Rheum Chapter Notes (4.26.2024)

Jack Cush, MD

Apr 26, 2024 1:35 pm

Dr. Jack Cush reviews this past week’s news and journal articles from RheumNow.com.

Prevalence of MSK presentations in practice = 21.1%, based on UK practice cohort. Most common: pain in LS spine (18%) & knee (17%). Re-presentations of existing Dx made up 74% all MSK consultations. Steroid injx given to 1/3 of knee consults https://t.co/nTioq1lCEB
Articular Findings Sarcoidosis: - Acute arthritis: Lg Jt Oligoarthritis; Loffgrens syndrome (hilar LN, arthritis, E. nodosum) - Acute > Chronic arthritis - Chronic arthritis: tenosynovitis, oligo- &polyarthritis, dactylitis, erosions or Jaccouds arthritis https://t.co/zDLJqsjnbj
Hyperpigmentation from Hydroxychloroquine. From 316 HCQ pts, 26% got hyperpigmentation; delayed onset of 12 mos (6–30mos) after median cum. dose of 108 g. Seen on face (602%), Legs (36%) & hands (20%). Daily sun exposure decrease in the incidence (P=0.02) https://buff.ly/3xB0A0z
Prospective look at 25 280 older adults (mean 74yrs) w/ incident fracture, shows impact of multimorbidity by Charlson Comorbid Index (CCI). If CCI =2-3, Incr risk of subseq Fx (16-25%) & death (HR ~2); If CCI=4+, Fx Risk ^33-48%, death HR~4. https://t.co/6wnhFNiSXH
CPPD in seronegative RA? Among 364 RA patients - 73% seropositive & 26% seronegative (n=96). Amongst latter, 18 pt (18.9%) met CPPD-disease criteria. CPPD+ pts were more likely to be older & have Hx of acute episodic arthritis https://buff.ly/3JtGzfe
STEP 9 - a, multinational phase 3 RCT studied semaglutide vs PBO in 407 Knee OA (Gr2-3) pts w/ pain >4/10 & BMI >30 (mean 40.3; mean WOMAC 71). At wk 68 SEM > PBO lowering WOMAN pain (-42 v -27; p<.001). Wt loss: 13.7% v 3.2%, respectively. https://t.co/101qML0wQM
JAMA review of ILD; that affects 650,000 in USA, leading to 25,000-30,000 deaths/YR. Types reviewed. Key Symptoms: dyspnea and cough, w/ chest CT being diagnostic tool. Antifibrotic & immunomodulatory may slow disease progression. https://t.co/xegChTUysM
Single center retrospective 173 pts w/ CTD-ILD - 34% Sjogren’s, 30 RA, 25 systemic sclerosis, 6 UCTD, 3% idiopathic inflam myositis, 1,2% MCTD, 0.6% SLE. NSIP most common (60%) inSS & SSc; UIP more common in RA. 6 died, mostly infection https://t.co/IL2tnVDtoQ
50 active RA pts RCT Rx w. either low dose IL-2(n=26), IL-2+TCZ (9) or control (15). All improved clinically by DAS28-ESR, but IL-2 Rx pts had signif proliferation of Tregs, w. decr inTh1, Th2, & Th17 cells. TREG #s correlated w/ ESR drop (r=0.54) https://t.co/1tF63FuXzx
New Oregon law rebrands Physician Assistants to a new title of “physician associates" (goes into effect 6/6/2024). The title change only applies to PAs and not NPs. The AMA has come out against such change in title, thinking it may confuse patients. https://t.co/oWxNwpIW7U
Pediatric IMID pts have 4 fold mortality. Danish population study of 11,581 pIMID (vs 99K controls), 1.37 million PYs F/U. Dx age 12.6 yrs; 152 pIMID deaths (vs 316) aHR=3.8. +6.9 deaths/100K PYs. Most for GI Dz/CA & lymphoproliferative dz https://t.co/JpGzusLXMH
Renal Dz in 44 AOSD (Stills)pts-mean age 38; 28 w/ renal onset after Dx. 36 renal Bx showed amyloidosis (25%), collapsing glomerulopathy (11%), thrombotic microangiopathy (11%), IgA nephropathy (9%), minimal change (7%). Renal assoc w/ 6 deaths; 4 ESRD https://t.co/tQykmjNIIb
AbbVie announced preliminary positive results from phase 3 SELECT-GCA study showing remission in 46% of #GCA pts Rx w/ upadacitinib for 52wks (vs 29% PBO); RCT included a 26-wk steroid taper regimen https://t.co/DIstJ4hazo
Self Acupressure in Knee Osteoarthritis
Predicting CKD Outcomes in Lupus Nephritis