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Activity & Pain Tolerance (3.29.2024)

Dr. Jack Cush reviews the news and journal reports from the past week on, including where you should sit in clinic and why you should worry about secondary Sjogren's in RA.

  1. GEM: Your Clinic Desk needs to be where you can see your patients enter/walk/rise into the clinic. Also pts can see where you work. They learn you & you learn them in ways not gleaned from the exam room
  2. >25% of elderly fall each yr; falls are leading cause of injury-related death in > 65 yrs. PT & Functional exercises to improve leg strength and balance are recommended for fall prevention in @risk populations & show 20-30% less risk overall
  3. Chikungunya Arthritis - 2 studies show benefit of dexamethosone (up to 4mg/d) w/ improved DAS28 scores; Uncertain benefit however with MTX; 133 Brazilian pts studied for 5 mos & 31 pts studied for 8wks.
  4. Norwegian Institute of Public Health found that among more than 10,000 adults, those who were physically active had a higher pain tolerance than those who were sedentary; and the higher the activity level, the higher the pain tolerance.
  5. Korean biologics registry study 526 Ank Spondylitis pts on TNFi > 1yr and tapered; 24.1% experienced flares. Predictors of flare included B27+, inflammatory LBP, psoriasis, SpA Fam Hx, DM, ≥50% TNFi tapering, Dz activity (ASDAS-CRP, BASFI)  at tapering
  6. BIOBADASER registry 1128 RA pts Rx w/ 1st ts/bDMARD, Among the 9.3% w. multimorbidity they noted higher DAS28 dz activity, but no differences in ts/bDMARD retention rates betw those w/ and without multimorbidity
  7. Korean claims study of #RA & pregnancy (& adverse preg outcomes (APO), shows MTX or LEF use w/in 3 mos of conception assoc w/ incr. in APOs (aOR 2.14-.68). In 5728 preg: 1152 APOs, HCQ most commonly used, DMARD use decreased during preg.
  8. Autoimmune dz pts have higher risk of macular degeneration. Cleveland Clinic study of 200K AMD vs controls, finds: - SLE (RR 1.73) - Scleroderma (1.65) - Psoriasis (1.48) - Vasculitis (1.48) - RA (1.4) - UC &CD (~1.42) - Sarcoid (1.42)
  9. According to CDC, drug overdose deaths increased in 2022 - up to 107,941, ~1% higher than the nearly 107,000 overdose deaths in 2021. 70% of these are males. 2023 numbers are not yet final but appear to be stable...
  10. High Mortality & complication rates seen in 53 #RA pts presenting w/ Periprosthetic joint infection - 54 PJI w/ avg age 65 yrs (32-88); mortality rate was 19%. Most common was Staphylococci (63%), w/ 20% w/ multiorganism infx & 6 C/S neg
  11. Post-COVID MDs spend more time on EHR mostly messaging w/ patients, with a 157% increase from prepandemic average. Each additional patient message was associated with a 2.32-min increase in EHR time per day (P < .001), mostly messaging
  12. Window of Opportunity in Psoriatic Arthritis A Dutch Early Psoriatic Arthritis cohort study shows that psoriatic arthritis (PsA) patients treated early (referred and diagnosed within in less than 12 weeks) had the best clinical outcomes.
  13. Secondary Sjogren’s Ups Rheumatoid Arthritis Severity A Swiss observational study has shown that RA patients with concomitant Sjögren’s disease (SjD) are more likely to have a severe RA phenotype, and be less responsive to treatment.


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The author has no conflicts of interest to disclose related to this subject