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Indications Awaiting (12.17.21)

Dec 17, 2021 12:42 pm

There's good news and bad news in rheumatology fellowship matching for 2022.  There's also new FDA approvals and indications, but a new serious safety warning has arisen from the CDC about the J&J COVID-19 vaccine. 

Dr. Jack Cush reviews the latest news, journal reports, regulatory approvals, plus 3 new cases from rheumatologists.

  1. NRMP has released match results for adult Rheumatology programs. From a total of 125 programs, 120 filled & 98% of Rheum slots (266/272) filled. Rheum was one of few to fill >95% slots (also Allergy, cardiology, Endo, GI, Hem/Onc, Pulm/Critical Care
  2. NRMP announced match results for Pediatrics & Specialties. Unfortunately 31% of positions are unfilled (40% programs unfilled). We need more Pediatric Rheumatologists!!!
  3. RESTORE trial: yet another failure for PRP injections for knee #OA. Study of 288 Knee oA over 50 years - knee pain scores of −2.1 vs −1.8 on an 11-point scale (range, 0-10) and no difference between PRP and PBO at 12 mos
  4. CV mortality with infection & inflammation studied using CDC database; From 1999 to 2018 CV mortality decreased in general population (40.9 to 30.6%) but increased w/ HCV (7.0 -10.2%) & HIV (1.9 to 6.7%); decreased in plateaud in IBD, PSO, RA, and SLE
  5. Telemedicine? Surveys (patients=1340, MD=111) & interviews (pts= 31, MD= 29) April 2021 and July 2021. Results suggest pts and MDs prefer F2F over Telemedicine almost all categories. Some negatives may be due to the pandemic
  6. Cochrane analysis of NSAIDs in acute #Gout - 28 trials, 3406 pts showed: - NSAIDs > PBO 50% pain reduction @24hrs, but = to PBO for AEs & W/D - nonselective NSAIDs = COX-2 inhib, but former has more AE & WD - PRED - NSAIDS, but pred has more AE & WD
  7. Study of 408 men with inflammatory arthritis fathered 897 singleton pregnancies with 794 live births. Pregnancies conceived after the diagnosis of IA had higher rate of miscarriage (12.3 vs 7.5%, p = <0.05), even after adjusting for confounders (OR 2.03)
  8. Increased risk death in 310 scleroderma pts: 63 diffuse SSc, 279 limited dz & 33 sine scleroderma (SMR = 1.88). Reduced survival at 10 yrs (78%) & 15 yrs(61%). 69 deaths, 46% in diffuse PSS - due to ILD, PHA, and GI involvement
  9. NYC Hosp for Special Surgery is the 1st to use a "smart" knee arthroplasty - TKR with a smart sensor capable of monitoring steps, speed, range of motion & other knee functions fed back to the orthopedist = called Persona IQ, FDA authorized
  10. Fibromyalgia pts are prone to suicidal ideation (29.6%; OR 9.1), attempts (5.7%; OR 3.1), & events (OR 1.38), but significance lost when correcting for psych illness. Risk assoc w/ work, dz severity, obesity, addiction, chronic pain & co-morbidities.
  11. SOBI has received a positive opinion by the EMA's CHMP on Kineret (anakinra) for the treatment of COVID-19 in adult patients with pneumonia requiring supplemental oxygen or at risk for progressing to severe respiratory failure. Final approval pending
  12. BMS announced today that Orencia as 1st FDA approved drug to prevent acute graft versus host disease & may be used in bone marrow or stem cell transplantation from an unrelated donor. (Based on 186 pt RCT w/ Orencia showing better survival (98 vs 75% PBO)
  13. Tofacitinib 1st JAK Inhibitor Approved for Ankylosing Spondylitis
  14. Rinvoq FDA Approved for Active Psoriatic Arthritis
  15. CDC Panel Recommends mRNA COVID Vaccines Over J&J Vaccine
  16. Ask Cush Anything #ACA  Questions and cases from Rheumatologists! 
  • Dr. Joe Thomas: RA, JAK inhibitor and What to do with H. Zoster infection?
  • Dr Nayef Alghanim: Management of Pulmonary Hemorrhage in SLE
  • Dr. Srinath  Bathula – Triple Positivity in SLE - anticoagulate or not?
The author has received compensation as an advisor or consultant on this subject

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