Intrathecal Methotrexate for Cerebritis (3.31.2023)

Jack Cush, MD

Mar 31, 2023 6:00 am

Dr. Jack Cush reviews the CV advantage to walking, the OA risk with running and the eczema-OA connection; these articles and journal reports from the past week on RheumNow.com.

RCT shows vitamin D does not improve psoriasis. 122 mild PSO pts (PASI=4) w/ mean low vit D levels 14.9 ng/mL; randomized to vit D (20KIU/wk) or placebo. At 4 mos, vit D levels rose to 30 w/ Rx, but no signif improvement in PASI change, MD global or DLQI https://bit.ly/3lOlWlT
199 psoriasis Pts Rx w/ MTX monotherapy. Drug survival at 1, 2, & 5 yrs was 47, 36, & 29%; Avg MTX duration was 10.1 mos. Discontinuation mostly for AE (39.2%), ineffective (38.5%), PSO remission (12.2%). Durability best w/ ^age & dose >15 mg https://t.co/zKP0QCDzE2
Small trial of MTX vs Apremilast in PsA from India. OL, MD blinded RCT of 31 pts (26 completed). 15 APR vs 16 MTX (had more enthesitis, dactylitis); wk 24 responses favored MTX for major cDAPSA (37% vs 20%; p=0.4), ACR20 (56 v 47%;NS) w/ no diff in AE https://t.co/KIItKgCq4w
Bimekizumab in Hidradenitis Supprativa (HS) - results of 2 phase III BE HEARD I & II trials show Week 16 50% HS Responses to be 48% and 52% (vs PBO 29% and 32%). >75% maintained response out to wk 48; at wk 48, a 75% HS response seen in 55%. https://bit.ly/3zhrpVl
Single center study of 320 Difficult to Rx RA (D2TRA) pts, found 76 EULAR-D2TRA pts (24%). D2TRA more likely to be lower socio-economic, RF+, have ILD, higher DAS28-CRP and were more likely to respond to rituximab and JAK inhibitors https://t.co/aEvP6WDvQu
30 consecutive seropositive (CCP or RF+) early RA pts - 60% had pulmonary abnormalities (PA). PA correlated with presence of neutrophil activation, parameters of inflammation and RF titres. https://t.co/T7CRLzhOMD
386 pts w/ NPSLE (cerebritis); half (194) were Rx w/ intrathecal MTX+dexamethasone(iMTX); iMTX grp had higher SLEDAI (17 vs 14) & more pulse IV steroids (72% vs 50%). iMTX grp had better survival & NPSLE remission((P=0.042); best w/ ^CSF protein or SZ https://t.co/JsqUrYEwTK
Study of 28,544 gout pts examined fracture risk based on achieving T2T w/ urate-lowering therapy (ULT). The 5 yr risk of hip Fx was 0.5% in those achieving target SU level, but was 0.8% for not achieving SUA target (HR 0.66; 95% CI: 0.46 to 0.93). https://t.co/Yw2zOS0g2v
NHANES US population survey of 3101 adults (age 50yrs) wearing accelerometer in 2005 - looked at mortality in 2019. Compared to non-walkers (<8000 steps), mortality signif lower for walkers (> 8000 steps) 1-2 days/wk (−15%) or 3 - 7 days/wk (−16.5%) https://t.co/o8ved3gfsW
Study of 3804 runners from 2019, 2021 Chicago marathon looked at assocn betw marathons running and arthritis. Prevalence of hip / knee arthritis was 7.3%. Hip/Knee OA was assoc w/ prior injury/surgery, older age, FamHx, & BMI (not #marathons, mileage) https://t.co/P91dR9kSgY
Autoimmune-Rheum Dz (AIRD) flares occur in 10% w/ COVID vaccination, esp in pts w/ comorbidities, autoimmune morbidities & mental health disorders & Moderna vaccine. 3453 AIRD pts who recv Vax 9.5-11.3% had clinical flares (Arthritis 62% & fatigue 59%) https://t.co/RCtQnA9vc9
Atopic Disease Increases Osteoarthritis Risk
April 2023 – Women in Rheumatology: The XX Factor