RheumNow Podcast - Preaching to the Choir (5.22.20)

Jack Cush, MD

May 22, 2020 9:00 am

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.

Secukinumab shown to work in 9/15 (67%) of refractory Behçet’s patients (mucosal and articular dz) by 3 mos - Retrospective study looked a complete or partial responders. #s increased to 86.7% at 6 months. Doses: either 150 or 300 mg qmonth https://t.co/a3Fp3qdbkG
FDA has approved OTC availability of Voltaren Gel - now called Voltaren Arthritis Pain: a topical NSAID, 1st approved by FDA in 2007. Indicated for the pain of osteoarthritis - It has not been effective in strains, sprains, bruises, sports injuries https://bit.ly/3204R9W
Genetic study of 57 systemic JIA children finds presence of MEFV variant p.M694V/I was a risk factor for sJIA (OR: 7.13) https://bit.ly/2zTdQzI Other studies have shown ~31% of Still's patients at lease 1 genetic variant for periodic fever syndromes. https://bit.ly/2ZkfRzW
14 pts refractory AOSD pts (Yamaguchi+) showed a good response to usual doses of tofacitinib. 7/14 complete remission, 6/14 partial remission & 1 relapse w/ pred reduction. May work by reducing reducing IL-6, IL-10, IFN-γ, IFN-α, GM-CSF, neutrophils. https://bit.ly/2WRHLRS
JAK inhibitor safety review - Meta-analysis shows a significant 57% increase in risk of H. zoster with JAKi (RR 1.57; 1.04-2.37). Data from 82 studies, 66,159 pts w/ RA, IBD, Pso, PsA, AS. Rates of SIE=2.81/100PY and HZ=2.67/100 PY. No increase in mortality https://t.co/Tyb0VDlJOT
Specialties w/ highest percentage of women? OBGYN 58%, Peds 59%, Rheumatology 54%, Derm 49%, Endocrine 45%, Family medicine 43%, Psych 43%, Pathology 40%, IM 36%, ID 36%; yet men (375K) earn 31% more than women ($286K) as specialists https://t.co/oNTwm8vRFq
Review of 525 critically ill, rheumatic dz pts (25% vasculitis, 21%SLE, 19% RA, 9% PSS, 5% myositis). ICU adm for shock (41%), respiratory failure (32%), infx (39%) Dz flares (35%). Hospital mortality was 31% predicted by age, steroids, mech ventilation. https://t.co/xcw8xU9hPl
Effect of Covid on Practice? Medscape survey 55% drop in revenue, 60% drop Patient Volume; 43,000 healthcare workers laid off in March 2020; 9% of practices have closed temporarily; 225% increase in remote patient engagements. https://t.co/LHeYA5pE29
NEJM report shows that hospitalizations for acute MI are down ~-40% with the onset of the COVID Crisis (data from Kaiser N. California) - Will the shutdown/lockdown lead to other necessary services or hospital admissions? https://bit.ly/2ZlCEvb
MMWR reports that among 92 attendees at a rural Arkansas church during March 6–11, 35 (38%) developed laboratory-confirmed COVID-19, and three persons died. Highest attack rates were in persons aged 19–64 years (59%) and ≥65 years (50%). https://bit.ly/2Tr6XwO Similar to last weeks tweet w/ 61 in choir practice and 53-87% COVID+, 3 hosp, 2 died.
Please believe that the Coronavirus is not a hoax, COVID-19 is not a conspiracy. Your doubts, ideology and slick videos cant change nearly 100,000 Americans dying from COVID in 3 short months. Please be vigilant with Distance, washing and masks
Governor Cuomo cites NY study showing front line workers have lower rates of COVID positivity - Suggests that WEARING PPE's Works! (NY population 20% vs 14% transit workers & 12% healthcare workers & 10.5% NYPD and 17% FDNY/EMTs) https://bit.ly/2TscClU
High Dose Anakinra Effective in COVID-19