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The Great Unknowns (8.5.2022)

Aug 05, 2022 5:00 am

Dr. Jack Cush reviews the news, FDA approvals, journal articles from the past week on RheumNow; plus viewer questions. This week great hopes for vitamin D, the great unknows of CSA and the great big mess that is the gout.

  1. 521 clinically suspect arthralgia (CSA) pts were assessed - Low educational attainment was associated with increased risk of developing inflammatory arthritis (HR = 2.35), independent of BMI & smoking

  2. Sex & gender differences in PsA? Females: more likely to have Peripheral arthritis, have more pain, fatigue, poor function, lower QOL and less likely to have xray damage (than men) Males: more likely to have axial dz and severe psoriasis PsA Women may need more psycho-social support, job modification & pain management

  3. Evusheld works & reduces COVID-19 by 77%; yet only 25% of available Rx has been used. Its FREE to the ~7000 immunocompromised pts who might benefit from it. Repeat doses (300 mg) every 6 mos! Time to jump on this!

  4. In the RECOVERY trial - 8156 hospitalized COVID-19 patients; those on baricitinib had significantly fewer deaths (12% vs 14% PBO) but the size of benefit was somewhat smaller than that suggested by previous trials. (adjusted rate ratio 0·87)

  5. Biosimilar availability is slow coming in US (only RTX, Inflx), but by 2030 these rheumatologic biologics should be available as biosimilars: - rituximab - infliximab - adalimumab - etanercept - golimumab - abatacept - tocilizumab - ustekinumab – denosumab

  6. Supplemental Vitamin D Fails to Lower Fracture Risk NEJM has published study results showing that vitamin D3 supplementation does not significantly lower fracture risk (vs. placebo) when used in generally healthy adults.

  7. Study of Erythrocyte MTX-polyglutamates (MTX-PG1-5) levels in Crohns patients shows that age, lower GFR and subcutaneous #MTX use all significantly increase RBC MTX-polyglutamate levels (all risk factors for MTX toxicity)

  8. Study of 57 #RA pts. w/ ILD treated with abatacept. Lung progression in 46% before ABA. After median 27 mos of follow-up, ILD - 72% improved or stabilized - 23% worsened - 5% died. No significant change in FVC, DLCO ILD worse assoc w/ DAS28, FVC DLCO

  9. Risk of incident & recurrent H.Zoster higher after tofacitinib - Korean claims analysis of 11,720 seropos. RA pts Rx w/ bDMARD or tofacitinib (2011-19). 14% got HZ. Compared to other biologics (ABA), Tofa incr HZ (HR 2.5) & recurrence (HR 3.69)

  10. Oral surveillance - tofacitinib vs TNFi in high risk pts: more infections, serious infection (SIEs) & non-serious infx with Tofa vs TNFi. SIE risk 17%-48% higher; SIE higher w/ high dose Tofa, esp in pts aged≥65. Usual risk factors - age, pred, comorbid.

  11. FDA has approved a topical PDE4 inhibitor Roflumilast (Zoryve) a 0.3% cream for use in Plaque Psoriasis (Age 12 and Older)

  12. The FDA has extended its indications for ustekinumab (Stelara) for use in pediatric psoriatic arthritis aged 6 years and older. Pediatric PsA makes up 6% of all pediatric inflammatory arthritis pts.

  13. Upadacitinib (Rinvoq) Approved by European Commission for use in adults with active Non-Radiographic Axial Spondyloarthritis - 15 mg qd p.o. Approval based on Phase 3 SELECT-AXIS 2 nr-axSpA trial published in Lancet

  14. Upadacitinib in non-radiographic Axial Spondyloarthritis The janus kinase inhibitor, upadacitinib, has been shown to significantly improve the signs and symptoms of nr-AxSpA, extending the efficacy of UPA beyond classic ankylosing spondylitis.

  15. Gout Flares Up Cardiac Risks 

  16. Krill Oil Effective in Knee Osteoarthritis


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