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Naysayers & Disrupters (3.22.2024)

Dr. Jack Cush reviews the news and journal reports from the past week - including a few contrary reports on infection, seropositivity and plasmapheresis.

  1. 1st trimester exposure to Plaquenil is not assoc. w/ risk of congential malformations (MCM). Swedish registry data on 1007 births (453 exposed) & 2500 births (144 exposed) in SLE & RA, respectively. MCM risks in SLE &RA were 3.4-5.7%, no diff betw groups
  2. 929 Sjogrens pts from 2 French cohorts subdivided into 3 Groups: 1. BALS: Hi B-cell activity, low Sxs (Dz activity worsened w/ time) 2. HSA: Hi systemic Dz 3. LSAHS: low systemic Dz, Hi Sxs Lymphomas in 3-4% BALS & HSA
  3. Series of Chronic Cutaneous Lupus responding to anifrolumab. 6 pts (4 DLE, 2 CCLE) betw 37-66 yrs old w/ Dz duration 10.5 yrs, 4 w/ SLE, all refractory to multiple therapies Rx w/ ANIF w/ Skin benefit. 1 developed herpes, 1 had worsening of nephritis
  4. 91 #SLE pts w/ no baseline synovitis, underwent Ultrasound exams. 10 yrs later, 31 had clinical progression of arthritis. Pts w/ progression, 75% had baseline subclinical synovitis on US vs without progression 77% did NOT have an abnormal US at baseline
  5. 4873 gout pts w/ High SUA renally typed: UA overproduct. (ROA 9%); underexcreter (RUE 61%); combined (23%) or normal (7%) ROL: older, lower SUA, tophi & DM RUE: lower BMI, No DM Combined: younger, HighBMI/SUA/eGFR & smoking Normal: older, Low SUA/eGFR
  6. Stills pts w/ remission on Tocilizumab who stop TCZ, 50% will relapse in 1 yr. Lower relapse rate w/ longer TCZ use w/ prednisolone lowering. 38/48 AOSD Rx w/ TCZ were in remission after 6 mos. & 12 D/C TCZ - half flared after mean of 5.5 mos.
  7. Japanese study of 672 autoimmune pts on TNFi & tocilizumab - 1.6% (n=9) developed non-tuberculous Mycobacteria (NTM) infx post biologics. 2 disseminated NTM, 2 died. NTM pts had higher mortality [(22% vs 2.6%) & took more steroid (17 vs 3 mg, P=0.004).
  8. UAB study shows the US adult rheumatology workforce grew clinically active adult rheumatology workforce grew 23% betw 2009-2020; including a 43% increase in women. Number of Rheums (5,667) grew 23% and APPs (379) grew 141%.
  9. Case of Delayed Rheum Diagnosis The Washington Post recently published a case titled, "Medical Mysteries: A rolled ankle set this runner down a painful path", which tells the tale of how/why rheums are often not consulted or consulted too late.
  10. In RA, NO selective response with Seropositivity. Study of 28 eligible RCTs shows pts Rx w/ cs- or bDMARD that seropositivity did not predict better bDMARD response (ACR20 RRR ~1). Comparable resp in RF+ & RF- w/ TNFi or non-TNFi bDMARDs.
  11. post hoc of the PEXIVAS study 704 participants w/ severe ANCA vasculitis: 92% achieved remission & 23% had relapses (rate 10.3/100PYs)-- Neither plasma exchange nor glucocorticoid tapering regimen impacted relapse risk.
  12. Retro study 109 oligoarticular JIA pts (~8 yrs) Rx w/ intraarticular steroids w/ 4.3 yrs F/U: 38% needed no Rx, 15.5% needed more IAS; 46% systemic Rx(MTX; 8 mos) &22% biologics(2.2 yrs later). @FUV 89% were inactive. Persistence predicted by ANA+ & B27+
  13. Infection and Rituximab-linked Immunoglobulin Deficiency 
  14. CV Risk Early with Rheumatic Disease Diagnosis 
  15. RheumNow 2024 replays begin with Tuesday Night Rheumatology all April long. Register today! Our first TNR takes place 4/2 at 6:30pm ET and will focus on Success in Rheumatoid Arthritis.


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The author has no conflicts of interest to disclose related to this subject