Fever, FROST, & Pericarditis (12.16.2022)

Jack Cush, MD

Dec 16, 2022 8:00 am

Dr. Jack Frost reviews the news, and journal articles from the past week on RheumNow and ends with an audience question on "Macro-CK".

During 2021–22 FLU season, 6% of hosp pedi-influenza pts had SARS-CoV-2 coinfection; these required more respiratory support. Risk of influenza death augmented by not recv vaccination (flu or covid), no antiviral Rx, comorbidities & coinfx w/COVID https://t.co/bfjeClHflW
Study of 172 febrile pts w skin rash + arthralgia; 112 Dx w/ #AOSD. Use of a "streamlined diagnostic process (looking @ neutrophilia, hyperferritinemia, high IL-18), shortened Dx time (2 vs 4 wks), earlier Dx and more remissions (85% vs 68%, p < 0.05) https://t.co/MSMq2XLeYA
Small, open label study of 43 RA pts Rx w/ csDMARDs randomized to denosumab or PBO x 24 weeks. Erosions of MCP 2,3 assessed by HR-pQCT shows no significant differences in erosions or safety signals at 6 mos between groups. https://t.co/AuysVPFD4S
Swedish study of 4033 incident RA vs 6485 controls - Exposure to occupational inhalable increased risk ACPA+ RA (OR 1.25). Occupational inhalable agents plus smoking and shared epitope markedly elevated risk (OR 18.22) esp in ACPA+RA https://t.co/4lKLEhkURm
Retrospective study in RA shows Red cell distribution width (RDW) & absolute lymphocyte count (ALC) predict 10 yr mortality (P < 0.001); highest with both high RDW and low ALC. Data developed on 327 VA RA pts & validated on national cohort (13,914) https://t.co/aBGECUfKGH
FROST study (First-line options sJIA Tx) - a prospective study to assess treatments in SJIA. 86% Rx w/ biologic (IL-1/IL-6 i) & 14% non-biologic Rx. oral GC used in 54% biologic & 90% of non-biologic. 1/2 non-biologic went onto biologics w/in 4 mos. https://t.co/8TMpEPgzOr
73-87% of autoimmune (RA, SLE, UCTD, APL) pts used HCQ during pregnancy. HCQ significantly reduced pre-eclampsia (20% vs 9%), early-onset pre-eclampsia (8% vs 2.5%), 2nd/3rd trimester pregnancy loss (3% vs. 0.6%) https://t.co/KrA3XtGNmK
Review of the Rheumatic causes of Pericarditis and their management. Causes: SLE, RA, MCTD, Myositis, EGPA, GPA, IgG4-rel Dz, FMF, TRAPS, CAPS, AOSD, JIA, Sarcoidosis, Kawasakis, GCA, Takayasu's https://t.co/h6zpTOIuyu
From a cohort of 689 SLE pts, prevalence of lupus pericarditis was 16.4% Pericarditis was signif assoc w/ renal dz (p 0.003), lymphopenia (p <.0001), thrombocytopenia (p 0.004), +APL Abs (p = 0.002) https://t.co/BndDu21aXF
Syphilis has risen 5 fold since 2001, 38 992 cases, or 11.9 per 100K in 2019. The USPSTF recommends screening in persons at increased risk. Most labs rec “reverse sequencing” w/ automated treponemal test (eg EIA), instead of RPR or VDRL1st https://t.co/vL2rkP2rO1
Inflammatory Arthritis and Hidradenitis Suppurativa Aa 2021 meta-analysis of 7 studies (200,361 HS patients and 385,599 controls), showed that HS patients have an increased risk for inflammatory arthritis (OR 3.44; 95% CI, 1.92–6.17) https://t.co/JQqosM26fZ
Marginal Benefit with Diet and Exercise in Obese Knee Osteoarthritis Patients
Ask Cush Anything - What to do with Macro-CK elevations? (Dr. Howard Van Gelder)