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RheumNow Podcast – What Not to Do (7.16.2021)

Jul 16, 2021 10:31 am

Dr. Jack Cush reviews the news and journal reports from the past week on

  1. Of 100 newly diagnosed #RA patients, Foot Involvement was the 1st manifestation in 29%. Pattern: 59% w/ forefoot involvement, 27% hindfoot and 14% midfoot. Pts were 58-63% RF+/CCP+.
  2. Survey of women re: sex & reproduction (SRH) says women prefer 1) Rheums to initiate SRH discussions, 2) clear info on pregnancy & infertility risks w/ Dz & DMARDs, 3) holistic Rx approach, 4) not to be intermediaries betw Rheum & OB
  3. Ann Int Med: 185 Hospitalized COVID-19 pts were treated with either PBO remdesivir or HCQ. Neither remdesivir nor HCQ affected viral clearance, Sxs duration, mortality or need for mechanical ventilation.
  4. Systematic review of muscle relaxants use in nonspecific low back pain shows uncertain, small, but not clinically important reductions in pain in the 1st 2weeks. Muscle relaxants are 3rd most common Rx for LBP (30 mill Rx in 2016)(49 trials >6505 pts)
  5. Knee corticosteroids injx within 4 wks of total joint arthroplasty may be assoc w/ a higher risk of postop infection (studies suggest a risk w/in 3 mos of TKA). Greatest risk seen w/in 2 wks of injx (OR 2.89), worse in <65 yrs & w/ comorbidities (RA)
  6. Metanalysis of 33 clinical trials show that corticosteroids are anaglesic, especially in 1st 3 mos (mean drop VAS pain -12mm); after that benefit wanes to -8mm @3-6 mos and -6mm (95% CI, -10mm, -2mm) after  6 mos.
  7. Telehealth has declined but still much higher than pre-pandemic. CMS is proposing to extend Medicare coverage of certain telehealth services until the end of 2023. A -3.75% payment adjustment has been proposed & will be debated
  8. Doximity Telemedicine report estimates 20% of US medical visits via telehealth; ~$29 billion of medical services in 2020. Top 10 telemedicine specialites: 1 Endocrinology 2 Rheumatology 3 GI 4 Renal 5 Cardiology 6 GU 7 Neuro 8 Geriatrics 9 Hem/Onc 10 Pulm
  9. NHANES survey study shows adult psoriasis in the US was 3.0% (7.5 million adults). Psoriasis was most common in non-Hispanic White individuals, and the prevalence of psoriasis has not significantly changed since 2003 in the US.;
  10. Todays NEJM: Ruxolitinib effective in glucocorticoid-refractory Chronic Graft-versus-Host Dz. Phase 3, 329 pts; wk 24 responses better w/ RUX (50 vs 26%; P<0.001). Important? as there is phase 2 data showing JAK efficacy in scleroderma
  11. HCQ prolongs SLE survival. Case–control study 6241 incident SLE pts compared 290 SLE dead to 502 alive controls. HCQ reduced all-cause mortality by 50% (aOR 0.50; .30–0.82) but HCQ stoppers had incr mortality (aOR 2.47) - sick stopper effect?
  12. 185 Lupus pts undergoing renal transplant for ESKD saw good outcomes. Pt survival = 88%, 82%, 78% & 67% (@ 1,3,5,10 yrs). Graft survival was 93%, 89%, 87% & 89% (@ 1,3,5,10 yrs). Immunosuppressive use was protective & only 2 cases of recurrent LN seen
  13. Modest IL-6 mAb benefit w/ COVID. Metanalysis 27 RCTs & 10 930 hosp COVID pts shows 28D all-cause mortality lower w/ IL-6i (vs usual care.PBO) (OR 0.86), better w/ steroids (OR 0.78). Mortality 22% w/ IL-6i vs 25% usual care.
  14. Impact of Nail Psoriasis on Psoriatic Arthritis 
  15. Arthritis as a Harbinger of Pediatric Cancer  
  16. Potential Birth Defects with Hydroxychloroquine    
The author has no conflicts of interest to disclose related to this subject

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