Rheumatology: Believe It or Not (4/25/2025)

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Should we believe the reviews and metanalyses?

  1. Retrospective EGPA study of mepolizumab Rx 45 pts Rx initially w/ 300 mg/4 weeks, 27% switched to 100 mg/4 wks after 26 mos & 50% maintained complete remission without GC. Other half had sinonasal Sxs Rx w/ increased MEP dose orlocal therapy. https://buff.ly/pRU4Uhv
  2. IL-17 inhibitors increase risk of IBD. TriNetX database study of PsO & AS pts starting IL-17i vs apremilast. 13,216 matched pts per group, 142 developed IBD w/ IL-17i vs. 60 with apremilast (aHR = 2.50, 95% CI: 1.85–3.39). https://buff.ly/TJ8wWJ1
  3. Pairwise Network Metanalysis suggests that JAKi use may NOT be assoc w/ Gastrointestinal perforation (GIP), as suggested by the PI. 23 RCTs, (20,023 pts) followed for 24 wks. Incidence of JAKi GIP=0.19%. compared to csDMARDs this was not signif increased (RR 1.02; CI: 0.41-2.56). SUCRA of JAKi (51%) & bDMARDs (77%) indicated a low risk of GIP. 
  4. Systematic review shows PTSD is strongly assoc w/ an increased risk of developing SLE. 7 studies (5 prospect cohort) and 11614 SLE pts - 1,325 (11.4%) had comorbid PTSD, mostly females. All showed + association of PTSD & SLE, 3 showing 2fold incr risk of SLE. No genetic variants assoc w/ this risk 
  5. A review of 18 guideline recommendations on DMARDs in pregnancy & reproductive health. There were recs. DMARDs & pre-conception (56%), lactation (67%), male fertility (33%), & use of csDMARDs (72%), bDMARDs(72%), tsDMARDs (28%); less recs for b/tsDMARD use 
  6. Metanalysis suggests MTX may be effective in knee OA. 6RCTs, 602 pts of MTX vs PBO, showed MTX significantly relieved pain (mean diff −0.44; P 0.0003) knee/hand OA; Functional improved for knee only, but no differences in quality-of-life outcome or adverse events https://buff.ly/IKF6INT
  7. Hip replacement outcomes are not linked to OA severity, instead pts muscle quality before THA best predicts recovery after surgery. Imaging of 10 pts undergoing THA showed poor muscle quality predicted post-op performance/movement after surgery https://t.co/io0UXQl6n2
  8. Retrospective study of 334 children with non-organic amplified MSK pain syndr (AMPS) plus back pain. Pts w/ localized AMPS were more likely to have a (+) straight leg raising test (P 0.01) & diffuse AMPS more likely to have allodynia & incongruent affect (reporting pain, but still cheerful) https://t.co/qqCrL7b4H2
  9. Obesity is a risk factor for not achieving remission in early #RA (ERA), independent of comorbidity. 1285 ERA RA pts; remission failure @6 mos = 64% w/ obese, 52% if overWt & 48% if NL wt. RR 1.33 w/ no change after adjusting for RF/CCP, education, EtOH, smoking, phys activity, https://t.co/341ba1rCSk
  10. Incr. neutrophils in RA synovium correlates w/ higher Dz activity and poorer Rx responses. Study of 55 #RA pts, 1/3 (17) enriched for synovial PMNs - these correlated w/ DAS28--CRP, synovial inflammation, and CD3+/CD68+ cell counts https://buff.ly/snZSXGz
  11. 84 RA pts on CZP+MTX w/sustained LDA (CDAI ≤10) ≥ 12 wks. 1/2 OL withdrawal of MTX & @ wk 36, LDA was maintained in 85% on CZP+MTX vs 84% on CZP alone (w latter group having signif less GI Sxs (2.4% vs. 15.8%, P = 0.034) https://buff.ly/afBPR2x
  12. Better Responses with Chronotherapy for Baricitinib 
  13. Diabetes Prevention with Hydroxychloroquine in Sjogren’s  

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