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Hit Parade Review (8.12.2022)

Aug 12, 2022 3:00 am

We've got a lot to discuss this week: psoriasis; fatigue; sleep; sural nerve biopsies; uveitis and SpA; diet and RA; tofacitinib and the ORAL surveillance study; what not to take with mycophenolate - and more. In what order should these items be discussed? This week the run down is based on popularity, measured by rheumatologist engagements on the website and social media. Dr. Jack Cush reviews the news and journal reports from this past week on 

  1. More Bad Safety News for Xeljanz

  2. Prospective study of 189 new non-infectious anterior uveitis pts, found a high prevalence SpA (56%), 93% w/ axial SpA, few (7) w/ peripheral SpA. 74/106 were newly Dx SpA. SpA predictors: psoriasis (OR 12.5), B27+ (OR 6.3),^CRP (OR 4.8) & male (OR 2.1)

  3. Lilly has announced that Taltz (ixekizumab) is now available as a Citrate-Free Formulation to reduce injection site pain for patients with psoriasis, psoriatic arthritis, spondyloarthritis & nonradiographic axial spondyloarthritis.

  4. Should you do sural nerve biopsy (SNB) to Dx vasculitis? Study of 91 pts undergoing SNB suggests the SNB must be off sufficient length to improve Dx yield. 40/91 (44%) showed vasculitis. +SNB assoc w/ longer SNB sample, other organ Sxs & +ANCA

  5. Study of diet & RA in 100 new RA & 197 controls; fish/seafood consumption assoc w/ less RA risk (OR 0.52; 0.27–0.98); but processed meat intake yielded increased RA risk (OR 3.45; CI 1.78–6.68). No significant association btw RA and red meats or poultry

  6. Retrospective study of 99 Henoch-Schönlein purpura (HSP) pts complicated by GI bleeding (61 mild; 38 severe). Severe GIB assoc w/ summer Onset, facial rash, HI D-dimer (>0.89 mg/L) & neutrophil-to-lymphocyte ratio (NLR >10.56).

  7. Do not take antacids or PPI with mycophenolate. Magnesium & aluminium hydroxide antacids (Maalox) will lower MMF Cmax 33% & AUC 17% if given simultaneously. PPI also lowers AUC by ~33%

  8. Of 38 childhood SLE (12-25yrs) pts, 65% were non-adherent to meds. Those taking MMF, 33% had MPA drug level < 1 (nonadherent). 17% non-adherent by pharmacy refills rate. 46% pts c/o side effects; 33% remembering & 25% could not afford.

  9. Fatigue is Under-Appreciated in Psoriatic Arthritis Patient-reported fatigue is high in patients with psoriatic arthritis (PsA) and often goes under-recognized by physicians.

  10. 150 PsA pts assessed preferences in chosing biologics (of most to less preferred): 1 Oral over SC or IV routes 2 Avoiding severe side effects 3 Resume normal activity 4 Avoid infections 5 Improve enthesitis & 6 psoriasis 7 remission 8 Joint pain

  11. CARRA Registry study of Kids who D/C DMARDs or biologics but flared & restarted meds: the recapture rate was 55% overall (47% oligoarthritis, 69% systemic JIA. By 12 mos 67% of children achieved inactive dz - better odds w/ restarting biologics (OR 2.74)

  12. Population study of 28,756 individuals shows cognitive function is linked to sleep duration. Those with low (≤4 hrs) or excessive ( ≥10 hrs) sleep showed statistically significantly cognitive decline than reference group (7 hours per night)

  13. Study of >1million people/17 countries shows prevalence of NAFLD (fatty liver) to be 32·4% - higher than prev estimates & growing fast rate. Prevalence increased from 25·5% (2005) to 37·8% (2016); NAFLD incidence is 46·9 cases per 1000 person-years

  14. CDC Reviews Monkeypox - 99% men, 94% male-to-male sexual contact; less prodrome; rash (100% including genital), fever (63%), chills (59%), and lymphadenopathy (59%)

  15. Increased Mortality in Giant Cell Arteritis 

  16. Cytomegalovirus Increases Thromboembolism Risk in ANCA-associated Vasculitis 


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