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PMR & Popeye's Spinach (10.6.2023)

Dr. Jack Cush reviews the big PMR reports from this week along with other journal reports from

  1. Best quote from last nights Tues Night Rheumatology on #PMR , comes from Dr. Stephen Paget (#HSS) who said, "steroids to a new PMR patient are like spinach to Popeye"

  2. SAPHYR Trial: Sarilumab Wins in Relapsing Polymyalgia Rheumatica 

  3. Absence of prolonged AM stiffness (AMS >45 min) at the time of Dx may indicate a cancer Dx. 143 #PMR pts (age 71yrs) & 35 (24%) without prolonged AMS. Cancer found in 20% w AMS<45" and 2.7% if AMS>45". Of 10 Cancer pts in 1st 6 mos, 7 had AMS<45"

  4. GCA pts w/ prior #PMR Dx had 2 fold more Lg vessel dz & signif more vasculitic stenoses. Study of 311 GCA pts, 16% had prior PMR ~ 31 mos before. prior PMR had more LVV (51 vs 25%) & stenosis(18 vs 3%). Prior PMR incr LVV (OR 7.65)

  5. X-sectional case-cntrl study w/ UK Biobank looked @ comorbidity w #PMR (n=1036) & GCA (102) pts (98% W; age 63 yrs) - pts rated their health as poor. Comorbid Dx included-more hypothyroidism (OR 1.34), HRT use (1.26), HTN (1.21-1.86) & cataract (1.51-3.84)

  6. FDA Approves the first Actemra biosimilar (from Biogen) - called tocilizumab-bavi (Tofidence) or BIIB800 (during development). This IV FORMULATION is approved for use in active RA, polyarticular JIA and systemic JIA.

  7. Retrospective EHR study of 7,970 gout pts from Singapore finds ~28% are poorly controlled, with only 46% prescribed allopurinol (13% @doses ≥300). Poor control assoc w/ male gender (adj OR 1.66), Malay ethnicity (aOR 1.27), CHF (aOR, 1.64)

  8. Metanalysis of 17 studies (n=862849 pts) looked at fall risk w/ #OA. OA Hip (OR 1.50 & knee (OR 1.55) assoc w/ signif incr risk recurrent falls, but not FX. Xray knee OA w/ incr risk of falls (OR 1.28); Xray hip OA decr risk recurrent falls (OR 0.70)

  9. The frequency of demyelinating Dz (DD) studied in 2260 #SpA pts, finging 18 DD events (IR 31 per 100K PYs) DD at 20 yrs was higher in axSpA than PsA (1.30 vs 0.13%, p= 0.01). DD risk w/ smoking (HR 2.9), axSpA (8.8) & IBD (5.7) -- NOT TNFi!

  10. Pneumothorax in an RA patient is likely from rheumatoid nodules eroding into air spaces in advanced seropositive RA patients.

  11. Tuesday Night Rheumatology - Steroids and PMR

  12. REgister for next weeks TNR - 10/10/23 Steroids and PMR


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