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Methotrexate Nodulosis (1.19.2024)

Dr. Jack Cush reviews the news and journal reports from this past week on How good (or not) are rheumatologists and what to do about MTX nodulosis?

  1. Network meta-analyses of 153 trials & 8713 patients w/ chronic pain from TMJ disorders; Most effective (pain & function) were CBT, PT-assisted jaw mobilisation, trigger point injx, jaw exercise/stretching, manipulation, & acupuncture

  2. Burnout! A cross-sectional study of 3024 US physicians, 60% took <=3 weeks of vacation per year, and 70.4% worked while on vacation on a typical vacation day; both findings were associated with higher rates of burnout.

  3. Data from the American Rheumatology Network (2014–2021) shows that among 15182 new TNFi initiations, only 45% had a dz activity measure (CDAI/RAPID3); and of these, only 47% had a TJC, SJC or pain score. Can you treat HTN without measuring BP?

  4. Mayo study shows multimorbidity in RA increases serious infx (SI) risk; 911 RA pts (56 yrs, 2/3 seropositive) 17% had SI (3.9/100PY). Hi risk morbidities(bipolar Dz, CKD, COPD,, chr skin ulcers) were assoc w/ 3 to 5-fold increased SI risk

  5. Japanese retrospective study compared RA pts on JAK inhib vs bDMARDs (n=62 ea) having orthopedic surgery; JAKi- pts had more postoperative flares (29% v 12%, P=.01), esp if JAKi held >11d (p.04). No diff in other postop complications

  6. Increased CV Comorbidity in Dermatomyositis A cohort study suggest that patients with dermatomyositis (DM) are at an increased risk for multiple comorbidities, including chronic kidney and cardiovascular disease,

  7. While NSAID use has been assoc w/ lower risk of cancers (CNS, breast, esophageal, gastric, head & neck, hepatocellular, cholangiocarcinoma, colorectal, endometrial, lung, ovary, prostate, pancreatic); NSAIDs should not be used to prevent cancers

  8. Retrospective study of 170 #RA on TNFi (Inflx 53%, ADA 28%, CZP 19%). RF, CCP, Drug levels, anti-Drug Abs done.@6 mos HI baseline RF linked to lower drug levels for IFX & ADA; but not CZP. IFX/ADA Hi-RF pts had more dropouts vs CZP (80%/75%/33%, p=0.002)

  9. Metanlysis of 49 studies, 10 RCTs examined the relationship between RA and non-surgical Rx of periodontitis (NSRT) and in general short term studies show that NSPT benefits RA patients; and DMARD therapy benefits periodontitis

  10. Insurance claims data compared 33k RA to 1079 PM/DM pts and showed overall lower use of statin R in PM/DM (27% vs 181%, p<0.0001). But if DM/PM-HLD pts used statins they had lower mortality rate than non-users (HR = 0.515, p = 0.0273)

  11. Rheumatologists and the Early Diagnosis of Spondyloarthritis 

  12. Drug-Induced Dermatomyositis

  13. Florida Approves Import of Drugs from Canada

  14. Prior Authorizations

  15. Ask Cush Anything - Dr. Ronan Kavanaugh - Methotrexate Nodulosis?


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