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PsA Til Death Do Us Part (1.20.2023)

Dr. Jack Cush reviews the highlights from the past week on

  1. Rx failures w/ nonmedical switching of biosimilars may be Nocebo effect. 140 #RA pts, 51 non-switchers & 89 switchers. Non-switchers more likely to improve than switchers (68 vs 26%, p < 0.001) and less likely to worsen (1% vs 9%, p < 0.01).
  2. US study of 47 #GCA pts showed baseline US+ in 44/47 (72% TA, 72% LV). US was sensitivity to change over time w/ serial measures. TA-based US showed good correlation w/ Dz activity & discriminated remission vs, relapse
  3. International survey of 394 GPs & 937 rheumatologists shows most PMR pts are not referred to Rheum. GPs referred 25% suspected PMR for Dx & 50% were returned to GP. 39% of Rheums saw new PMR >2 weeks after referral, half already on Pred
  4. Danish registries stud of > 6 million persons finds 52898 new #IBD pts (over 18 yrs). Antibiotic exposure was assoc w/ increased risk of IBD, esp > 40 yrs. (40–60 yrs IRR 1.48; ≥60 yrs IRR 1.47)
  5. Elevated Uric Acid Is Associated With New‐Onset Atrial Fibrillation A Longitudinal Swedish study has shown that elevated serum uric acid (SUA) levels has cardiovascular implications and may predict the development of atrial fibrillation (AFib). 10-45% increased risk.
  6. Worldwide prevalence (major markets) of #RA was 4.9 million in 2020; the RA global treatment market is estimated at US $40.5 billion in 2021, and is expected to grow ~6% per year in the next decade.
  7. Naltrexone is indicated in opioid or EtOH dependence - not pain; yet it has wide off-label uses. Shown to be equal to Elavil in Rx of painful DM neuropathy; Little data from PBO RCTs in FM. Unclear how naltrexone modulates pain
  8. Causes of Enthesitis: SpA (AS, reactive arthritis, PsA, enteropathic arthritis, ERA), JIA, but also in RA, leprosy, trauma, OA, DISH, acromegaly, fluorosis, retinoid therapy, hypo- or hyper-PTH, POEMS syndrome, X-linked hypophosphatemia
  9. Enthesitis portends worse SpA. Data from 749 SpA pts in REGISPONSER-AS registry found 6.1% w/achilles tendinitis at baseline. Pts w/ enthesitis had worse pain, BASDAI, mBASDAI, ASDAS-CRP scores & after 2 yrs had fewer in low dz state (16 vs 31.5%)
  10. Half of all outpt. MDs are bound by restrictive covenants. FTC is considering a ban on noncompete clauses. AMA) code of ethics discourages covenants that "unreasonably restrict". FTC the rule change could save Pts up to $148 billion
  11. PsART-ID study of 1216 #PsA pts showed PsA mortality to be similar to general population, but during pandemic PsA mortality doubled (5.1 vs 10.86 pandemic) with a higher increase in females (2.9 vs 8.72) than males (9.07 vs 14.73)
  12. AS, but not PsA, has Increased Mortality Risk  
  13. Join us on 3/18 and 3/19 in Dallas, Texas or virtually for RheumNow Live! RheumNow Live is unlike any meeting you've ever attended.


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