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RheumNow Podcast –Rainbow Rheumatology (8.27.2022)

Aug 26, 2022 5:00 am

Dr. Jack Cush delivers this weeks rheumatology "weather report" with the best and least of news and journal articles from the past week on

Climate is what we expect, weather is what we get.” – Mark Twain

  1. Top 60 brand-name drugs in US cost ~395%higher than other high-income countries. New legislation by Congress lets Medicare negotiate drug prices & cap out-of-pocket costs @$2,000/yr. Read more on proposed restrictions importing drugs from Canada
  2. Anti-rheumatics drug market accounted for $57 billion in sales in 2018 and is expected to reach nearly $72 billion by 2026, registering a CAGR of 2.9% from 2019 to 2026.
  3. Study of 9611 pts w/ hip or knee arthroplasty for #OA tested aspirin (100 mg/d) vs enoxaparin (40 mg/d) (x35d w/THA; 14d after TKA). Enrollment prematurely halted as VTE rate was 3.45% w/ ASA and 1.8% w/ enoxaparin (superior to ASA: P= .007)
  4. VTE (clots) w/ JAK inhibitors? Metanalysis of JAKi in 9711 Atopic dermatitits pts shows no significant assoc between JAK and incident VTE (HR 0.95; CI 0.62-1.45; or 0.23 VTE/100PYs). Actual #s: 3 VTE per 5722 pts (0.05%)
  5. Review of VTE risk with JAK inhibitors - Tofacitinib: 10mg or 5 mg bid - PE rates 0.5 & 0.3/100PY; higher w/ risk factors, VTE 0.35/100PY - Baricitinib: IR of DVT/PE was 0.5/100PY - Filgotinib: 200mg VTEs 0.2/100PY Most VTE occured in LT extension of RCT
  6. Charcot (neuropathic) arthropathy of elbow due to Syringomyelia - review of 50 pts. Median age 45 yrs, 2/3 isolated elbow arthritis; other joints: shoulder > wrist > MCPs/IPs. 2/3 had Chiari malformations, sensory/motor deficits, or ulnar neuropathy
  7. Voltage-gated Na channels (NaV) in nociceptive neurons may lead to pain stimuli in #OA. Tamoxifen metabolites inhibit NaVs & was studied in animal model of OA, showing analgesic effects equal to CBD and lidocaine.
  8. Matched cohort study of survival in 1139 incident systemic sclerosis pts & 5613 controls. W/ median F/U of 5-6 yrs, deaths were 268 vs 554. 5 Yr survival was lower 79.8% vs 92.9% (10yr survival 67.7% vs 84.8%). SSc had higher 1 yrs mortality (HR 3.7)
  9. Bidirectional Association Between Depression and Rheumatoid Arthritis A recent meta-analysis suggests a bidirectional association between RA and depression. Finding RA patients with depression yields an 80% increased mortality risk.
  10. 73 #RA pregnancies w/ live births. 88% were in remission/low disease before conception. RA flares occurred in 37% (in 1st &2nd trim). Preterm assoc w/ Flares; flares more likely if bDMARD D/C @ +Preg test (55% w/ flare vs. 30% w/o flare, p 0.03, OR 2.9)
  11. Chinese study of 215 Bx proven #SLE pts - all rx w/ IV CTX+steroids. Responders were given either AZA or leflunomide. Renal outcomes were same w/ LEF or AZA as maintenance. Flares (16% vs 18%), Time to flare (16 v 14 mos), AE, proteinuria
  12. Hyaluronic Acid Knee Injections Equivalent to Placebo  
  13. Record Use of Marijuana and Hallucinogens in Young Adults
  14. Ask Cush Anything 

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Join The Discussion


| Aug 28, 2022 8:51 pm

About viscosuplementation I have a different opinion. In my clinical practice it has helped lots of patients. Thank God no infection yet in 28 years. I think it is the technique and who does it .

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