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Infections & Lupus (10.28.2022)

Dr. Jack Cush discusses the news and journal reports from the past week on RheumNow. This week more lupus nephritis, more drug induced lupus and more lupus infections that may kill. 

  1. FDA Approves Upadacitinib for Non-Radiographic Axial Spondyloarthritis

  2. PSOAS study of 354 with long-standing ankylosing spondylitis & SI radiographic changes; but 23 lacked syndesmophytes. Lack of fusion was more likely in women & w/younger age of Sx onset. All were B27+, thus B27 may be assoc w/ SI dz, not spinal dz.

  3. Pre and post-COVID-19 assessment of 78 FM pts by Fibromyalgia Impact Questionnaire-Revised (FIQR). While COVID affected FM pts, there was no statistically significant change in FIQR scores (65% had no improvement or deterioration on FIQR)

  4. 1915 Rheumatic (RMD)pts w/ COVID (42% RA. 15% SLE, 1/2 comorbidities); Outcomes: 28% hospitalized, 8% to ICU & 4% died from COVID-19. Poor COVID-19 outcomes seen w/ age, male, Hi Dz activity, steroids & RTX, & 1+ comorbidity

  5. TNF inhibitors Dont Increase Cancer Risk! 4592 RA pts:TNFi Rx (2296) vs matched DMARD Rx (2296) pts. TNFi had a lower cancer risk than DMARD Rx (IR 6.5 vs. 15.6 /1000PYs]). TNFi had Lower HR GI CA (0.432), breast CA (0.146), GU CA (0.220)

  6. Analysis of WHO Safety Vigibase found 625 cases of drug-induced SLE - mostly female (78%), 59 yrs old, w/ half suspecting only PPI. Most common was Omeprazole (30%). Another 800K French database ID 39 pts w/ PPI CLE, half SCLE, 5% DLE

  7. Efficacy of Shingrix Vaccine lasts for 10 yrs. Shingrix was approved in 2017 based on 2 Lg RCTs showing 6 yr. protective efficacy of 97% (ages>50) * 91% (age >70). Long-term F/U shows 81.6% effectfor mean of 9.6 (±0.3) years post-vaccination

  8. RA is an independent risk factor for Thyroid Dz & AITD. Study of 250 RA & 248 non-inflammatory RMD controls. RA had more abnl TFTs (34% v 19%; OR 2.2), Overt hypothyroidism, Anti-TPO Abs, & AITD (21.5% vs 9%; OR 2.8).

  9. Mayo Clinic Biobank  matched case-control study (1:3) of 212 incident RA cases Active work physical activity lowered risk of RA (aOR 3.00), while 3-5 servings high-fat foods, fruits/vegetables lowered risk (OR 0.45; OR 0.54).

  10. Metanalysis of emergency department Rx of opioids for MSK pain - 42 articles, 6128 pts - Short term (2hr) benefits of ED opioids were statistically but not clinically more effective than PBO or Tylenol, but not better than NSAIDs. Safety uncertain.

  11. Predictors of serious infection (SIE) in SLE? A prior SIE conferred the highest risk of subsequent SIE. Study of 346 SLE pts shows SIE rate of 3.8/100 Pt-Yrs. Other risk factors: Damage accrual, comorbidity, Dz activity, CTX use

  12. Infection: a Leading Cause of Death in Lupus

  13. Increasing Risk of Lupus Nephritis A population based study shows that LN in the US has increased in the last four decades and that LN patients have poorer outcomes with high rates of ESRD and mortality rates 6x that of the general population.


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