Skip to main content

RheumNow Podcast – What You Do For & What You Do To the Patient (4.8.2022)

Apr 08, 2022 2:30 pm

Dr. Jack Cush reviews the news and journal articles from the past week and discusses the use of fibroscan in RA, steroid hip injections in OA and famous quotes from a famous cardiologist.

  1. CorEvitas Registry study of173 Axial #PsA pts showed 6 mos of bDMARD/tsDMARD resulted in modest, nonsignificant improvement axial outcomes ,(irrespective HLA-B27 status), including ASDAS40, BASDAI50, & spinal pain. 31% of pts were B27+

  2. Deucravacitinib, TYK2 inhib, studied in phase II trial 203 active PsA pts randomised to PBO, or DEUC 6 mg or 12 mg qd. At wk 16 ACR-20 responses were significantly higher with DEUC 6mg (53%, p=0.0134) and 12 mg (63%, p=0.0004) vs PBO 32%.

  3. Differences between Palpated & Ultrasound Joint exams in 155 #PSA patients. 5616 joints - found 18.5% tender, 9.8% swollen, 20.4% w/ US GS ≥ 2 and 5.2% had US PD ≥ 1. Joints that were both tender and swollen more likely to have GS ≥ (44%)

  4. Among 1033 #PSA pts - 37% were obese. Obese PsA pts had higher PsAQoL, HADS-Anxiety, HADS-Depression, DAPSA, DAS28-CRP, BASDAI, BASFI, HAQ &FACIT scores (p<0.05). BMI affects QOL, depression, disease activity, fatigue

  5. 520 RA pts were screened with FibroScan (liver fibrosis)- F3 or F4 liver fibrosis seen 13.3% of controls vs 12.7% arthritis pts. MTX was not significantly correlated w/ higher FS scores. Liver stiffness was correlated w/ BMI, waist, male , age.

  6. ALEVIATE - small study of Alemtuzumab (anti-CD52) in 23 refractory ANCA-Assoc vasculitis or Behcets— 16/23 (70%) had either complete (6/23, 26%) or partial (10/23, 44%) response at 6 months. 10 SAE in 7 (30%) pts

  7. Metanalysis of psychological interventions for chronic low back pain (97 RCTs, 13,136 pts) finds that Only behavioural therapy delivered w/ physiotherapy care (mainly structured exercise) reduced pain intensity up (high quality evidence)

  8. 211 pts presenting w/ hot swollen joint to the ER; 28 w/ septic arthritis; pseudogout 32; gout 50; & others: 101. Predictors of Septic Arthritis: RA (OR 3.4); skin infx (OR 3.3); liver Dz (OR 9.9); knee involv (OR 3.5); immunosuppressive use (OR 3.5)

  9. FDA has granted a Priority Review for tocilizumab (Actemra) intravenous for the treatment of hospitalised COVID-19 adults receiving systemic corticosteroids and require supplemental O2, mechanical ventilation, or ECMO.

  10. “Do as much as possible for the patient, & as little as possible to the patient.” (B Lown). JAMA review of Antithrombotics in COVID-19 says all hospitalized COVID pts with COVID-19 should recv anticoagulation with heparin; no proven value to anti-Platelet Rx

  11. The BA.2 variant is now dominant in every region of the United States and accounts for 72% overall for new Covid cases @CDCgov

  12. 15 AAV patients Rx w/ RTX who had no response to 2 doses of SARS-CoV-2 vaccine; then  received a booster. Despite persistent B-cell depletion 7/15 had a response to booster vaccine #Vasculitis22

  13. Short-Term (not Long-Term) Benefits to Intraarticular Hip Steroid Injection 

  14. Dactylitis Indicates a Severe PsA Phenotype  

  15. Some of life's biggest and most positive changes are propelled by mini conspiracies of a few well-meaning folks. - Dr. Bernard Lown

The author has received compensation as an advisor or consultant on this subject

Rheumatologists’ Comments

Eingun James Song

| Apr 11, 2022 6:47 pm

Hi Jack,

Would you mind going over how you use the fibrosure (or fibroscan) to initiate and monitor patients on MTX? At what stage would you not start MTX?

Dr. Song, sorry in covering #5 above (Fibroscan) I thought the data was enough. I dont do Fibroscan and cannot recommend this assessment other than in a high risk PsA/PsO patient. JJC

If you are a health practitioner, you may to comment.

Due to the nature of these comment forums, only health practitioners are allowed to comment at this time.