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Pain in the Neck (7.28.2023)

Dr. Jack Cush reviews the news and journal reports from the past week on This week COVID persists, mortality from misdiagnosis, and cervical pain is more than a pain in the neck.

  1. While COVID rates are near historic lows & far less dangerous, hospitalizations are up 10.3%, ER visits up 7%, pos. tests rose to 6.3% from 5.8% in the last week

  2. CMS billing data shows female MDs are 25% more likely than male MDs to leave academia (OR 1.25; 1.23-1.28); at all stages of their careers. At 5 yrs, attrition rate from academia was 34.2% (38.3% for females and 32.4% for male physicians).

  3. Estimated 795 000 Americans are misdiagnosed annually (371,000 pts die; 424,000 permanently disabled). Just 15 diseases account for about half of all serious harms & top 5 (Stroke, Sepsis, Pneumonia, VTE, Lung CA) account for 39%

  4. Rheumatoid vasculitis (RV) metanalysis: RV decreased sincefrom 9.1 (1988-2000) to 3.9 (2001-2010) per million. RV risk increased w/ smoking, disease duration, seropositivity, males, HLA-DRB104, HLA-C3. Common: skin (65–88%), CNS(35–63%), cardiac (33%)

  5. Chronic neck pain is associated with increased mortality in individuals with osteoarthritis. NHANES study of 5965 adults, OA in 8.2% and 5.9% had neck pain. Neck pain assoc w/ 2 fold risk OA. OA pts w/ chr neck pain higher all-cause mortality risk (OR ~3)

  6. Structured interviews from 462 pts from Michigan SLE clinic. 22% admit to cost-related non-adherence (CRNA) over 12 mos. CRNA associated signif. higher levels SLE disease activity & more lupus damage. Worse scores in those with Fibromyalgia

  7. Study of 48 Jo-1+ anti synthetase pts shows Ab levels signif correlated w/ activity (r=0.4, p=.03) & CK (r=0.34, p=.002) & were signif higher w/ active disease (91.7 vs 44.4 IU/L). Modest correl. prev seen

  8. Double blind RCT of 101 active AS patients with BASDAI ≥4 showed the IL-23 inhibitor, tildrakizumab was not superior to placebo after 24 weeks (ASAS20: 74% on tildrakizumab 200 mg vs 80% on PBO). Study was terminated after wk 24 interim analysis

  9. EMA's CHMP adopted a positive opinion for 1st tocilizumab biosimilar, Tyenne® (from Fresenius Kab), for Rx of RA, systemic JIA, poly JIA, GCA, COVID-19 and CAR-T cell-induced cytokine release syndrome. No decision yet on IL6 biosimilar in USA

  10. IL-1β inhibitors can be effective in #Gout. Based on metanalysis of 14 studies(10 RCTs), 4367 gout pts (Rx w/ anakinra, canakinumab rilonacept) Shows CAN, RIL better than active comparator at pain; CAN/RIL reduced gout flares

  11. SGLT2 Inhibitors Reduce Gout Flares and CV Events 

  12. 2023 ACR/EULAR Criteria for Calcium Pyrophosphate Deposition Disease

  13. #Ask Cush Anything

    • Dr. Jerome Barr - Rheumatoid nodules


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