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Consequences of TNF inhibition (3.18.2022)

Mar 18, 2022 10:04 am

This week we're going to talk about the downside of TNF inhibitors, a few interesting observations in gout, and yes, kids do get COVID. We're also going to preview what's coming in April! This and more as Dr. Jack Cush reviews the news and journal articles from the past week on

  1. Medscapes 2022 Physician Suicide report. Sadly 10% of MDs have considered suicide. Highest in pathology (13%), surgery (12%), oncology (12%), ID (11%), EM(11%). LOWEST in Rheumatology (5%), nephrology (2%)

  2. Abbvie announced that the FDA has approved Rinvoq (upadacitinib) for use in adults with active ulcerative colitis (after failing TNFi); approval based on 3 endoscopic UC trials. Starting dose is 45 mg/d, then maintain w/ 15 mg (some can get 30 mg)

  3. Intravenous (IV) form of tramadol (Schedule IV) went in front of the FDA Drug Safety & Risk and Anesthetic/Analgesic Advisory Committees yesterday. They voted 14-8 against approval of IV tramadol (now available as tabs, liquid)

  4. Metanalysis looked at the risk of psoriasis or PsA flare associated with steroid use. 11 retro- and prospective cohorts (4,170 820 pts) w/ 38% of PsA & 35% psoriasis Rx w/ systemic steroids. 10/11 studies did not show increased flares w/ steroids

  5. In a Belgian cohort study of 2492 RA pts, 697 Rx w/ a TNF inhibitor -- four developed TNFi (3ETN, 1INFLX) induced sarcoidosis. 2 w/ pulm sarcoid and hilar LN; 1 Heerfordt synd; 1 w/ granulomas and ^^calcium. All recoved w/ steroids and TNFi-DC

  6. Korean study (TB endemic area) shows the risk of mTB & nontuberculous mycobact infx (NTM) are equal and nearly doubled in RA pts on TNFi. Among 4356 RA (1089 on TNFi) NTM & TB rates were 328- and 341/100K PY (US rate is 6/100K PY)

  7. COVID-19 mRNA Vaccine Safety #s - From ~300 million doses, there were 340,522 VAERS reported side effects, 92% mild, 6·6% serious (non-death)& 1·3% deaths(none from Anaphylaxis-0.025%). From 7.9 million V-safe participants, 1/2 had some AE.

  8. Infants and children do get COVID; all races, 35% w/ comorbidities. CDC study from 99 counties in 14 US states shows betw 3/20 & 2/22 there were 2,637 hospitalized infants & children 0–4 yrs old; 24% went to ICU; there were 18 deaths

  9. Study of 1141 consecutive gouty pts finds 10 (0.9%) with "Shrinking Toes" in those w/ tophaceous gout (usually MTP1,2) - toe shortening mainly due to lytic bone collapse during articular tophus dissolution (esp in severe gout w/ severe erosions)

  10. Disappointment Behind Acute Gout Hospitalizations

  11. Low Dose IL-2 Efficacy in Rheumatoid Arthritis


    Predicting Spondylitis in At-Risk Relatives 


The author has received compensation as an advisor or consultant on this subject

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