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RheumNow Podcast – World Going to Pot (7.23.2021)

Jul 23, 2021 9:50 am

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

  1. US life expectancy dropped by 1.5 years in 2020, driven by the pandemic.

  2. A study of 7459 adults with diabetes, shows that regular bicycling is associated with a 22-32% reduction in all cause mortality and CVD mortality - with a loss of benefit to those who stop.

  3. EULAR guidelines rec starting prednisone dose in #PMR to be between 12.5-25mg/d. A cross sectional study of 138 pts (63M, 75F, age 73.4 yes) saw the mean starting dose to be 19.2±7.7 mg.

  4. Steroid (GC) withdrawal studied in T2T RA cohort of 207 RA pts (F/U 39 mos); Only 60% discontinued GC, w/ low risk of flare. BUT D/Cs were SLOW w/ only 9.7%, 26.6%, 48.0% & 58.6% at 6 mos, 1, 2 & 3 yrs - median time to cessation = 27 mos

  5. In a study of 15123 RA pts >50 yrs; 1640 osteoporotic fractures occurred. Low-dose glucocorticoids (≤7.5 mg/D) was not associated with overall risk of OP Fx (adj HR 1.14) but was assoc w/ increased risk of vertebral Fx (adj HR 1.59, 1.11–2.29)

  6. National Inpatient study (2000-2014) shows increased risk of vertebral compression fractures (VCF) in Ankylosing spondylitis (2.7%), compared to RA 0.77% & gen population 0.35%. VCF Hosp increased over time in AS, but decr in RA pts

  7. Metanalysis of Tramadol efficacy & safety in knee or hip #OA. 6 RCTs (3,611 pts) showed little clinical benefit w/ 100/d or 200 mg/d; only 300mg/d was better vs PBO at pain & functional improvement. All doses had higher risk of GI, CNS AEs & W/D

  8. Study of 33 RCTs, 4544 pts Rx w/ either IL-17 or TNF inhibitors finds lower risk of UVEITIS with anti-TNF mAb (vs PBO OR = 0.46; vs IL-17i OR = 0.34. IL-17 inhibitors are not protective against uveitis

  9. COAST-Y - an extension study of 155 spondyloarthritis pts in remission on ixekizumab; they either continue or had IXE withdrawn. After 40 weeks, 83% on IXE vs 55% of PBO (WD) pts remained flare free. Most flares >20 wks of IXE withdrawal

  10. Retrospective cohort study of 1719 Psoriasis only pts (F/U 14721 py) were Rx w/ topicals (81%), cDMARDs (13%), bDMARDs (6%). Overall, 239 patients (14%) developed PsA - Lower risk of PSA if Rx w/ biologics (IRR=0.26 vs topicals; not csDMARDs)

  11. Tofacitinib Efficacy in Ankylosing Spondylitis 

  12. Can you refuse to see unvaccinated pts? NY Times letter reviews options for “vaccine hesitant” or “vaccine refusing” 1. Ask if vaccinated 2. Offer telehealth 3. Require masks & distancing 4. Minimize contact betw vax & no-vax pts 5. Address pt concerns

  13. 152 Israeli pts w/ Breakthrough COVID infx >7d after 2nd Pfizer vax; all hospitalized, 38 w/ Poor outcome & 22% (34/152) died. All were older, most males, w/ comorbidities, 40% immunocompromised; high risk w/ RTX & low anti-spike IgG titers

  14. Growing Cannabis Use in Arthritis Patients

  15. BACK TALK – record your question, comment or case to RheumNow.

The author has no conflicts of interest to disclose related to this subject

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