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Methotrexate Monitoring (5.13.2022)

May 13, 2022 3:21 pm

Dr. Jack Cush reviews the news and journal reports from the past week on Bad news for digitial ulcers in Systemic sclerosis, Readmissions in Lupus and Thrombocytopenia in APL patients.

  1. Risk factors for readmission among 132,400 #SLE hospitalizatiions included young SLE, AIHA (OR 1.86) Glomerular Dz (OR 1.41) pericarditis (OR 1.4), CHF (OR 1.38), Medicare (OR 1.2), Medicaid (OR 1.26). Most Readm Dxs were Sepsis, CHF, SLE and pneumonia

  2. Study of 218 primary APS w/ Thrombocytopenia in 74 (34%) - such pts had signif. more visceral venous thromboses (13.5% vs. 3.5%), hemolytic anemia (27% vs. 12%), low C3/C4 (26% vs 11%), & higher pregnancy morbidity (HR 8.0, p = 0.0006)

  3. Systemic Sclerosis patients with Digital Ulcers used significantly more healthcare resources per year. Study of 104 SSc pts; w/ DU's had more severe disease, more tests, More HCP/Rheum visits, etc (p˂0.05)

  4. Early inflammatory arthritis pts (n=35,807; 86% White & 5,164 ethnic minority). Whites & minorities were equally seen by rheum <3 wks & started on Rx < 6wks, minorities had less remission @3 mos (OR 0.79) or recv MTX 1st or steroids(0.68-0.63)

  5. Lumbar spinal stenosis affects 103 million worldwide (11% of older adults in US). 1st line Rx is activity modification, analgesia, PT. Benefits of epidural steroids havent been established. Decompressive surgery only for selected pts w/ pain & limitation

  6. NEJM has published results of 2 phase 3 trials (BRAVE-AA1, BRAVE-AA2) demonstrating the efficacy of Baricitinib in adults with severe alopecia areata - BARI was superior to placebo in hair regrowth by week 36

  7. Small RCT 39 pts with new PMR given tocilizumab or placebo. Steroid-free remission at wk 16 was 64% on tocilizumab (63.2%) and 12% placebo. Mean time to first relapse was shorter with PBO (82 vs 130days). 5 SAE PBO, 1 TCZ

  8. Evobrutinib, selective oral BTK inhibitor, has been studied in >1083 pts in phase 3 RCTs of RA, SLE, MS; shows well tolerated, most common AE ≥5% UTI (9.5%), nasopharyngitis (7.3%), diarrhea (6.2%), transient ^LFTs, SIE rate 2.72/100 PYs

  9. Prospective randomized trial of ultrasound-guided genicular nerve block (GNB) vs physical therapy (PT) in 102 pts chronic knee #OA - GNB was superior at walk distance, pain, functional and physical capacity, at 12 weeks

  10. Can You Reduce Frequency of Methotrexate Monitoring? 

  11. ASCORE: Seropositivity Favors Abatacept Drug Survival

  12. Diagnostic Delays in Spondyloarthritis Still Prolonged     


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

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