Rheum Believe it Or Not (1.13.2023) Save

Jack Cush, MD

Jan 13, 2023 6:00 am

Dr. Jack Cush reviews the notable standouts in the news since the 1st of January. Surprising reports on ferritin, alcohol benefits, cannabis for pain and a lower dementia risk with hydroxychloroquine. Here are the links below.

ACR GCA classification criteria tested in 676 patients suspected GCA (+US) - 276 dx w/ GCA; 400 not. Sensitivity was 87%, specificity 70%; 35 (13%) GCA pts did not meet criteria. & 119 non-GCA (30%) had ≥6 points (most PMR) https://bit.ly/3Quw8uB
JAK Inhibitor Promising for Polymyalgia Rheumatica Tofacitinib appeared highly effective against PMR in a small single-arm trial, researchers said, suggesting another potential alternative to long-term corticosteroids. https://t.co/XNhICcDU7t
Differential Dx of hyperferritinemia (≥500 μg/) in critically ill ICU pts includes: sepsis, liver disease/failure, hematological malignancy, HLH. Single center study of 2583 patients https://t.co/F5Dz2qpmAy
Ferritin may be more than biomarker in Stills, etc - may contribute directly to pathogenesis. Ferritin causes PMN activation & neutrophil extracellular traps (NETs). Could this be targeted therapeutically? https://t.co/42KeTbVsQb 
Hosp study of 2809 admissions, found 1+adverse events (AE) in 24%. Among 978 AE, 23% (222) were preventable; 32% (316) serious. Preventable AE occurred in 1/15 admissions (serious 1/100). Drug AE were most common (39%) https://t.co/gqty53ccyH
Case crossover study of 508 #RA pts starting biologics (75% on steroids) showed significantly higher rates of RA flares if steroid doses taken down ≤2.5 mg/d (vs >2.5 mg/d) - adj OR of 1.37 to 1.45 https://bit.ly/3IHDMjf
Anti-mitochondrial antibodies (AMA) in were assayed in 404 #RA patients & found to positive in 14-26%. Importantly AMA Abs were associated with erosive disease (p<0.05) and interstitial lung disease (p<0.01), independent of CCP or RF https://t.co/ZcrOYr0cWX
Hydroxychloroquine significantly lowers Alzheimer’s and dementia risk. Study of g 109,124 #RA pts starting HCQ or MTX. showed an 8-16% lower risk. https://t.co/gV4AYHRwmU
FDA Accepts Biologics License Application for CT-P13 SC, a Subcutaneous Formulation of Infliximab (Celltrion) that is approved in other countries. https://t.co/G1OIoqk9ga
520 RA pts were screened with FibroScan (liver fibrosis)- F3 or F4 liver fibrosis seen 13.3% of controls vs 12.7% arthritis pts. MTX was not significantly correlated w/ higher FS scores. Liver stiffness was correlated w/ BMI, waist, male , age. https://t.co/nINWp8vbUu
Neutrophil-to-lymphocyte ratio (NLR) was studied in 205 Idiopathic pulmonary fibrosis (IPF) pts - NLR correlated with lung function, & outcomes - NLR >= 2.9 was associated with a significant 2 fold increased risk of mortality https://t.co/FCuKx2NfeC
Free great handout on DRESS - Drug Reaction With Eosinophilia and Systemic Symptoms. May affect adults or children; usually 2 to 8 weeks after beginning a medication. ~1 in 1000 taking specific drugs get DRESS. Allopurinol is a common cause https://t.co/X8lHtGVunC
Autoimmune Dz may be assoc w/ new-onset Atrial Fibrillation, esp in women. Population-based UK Biobank found significant increases for AFib in Rheumatic fever w/o CVD (HR 1.47), Crohn’ (1.23), UC(1.17), RA (1.39), PAN (1.82), SLE (1.82), PSS (2.32) https://t.co/rpIiztUfg9
UK Database 1,955 breakthrough COVID-19 infxs in 54,576 #gout pts compared to 52,468 w/o gout saw more in gout (adj HR 1.24), also w/ more #COVID hospitalizations (adj HR 1.30) & death (1.36), more so in women. Same for unvaccinated https://t.co/596KvupZxi
Weekly (Ozempic) semaglutide SC (GLP-1 agonist) was given for obesity, 3-6 mos to 408 pts with BMI> 27. Wt loss was 5.9% (6.7 kg) @3 mos & 10.9% (12.3 kg) @6 mos. 55%) had >10% & 8% had > 20% wt loss. NIDDM pts had less wt loss vs non-DM pts. https://t.co/LXpP5OR5GA
RA Disease Activity and Alcohol Use
Cannabis Use for Pain is Common
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