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Two Week Twitter (6.17.2022)

Jun 17, 2022 2:38 pm

Dr. Jack Cush does a 2-week review of RheumNow Tweets on news and journal citations worth noting, along with some opinions on Telehealth, manpower, monkeypox and the price of drugs.

  1. Although Rheumatology currently ranks 2nd or 3rd in specialty use of telemedicine - the vast majority of rheums have given up on telehealth (<15%)

  2. 31 systemic JIA pts: w/ systemic sxs (n=8), chronic arthritis (7), remission on meds (10) & remission off meds (6). High IL-18 levels & impaired IL-18 signaling in NK cells correlated with systemic Dz activity. High IL-18 impairs NK phosphorylation

  3. Balance and falls studied in 228 #RA pts (24-85 yrs) followed x 1yr; 20% had at least one fall; risks included Age (OR 1.04), HAQ (OR 1.62), low FICSIT-4 score (OR 2.38) & 1-leg standing (OR  2.14). 1-leg stand is a good screening tool

  4. Small study 34 biologic-naive RA pts starting abatacept. Remission achieved 47.1% of early and 23.5% established RA. Remission @ 6 mos predicted by Baseline LOWER IL-6 levels ≤ 8.4 pg/ml, (66.7%) and CD4+CD25+FoxP3+ cells ≥ 6% (83.3%)

  5. There are 494K PCPs in the USA, While up to 1/3 will "refill" DMARDs, only 6-9% are confident or knowledgeable in "initiating" DMARD therapy in #RA. GIGANTIC NEED FOR PCP education in MSK & Rheum Dz.

  6. OA Initiative Study of 1212 knee OA pts (age 63 yrs), 73% walked for exercise. Walkers had signif. less New frequent knee pain (OR 0.6) & medial joint space narrowing (OR 0.8). Walking for exercise should be encouraged in knee OA pts.

  7. Study of interferon (IFN) gene signature (IGS) finds IGS elevated in half of early RA pts; high IGS portends higher DAS28, fewer EULAR good resp & higher IFN-α; the latter assoc w/ epigentic changes, more lymphoctye activation. IFN-α as a biomarker?

  8. 450 axSpA pts followed 2868 Pt-yrs, 48% on TNFis. TNFi Rx pts had reduced CV risk (HR 0.30; 0.10–0.85), but no longer signif after adjustment for CRP, ESR (HR 0.37, 0.12–1.12, p = 0.077). Reduced CV risk, may not be specifically due to TNFi use

  9. JAKi not yet safe in pregnancy - theyre fetotoxic at high doses (animals). JAKi do cross placenta. ACR Guidelines: no position due to no data. 47 tofa Rheum & 15 UC maternal exposures - no signif probs. Paternal use of JAKi is ok.

  10. GLORIA Study Pred vs PBO in >65yrs RA x 2 years. 451 Pts & DAS28 4.5. 79% on DMARDs (14% biologics) Upside: Lower DAS28 -0.37 & less Xray progression -1.7 Sharp units Downside: 24% more AE (mild infxns), signif.small lowering of lumbar BMD -1% You Decide

  11. MMWR: Monkeypox Outbreak in Nine States CDC is tracking multiple reported U.S. monkeypox cases, and monitoring cases in persons in countries without endemic monkeypox and with no known travel links to an endemic area

  12. Gout Undertreatment Persists Despite updated gout management guidelines from EULAR and BSR, treatment of gout is suboptimal with regard to the use of urate-lowering therapy (ULT) and normalizing serum uric acid (< 6.0 mg/dl) levels.

  13. Review on reactive arthritis & COVID: 22 articles , 25 pts (14M:11F), age 45 yrs. Oligoarthritis was most common. Onset (COVID to arthritis) was 6-48 days. Steroids in 13, 2 w/ SSZ, Sxs improved 22/25, mean resolution was 16 +/- 57 days

  14. Canadian study of 50,883 RA pts shows only 58% saw a rheumatologist yearly for 5 yrs. If >65 yrs, Rheum care assoc w/ DMARD use in 82%; but was only 31% if not under Rheum care. Worse rheum retention with age >81, male, lower SES, older Rheums

  15. FDA approved another rituximab biosimilar, rituximab-arrx (Riabni) (from Amgen), for use w/ MTX in active RA. Riabni is currently approved for B-cell NHL, B-cell leukemia, MPA, or GPA. pemphigus vulgaris (RTX is an orphan drug)

  16. Price of a newly launched drug increased from $2115 per year in 2008 to $180 007 per year in 2021. In 2008 only 9% of drug cost >$150k/yr; this rose to 47% by 2021. Greater increases seen w/ biologics, rare disease and nononcology drugs

  17. Yesterday the FDA approved baricitinib (Olumiant) as the first systemic treatment for Alopecia Areata. Approval based on 2 DBRPCT Trial AA-1, AA-2) - 32% & 35% of pts on Bari 4 mg regrew scalp hair coverage by wk 36.

  18. Baricitinib (JAK1/2 inhib) in 10 pts w/ systemic sclerosis showed improvement in modified Rodnan Skin Score ( −11.67 @wk 24; p=0.0008); 3/4 w/ digital ulcers healed at week 24. Similar findings seen in bleomycin induced animal model


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

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