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"Don't You Know Who I am?" (5.17.2024)

Dr. Jack Cush reviews the news and journal reports from the past 2 weeks. This week's question: can we prevent gout, ILD or psoriasis?

  1. A unique study in military medicine of 1.5 million ED visits reveals the dynamics of high-rank and high-power patients and doctors, and the care they get/provide
  2. Single center EHR study of 5 064 pts w/ pre-diabetes compared those starting metformin (1154) vs 13 877 non-users w/ ~4 yrs F/U. Incidence of future gout was lower w/ metformin use (7.1 vs 9.5/1000PYs; HR 0.68); with no change in SUA or CRP
  3. National French study finds post COVID Vaccine the IR of PMR (179 cases; RR 7.1/mill) & GCA (54 cases; RR 2.1 /million) were reported 7-10d post vax. These #s are below population incidence rates (1-20/mill for GCA)
  4. Retrospective, cross-sectional study from the Osteoarthritis Initiative (OAI), 2607 pts (age 64yrs; BMI 28.5). After 48 mos regular bicycling yielded signif less knee pain (HR 0.83), Xray OA (0.91) & Sxs OA (0.79), Encourage Bicycling!
  5. Since 2010, use of RTX has increased & AZA decreased in GPA/MPA. French national insurance study of 977 GPA/MPA in 2010-12 vs 1131 GPA/MPA in 2014–2017 saw incr RTX, decr AZA, but stable use MTX, CTX, steroids over time
  6. Retrospective cohort study compared 5825 #AS pts vs 28,356 matched controls; showed an increased risk of pulmonary embolism w/ AS; not present pre-Dx ((0.4% vs 0.2%), but incr post-AS Dx (PE IR 11.6 vs 6.8/10KPY: adj HR 1.70;; p<0.001)
  7. In animal models, IL-22 may have protective effects against pulm fibrosis. Study of 66 new #RA pts (1/2 w/ ILD) & 14 controls. Serum IL-22 was signif lower in RA-ILD; and was inversely correlated with the severity of RA-ILD
  8. MGH study compared 1148 acute CPPD vs 3730 controls (mean 73 yrs) found 2 fold more fractures (mostly wrist); 11.7 vs 5.5/1000 PYs (HR 1.8) in pseudogout pts (also had more steroids & OP)
  9. RISE study of 700 Pegloticase users (14 mos F/U) found 18% on immunosuppressive (MTX, MMF, LEF), these had signif less PEG D/C (HR 0.52-0.69). Immunosuppressives not assoc w/ more lab abnormalities
  10. 2023 Top 3 paper from JAMA Derm - 122 plaque psoriasis pts (mild-mod w/ PASI=3.1) & low vit D levels (~14.9), Rx w/ PBO vs vit D 20 000 IU/wk x 4 mos during winter; no signif vit D Rx benefit for PASI, MD global, DLQI or 25-OH levels(< than expected)
  11. PI states risk of GI Perforations (GIP) incr w/ IL-6i (1.1--2.6/1000PYs) & JAKi (~1-2/1000PY) . French Insurance pop. study of ~40K pts on JAKi or adalimumab found NO no signif difference betw JAK v ADA (IR: 2.1 vs 1.1/1000PYs; p=0.65).
  12. CD19 is not expressed on Plasma Cells or Plasmacytoid dendritic cells. Yet, Selective CAR-T cell mediated B cell depletion suppresses interferon signature in SLE !!
  13. Risk Factors for Hydroxychloroquine Retinopathy 

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