso") was King of León & Galicia (982 to 999). Some campaigns were a success but he lost wars & reign, presumeably from severe gout & could no longer ride horseback, & had to travel by litter

  9. In the UK, MHRA has somewhat softened its warnings on Febuxostat use in gout - stating use caution if considering Febuxostat in patients with a prior  history of major cardiovascular disease; esp w/ high urate and tophi burden or starting ULT

  10. Colchicine does not work in Hand OA. Danish trial of 100 HOA pts (age 71 yrs) given placebo or COL 0.5 mg bid x 12wk. Finger pain improved –13·9 mm w/ colchicine vs –13·5 mm w/ PBO (NS). More adverse events w/ Colchicine (72% vs 44%)

  11. U.S. FDA Approves RINVOQ® (upadacitinib) as a Once-Daily Pill for Moderately to Severely Active Crohn's Disease in Adults based on induction studies, U-EXCEED, U-EXCEL,& U-ENDURE maintenance study. This is 7th FDA approval for RINVOQ

  12. Cochrane metanalysis of antidepressant use in managing chronic pain shows they dont work, with the small exception, duloxetine - at standard dose (60 mg) it was effective, but no benefit to using a higher doses

  13. The Burden of Chronic Pain in US Adults (2019-2020)


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