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Hand OA and Heroes in Rheumatology (2.11.2022)

Feb 11, 2022 12:24 am

Dr. Jack Cush reviews the news and journal articles from this past week in Interesting reports this week about dementia, who gets hand OA and a great list of women Heroes and Pillars of Rheumatology.

  1. Data from 2 phase III studies of psoriatic arthritis using tofacitinib, adalimumab shows that a significant meaningful clinical response is achieved in 29-53 days -- why then are we not making go vs no-go decisions with modern biologics at 6-8 weeks?

  2. CARRA Registry looked at TNFi use in JIA and found a nearly 3 fold increased risk of psoriasis. 8225 pts w/ 3.9 yrs of F/U. 54% recv TNFi; the aHR of new onset of psoriasis after TNFi exposure was 2.93 (2.15 to 3.98). MTX had lower risk (HR 0.45)

  3. Osteoarthritis Initiative study looked at Hand OA. Among 3588 participants, 41% had hand OA by xray and 12.4 % by Sxs. Over 4 yrs, 27.3 % showed Xray OA progression. More in women (DIPs)>men (MCPs), but less in blacks

  4. Scandinavian study of cardiac abnl. in idiopathic inflammatory myopathies showed prolonged QTc abnormalities was more common in IIM pts (16%) & Anti-Mi2, anti-Pl-7, elevated CRP are associated with prolonged QTc (potential biomarkers?)

  5. Among 10,205 admissions for psychosis, 19% were tested for ANA, 15% of those were ≥1:160; BUT ONLY 4 patients met 2019 ACR/EULAR criteria for SLE, & 2 met criteria for Neuropsychiatric SLE - NPSLE prevalence of 1.5% ANA+ psychosis pts

  6. Psychosis is rare in SLE; Retrospective cohort review finds 18/709 SLE or 2.5% developed lupus psychosis. Psychosis remitted in 12/18 w/ a combo of antipsyschotic (in 38.9%) and immunosuppressive (steroid 72%, CTX 56%, RTX 17%, etc)

  7. BMJ reports that dementia is associated with multimorbidity (>2 chronic diseases) in midlife (before age 55 yrs) rather than late life; and greater risk with greater multimorbidity before 55 yrs.

  8. NEJM study of ~2000 persons showed that prior PCR proven SARS-CoV-2 infection was effective at preventing Symptomatic Reinfection against alpha variant (90.2%), beta ( 85.7%), delta (92%), but not omicron variant (56%).

  9. Analysis of nearly 1000 undifferentiated-arthritis(UA) pts show that MRI use is most effective when applied to those who are seronegative or who have oligoathritis.

  10. Retrospective study of 179 antiphospholipid syndr pts, looked at noncriteria findings- their presence incr relapse rates (59% vs 34%;p=0.018) triple positivity & need for Rx. (cytopenias, APS nephropathy, livedo, CNS, Libman Sachs endocarditis)

  11. Women Heroes in Rheum: - Barbara Ansell - JIA - Nanna Svartz - SSZ - Gertrude Elion - Nobel Prize for allopurinol, AZA - Tsai-Fan Yu - gout Rx - Mary Betty Stevens - lupus & vasculitis - Marian Ropes - 1st F ARA president - Fionula Brennan - TNFi & more

  12. Hip fractures in elderly occur at >250 000/YR in US w/ a 1-yr mortality rate, 12%-37%. During COVID-19, surgery volumes among older individuals were lower than 2 years previously starting spring 2020 until vaccine was widely available

  13. Despite guidelines rec against hyaluronic acid knee injections, HA injx by ortho significantly increased from 1,090,503 in 2012 to 1,209,489 in 2018 (p = 0.04) amongst Medicare beneficiaries

  14. Hand Pain Related to Obesity and Inflammatory Markers


    Why Would Hand OA Be Less Severe in Black People? 

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

Rheumatologists’ Comments

Jack, thanks for bringing the commentary of Dalbeth and Neogi from BMJ to our attention. Added to the list of women who have had immense scientific impact on our practice should be a multitude who have had an immense impact on our learning to practice. Among them, Fiona McQueen in NZ and the late Valentina Nazonova of the Russian Federation. (Caldron Paul H, Tartakovsky Igor. Russians Mourn Iconic Rheumatologist:
Valentina A. Nasonova, MD was Renaissance figure in Russian rheumatology.
The Rheumatologist, May 2011. p14-16.)

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