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The Inflammation Reflex (5.20.2022)

May 20, 2022 1:29 pm

Dr. Jack Cush reviews the news and journal reports from the past week on 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

  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

  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

  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

  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)

  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

  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

  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.

  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

  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

  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.

  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

The author has received compensation as an advisor or consultant on this subject

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