Late Should Not Be Less (11.3.2023) Save

Dr. Jack Cush reviews the news, journal reports and regulatory approvals from the past week on RheumNow.com.

1. Study of LATE-onset RA (>65y), shows DMARD initiation is low in LORA;  despite current clinical practice guidelines recommending early aggressive Rx. Among 3,373 LORA pts (age77 yrs),  only 29% initiated on a DMARD. https://bit.ly/47dT6x6

2. 256 Early RA pt cohort followed 10yrs showed SDAI sustained remission(n 48) had less 10 yr Xray progression (mTSS 4.06), vs sustained LDA (14.6) or MDA/HDA (21.04). Sustained remission pts were younger, lower HAQ & mTSS scores; less need for GC & bDMARDs https://t.co/92L7RTCx82

3. Study of TNFi tapering in 108 axSpA patients in remission. Gradual tapering over 2 yrs resulted in flares in 99% (108). - 27% flared at 2/3 dose - 20% at 1/2 dose - 27% at 1/3 dose - 25% w/ discontinuation WHY WOULD YOU DO THIS? I DONT! https://t.co/mIJKaK3LK5

4. Analysis of German RABBIT registry did not show more MACE events in pts w/ JAK inhibitors compared to other DMARDs. 154 MACE w/ 14203 Rx episodes (21218 Pt-Yrs). IRs were 0.68 JAKi, 0.62 TNFi, 0.76 bdMARDs and 0.95 csDMARDs; higher in CV risk pts https://t.co/2UZh4zQFEM.

5. FDA has approved secukinumab (Cosentyx) for use in adults w/ moderate to severe hidradenitis suppurativa. Recommended dose is 300 mg SC @ wk 0, 1, 2, 3 and 4 and then every 4 weeks thereafter. https://t.co/Pi6RbDbroG

6. FDA has approved Abatacept to Treat Juvenile Psoriatic Arthritis (JPsA) in patients aged 2 to 17 years. (JPsA) in patients aged 2 to 17 years. This expands the current indications for ABA use in RA, poly JIA, PsA, and GVHD. https://t.co/eAc8Dsyc3b

7. Metanalysis of 26 studies (2252) pts w/ HBsAg-/HBcAb+ RA treated with b/tsDMARDs, shows the pooled HBV reactivation rate was 2.0% HBV reactivation higher w/ RTX (9%), ABA (6%), JAKi (1%); none w/ IL-6i or TNF-i More reactivation if pt is HBsAb- (OR=4.56) https://t.co/fSqvkEGbw3

8. Analysis of the NOR-DMARD registry and Vienna #RA cohorts provided novel definitions for an RA flare, requiring an increase of -4.7 on the SDAI or -4.5 on the CDAI Flare definitions correlated with functional and Xray outcomes. https://t.co/f2G2nYyyWT

9. JAMA Review of Knee Pain: - 5% PCP visits for knee pain: - Knee #OA: 654 mill worldwide, mostly >45 yrs age - Patellofemoral OA: < 40 yrs age; Sx: ant knee pain w/ squat - Meniscal tears: 12% adults < 40 yrs; dx by McMurray test & joint line tenderness https://t.co/kf1OOiwIR4

10. H. Zoster Subunit Vaccine Efficacy with JAK Inhibitor Therapy

11. Optimal Management of de Quervain Tenosynovitis

12. Ask Cush Anything

    • Dr. madan padmajan MTX with food

    • Dr. Mazen Al Zo'ubi – ANA, dsDNA no Sxs

    • Dr. Christian Dequet: LV imaging in GCA

    • Monika Mohan MD - Paxlovid and RA pain

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