CBT or Naltrexone in Fibromyalgia (12.8.2023)

Jack Cush, MD

Dec 08, 2023 6:00 am

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com. Be sure to catch the early registration break for 2024 RheumNow Live.

Palmoplantar pustulosis (PPP) is difficult to treat; w/ few reports of JAKi efficacy. Now a report of 21 PPP pts given bimekizumab and 17 patients showed complete clearance in 1 to 4 months. SAPHO pts had complete clearance of skin & improved joint pain https://t.co/aHEiXZJGD8
UK Dermatology Registry of 13 699 Psoriasis pts on biologics (25K biologic exposures) found 1% risk of paradoxical eczema. Biologics included inhibitors of TNF, IL-17, IL12/23, IL-23. Lowest risk w/ IL-23i (0.56/100kPY), and higher w/ IL-17i (1.22) https://t.co/SorkOl5G0J
Systematic review (3 studies) RA pts shows bariatric surgery (n=6700) can significantly lower disease activity at 12 mos and reduce comorbidities (OR=0.45) and in-hospital mortality (OR=0.41). BMI at baseline and after BS was 43.1 & 29.7kg/m2, respectively https://t.co/3Uweb5spGC
Kuwait #RA registry study - shows in RA, the Uric acid level is inversely proportional to RA disease activity. 1054 RA pts, 15% had high UA level; lower DAS28 score associated w/ higher UA (p=0.032) OR 1.39; but higher HAQ assoc w/ higher UA https://t.co/muN0BFDs2Z
RCT 114 fibromyalgia pts Rx w/ cognitive behavioral Tx (CBT) vs control education. CBT had significant reduction in pain catastrophizing, pain interference & Sxs w/ improved function; neuroimaging in 98 pts also showed comparable improvement https://t.co/bKwREZdDF0
Naltrexone was NOT superior to placebo in a blinded RCT of 99 Fibromyalgia pts. Pain decreased –1·3 points w/ NAL vs –0·9 in PBO (p=0·27). D/C were similar (8% vs 6%). NAL may improve improve memory problems in FM pts. https://t.co/5i98Jr4u84
Polands disease study (sarcoidosis 78.6K; #AOSD 3294; systemic sclerosis 35.5K) betw 2009-2018. Avg hospitalization was 5.39 days sarcoidosis, 6.22 days scleroderma, & 7.44 days for Still’s (latter decr 11.7 to 5.8, betw 2008-2014) https://t.co/OcNzt7IKC5
Difficult-to-treat (D2T) axSpA seen in 88/311 axSpA pts. D2T axSpA= failure of ≥2 b/tsDMARDs (Very D2T-axSpA: same in <2yrs). D2T had signif more periph arthritis (35 vs 21%), higher BASDAI (64 v 59) & more FM. Very D2T had more CRP, IBD, no FM https://t.co/DnxxypAEqo
2023 EULAR #PMR referral recommendations: 1 Suspected/Dx pts: consider Rheum eval 2 Do full Hx+PE+Labs before referral 3 Refer Severe Sx PMR to rapid access 4 Defer steroids til rapid Rheum eval 5 Rheum Dx PMR w/ +steroid response can be Rx by PCP https://t.co/42bL8BL3QJ
Risk of Hepatitis B reactivation is assessed by serology - Resolved HBV (low risk reactiv): HBsAg-neg, HBcAb–pos & Pos HBsAb - If HBcAb(+), HBsAb negativity incr risk; - HBsAg(-), HBcAb(+), HBsAb(-) negative= resolved infx, occult infx, chronic hepatitis https://t.co/91ZwqWkdvo
Resolved HBV (HBsAg-, HBcAb+, HBsAb+) are at low risk of reactivation (~2%) w/ TNFi or biologics. But in a high risk endemic region (ie, Korea) this risk is higher. Study of 416 such pts HBV reactivation rate 3.5% @5 yrs, 6.1% @10 yrs & 24.2% @17 yrs https://t.co/oQ5e6O9wds
FDA Warning on CAR-T Cell Therapy