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The Match Game (4.14.2023)

Apr 14, 2023 1:33 am

Dr. Jack Cush reviews the news and journal articles from the past week on, including Rheumatology success in the NRMP MATCH, Cocaine vasculitis and worrisome safety risks with Biologics and tsDMARDs.

  1. 2023 NRMP Match: 365 applicants for Rheum; 97.8% (265 of 271 avail) of Adult Rheum fellow positions matched (only 4/127 programs did not fill their match). Pediatric Rheum 27/41 positions (62.8%)were filled (14/32 programs not filling).

  2. 2022 Doximity Physician salary survey shows that among the least paid specialties; Pediatric rheumatology was #3 at $226k and Adult Rheumatology was #20 at $299K

  3. Olmstead Co. population study: Clinically Isolated Aortitis (CIA) saw 8 cases over 20 yrs; incidence of 8.9 per 1,000,000over age 50 yrs. 6 of 8 were female, mean age 76yrs; all Dx @ ascending aortic aneurysm repair. Having CIA did not affect mortality.

  4. Retrospective study of 42 pts w/ cocaine-induced midline or systemic vasculitis; Current cocaine use common (20/23 + urine tox, including pts who prev. deniedcocaine). Found: septal perfs (75%), oronasal fistula(15%), less(27%) systemic Sxs, 56% PR3-ANCA+

  5. Japanese cohort study shows Lung cancer is more common in males w/ elder-onset dermatomyositis - risk increased by Smoking, anti-TIF1-γ-Abs and elevated MLR (monocyte to lymphocyte ratio)

  6. Retrospective of 28,360 #PsA pts saw more comorbidities by race - AAs had signif. more HTN (59% vs 52%), DM (31% vs 23%), obesity (47% vs 30%) & gout (12% vs 8%); but whites more cancer (20% vs 16%), anxiety (28% vs 23%), OP(14% vs 12%), more biologic use

  7. FDA FAERS study of IL-17 inhib & colitis: 388 pts w/ suspected IL-17i assoc. IBD. Median age - 42 yrs; Initial Sxs= diarrhea 91%, Abd pain 58%, bloody diarrhea 51%), & fever 36%, ^WBC 87%; Time to onset=2.9 mos. Time to remission after IL-17i D/C =4 wks

  8. Probiotic strain Ligilactobacillus salivarius studied in gout (stain w/ ability metabolizes purines). 30 pts w/ hyperuricemia & recurrent gout were given L. salivarius or allopurinol for 6 mos. Probiotic group had less gout attacks (5/15) than controls (13/15).

  9. vit D shows no change in Fx Risk. Study of 20,326 Australians given placebo or vit D3 60K IU/mo. 46% women, age 69 yrs. W/ 5.1 yrs F/U - no effect on Fx risk (HR 0·94; 0·84–1·06). Fx in 5.6% of Vit D vs 5.9% in PBO (non-vertebral, major OP & hip Fxs

  10. Spanish Society of Rheumatology (SER) study finds w/ retirement of many older (male) Rheums; there are workforce shortages. Most (59.7%) of rheums in Spain are women, the majority below age 54 yrs.

  11. April's Therapeutic Update focuses on gender differences in disease states and therapeutic outcomes. Sex Differences in axSpA and PsA, Gender Differences in Vasculitis, and Gender Differences in Counseling Patients on Reproductive Health now available.

  12. Women are 80% of healthcare workforce; 97% of EU nurses & midwives are women- yet women earn 24% less than men & hold 25% of senior roles in the health sector. WHO officials call for equal pay/promotion, better work conditions &gender specific solutions

  13. Why I hire Women

  14. RheumNow Presents Women In Rheumatology: Contract Negotiations

  15. Pain and Opioid Updates   

  16. Clinical Profile of RA-associated Interstitial Lung Disease  

  17. Predictors of RA-ILD include smoking, Dz activity, steroid use and obesity. And MUC5B promoter gene variant @jeffsparks @UTSW_Rheum

  18. Disease activity increases the risk of future RA-ILD. For every one point increase in DAS28, theres a 35% increase risk of RA-ILD @jeffsparks @UTSW_Rheum

  19. Risk of RA-ILD is 15% (or 1 in 6) according to Mayo clinic (Olmstead county) data. @jeffsparks

  20. #RA with ILD portends poor outcomes, especially if seropositive. Visiting professor Dr. Jeff sparks @jeffsparks @UTSW_Rheum

  21. Methotrexate-induced pneumonitis (0.3% risk) is different than RA-ILD. MTX does not increase odds of RA-ILD. @jeffsparks @UTSW_Rheum

  22. RA Patients on Biologics and tsDMARDs are still High Risk 


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