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How Often Do You Monitor MTX? (6.16.2023)

Dr. Jack Cush reviews the news and journal reports from this past week on, including new drug approval, a new SpA variant and new rules for methotrexate (MTX) monitoring and depression screening. 

  1. 519 pts in the Hand OSTeoArthritis in Secondary care (HOSTAS) cohort studied & 17% had prolonged morning stiffness (>60 min); mild in 30%, intermediate in 37%, severe in 18% and extreme in 4%. Assoc w/ more pain, worse function and QOL

  2. Metanalysis of 62 RCTs, 16 LTEs of JAKi, placebo, TNFi, & MTX Rx pts shows that malignancy incidence rate =1.15-1.26/100 Pt-Yrs. Neoplasia risk w/ JAKi = PBO or MTX risk (IRR 0.71 & 0.77); but JAKi CA risk if compared to TNFi (IRR 1.50;1.16 to 1.94)

  3. #RA pts at increased risk of gastroparesis (GP). From 2012–2014 National Inpatient Sample database; among 1.5 million RA, 1070 hospitalized for GP (OR 1.36; 1.24 to 1.49,P< 0.0001). GP risk incr by aging up to 65 yrs, DM, RA, income 26-75th percentiles

  4. Bimekizumab (Bimzelx) has been EMA approved to treat adults with active PsA & axial spondylarthritis in the EU. This dual IL-17 A/F inhibitor is approved to treat moderate -severe plaque psoriasis in the EU, Canada, UK & Japan; but not yet in USA

  5. Report of 54 nonradiographic axial SpA pts w/ recurrent fever. Fever preceded SpA in all; age @ axSpA Dx 39.9 yrs, w/ Dx delay 9.3 yrs. Fevers 38-42°C, arthralgia 61%, myalgia 44%, arthritis 41%, GI 25%, Rash 22%. Best Rx to TNFi > IL1i, colchicine, DMARD

  6. Study of 2883 pediatric patients with Hidradenitis Supprativa (HS), finds a higher risk of Crohns disease - 0.69% of HS and 0.17% of control patients developed CD (OR 4.90, 3.07-7.84; P < .001) higher in patients with HS than in control patients.

  7. Karolinska SARA (secretory antibodies in RA) study of 132 RA pts found salivary IgA anti-RgpB Abs signif higher in RA than (p = 0.022), & were assoc w/ disease activity (p = 0.036), but not with periodontitis or serum IgG ACPA.

  8. Swedish registry study shows of 3629 children born to mothers with RA#, 70 (1.94%) were diagnosed with Autism Spectrum disorder (ASD). If RA was dx before delivery, an increased risk of ASD (HR = 1.43), especially for seronegative RA (HR = 1.61)

  9. High Mortality Rates with Depression in Rheumatoid Arthritis

  10. Why Depression Screening Should be Mandatory at Each Visit

  11. Study of 162axSpA pts found that 46.6% reported abnormal sleep behavior, worse in Female patients vs males (P <.001). Such pts were more likely to have depression (P = .015) and worse health-related QoL (HRQOL) (P = .015)

  12. Time to Risk Stratify Methotrexate Lab Monitoring?


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