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Late Should Not Be Less (11.3.2023)

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

  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.

  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

  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!

  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

  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.

  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.

  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)

  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.

  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

  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

  13. RheumNow Live registration is NOW OPEN! Early bird pricing through 11/30/2023. Register today!


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