The Inflammation Reflex (5.20.2022) Save

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. This week, neuroimmunology leading to therapy, the cold shoulder approach and Regulatory updates from the FDA.

1. Bimekizumab Development Delayed by FDA

2. Ontario population study shows that musculoskeletal disorders account for 12.3% of all adult emergency dept. visits and 28.5% outpatient physician visits https://bit.ly/3G2psib

3. From 4 Nordic Registries, 24083 RA patients starting 41K courses of bDMARDs shows RA patients had an 80% higher risk of acute coronary syndromes than in the general population. ACS risk on bDMARDs did not improve at 3yrs or 5 yrs https://bit.ly/3NqN3eQ

4. Local cryotherapy in adjuvant-induced arthritis in rats given bid resulted in lower arthritis scores, structural damages, less vascular inflammation/endothelial activation (less mRNA CXCL-1, IL-6, IL-1β, leukocyte infiltration, lower IL-17A and OPG https://t.co/b4cAa9E4PJ

5. RCT (WBC) whole body cryotherapy (-130C x 3 min; 6 WBC in 14 d) in 56 RA pts. Pain at 2 wks was signif better in WBC than controls (-2 vs -0.88 ; p=0.003) & remained lower x 12 weeks (w less pain meds); Dz activity & Function improved but not signif @wk 12  https://t.co/K7a7CQ7rGj

6. Israel study of 171 kids w/ MIS-C (med age 8 (5-12): Dx#s - 59 during Alpha , 79 Delta , & 33 Omicron waves. All Rx w/ IVIG + steroids. 6-15% prev recv COVID VAX, none ICU admitted. Worse Dz & higher incidence during alpha wave (54.5/100K) https://bit.ly/3sLjo8b

7. SARS-CoV-2-infected alveoli (specifically N protein-coding plasmid alone) induces IL-6 production. Also, COVID-19 Sera also induced IL-6, moreso in those w/ severe disease. anti-N Ab promotes IL-6 production & may lead to cytokine storm  https://t.co/FwIs11i2qc

8. FDA has approved baricitinib (Olumiant) for the Treatment of Certain Hospitalized Patients with COVID-19 who require supplemental O2, mechanical ventilation, ECMO. Rec dose: 4-mg once daily for 14 days or until hospital discharge https://t.co/RiEp01tc0v

9. 24 week, Phase II RCT of baricitinib in 314 active #SLE patients showed significant reductions in levels of dsDNA, IgG, Sm & ACL Abs; but had no effect on C3/C4, RNP, SSA, SSB. Changes in dsDNA did not correlate with SRI-4 responses though. https://bit.ly/3FSWXmF

10. Differential diagnosis of dysphagia - when due to autoimmune dz is called Autoimmune neurogenic dysphagia - causes include inflammatory myopathies, inclusion body myositis, myasthenia gravis, Guillain–Barre, MS, NMO, paraneoplastic neuropathies  https://t.co/58MyQwmxhL

11. Large Granular Lymphocyte Leukemia rarely assoc w/ #RA. LGL accounts for 2-5% of lymphoprolif. disorders; often assoc w/ Autoimmune Dz (mostly RA). RA w/ LGL presents with leukopenia, anemia, splenomegaly, onset after mean 6 yrs of RA https://t.co/AIz2edHDXp

12. Multimorbidity Burden in Rheumatoid Arthritis Crowson and colleagues at the Mayo Clinic have shown that rheumatoid arthritis (RA) patients have a higher prevalence of multimorbidity with as many as 44 different morbidities of interest in RA. https://t.co/vgC1dCA7kZ

13. Inflammatory Arthritis Spread by ATP and Neural Crosstalk 

14. Rising Incidence of Systemic Lupus Erythematosus 

15. RNL22: STEP talk by Dr. Uma Mahadevan - How Stopping Drugs in Pregnancy Leads to Greater Harm

16. ASK CUSH ANYTHING – NP and PA’s – record your question or case  

17. TNR 5/24 RA Best Management – Register for the webinar or watch our live stream (Youtube, Twitter or LinkedIn) – lectures from Drs. Janet Pope, Elena Myasoedova and Karen Costenbader