VITAL Info on Autoimmune Disease (2.9.2024) Save

Dr. Jack Cush reviews the journal reports from the past week on RheumNow.com. Highlights are summarized by three songs: "Stairway to Heaven", "You're No Good", and "How Long (has this been going on)".

1. Many #RA pts remain on Steroids despite b/tsDMARD use! Study 228 #RA pts, 68% Rx low-dose GCs (32% no GCs). After 3 yrsof b/tsDMARDs, 32% still on GCs, 23% D/C GCs, & 20% go on & off, 25% never took GCs. GCs use assoc w/ HTN (20 v 11%) & MI (2.3% vs 0) https://t.co/lWVfvJrAyp

2. 649 RA pts (291 ACPA+) from the Leiden Early Arthritis Clinic shows Disease activity incr by: - Obesity: + 0.32 higher DAS - Obese + ACPA+: + 0.43 DAS - ACPA+ RA: SJC incr 60%, TJC 55%, CRP + 3.7 mg/L https://t.co/WH0tpybe4a

3. Study of 78 #RA pts(83% CCP+) showed signif. discordance between office visit DAS scores & telephone eval by RAPID3 (w/in 2 wks of F2F visit). By RAPID3, 27% were in remission, vs F2F DAS-CRP 71%) or DAS-ESR (33%) kappa= 0.48 (mod) & 0.14 (low agreement) https://t.co/DsgR0aMUGf

4. Acute CPPD at significantly higher risk of fractures. 1148 acute CPPD pts matched to 3730 comparators(mean 73 yrs old); Steroids and OP more in CPPD pts. Fx risk was twice as high in the acute CPPD pts (HR 1.8;1.3, 2.3). Fx risk highest forwrist (HR, 3.6) https://t.co/25EOzXI0sH

5. Danish registries study shows maternal Autoimmune Dzs (all) were assoc w/ incr risk of childhood cancers (OR=1.25, 95% CI 1.06, 1.47), acute lymphoblastic leukemia (OR =1.52), Burkitt lymphoma (OR=2.6) & CNS tumors (OR=1.45); same seen for RA mothers https://t.co/VCgwQRSLEY

6. Korean Database study of 1796 #AS pf (vs 7184 controls 1:4 ratio); 9.3% develeoped cancer; AS pts have no overall increase in cancer risk (aHR 1.1); AS pts had higher risk of upper GI cancer (HR: 1.51) & hematologic CA (aHR: 2.36). Is there an NSAID effect? https://t.co/6W68upVQrn

7. No evidence of harm starting urate lowering Tx (ULT) during #gout attack. Metanalysis 6 RCTs (445 pts) w/ gout attacks given ULT vs PBO or delayed ULT. No differences in pain, time to resolve gout flare or risk of recurrent gout flare in 30d (RR 1.06) https://t.co/Zk6OjJ8I2F

8. Determinants of Gout Flares 

9. VITAL Study - Autoimmune Prevention Requires Continued Supplements 

10. Inflammatory Arthritis in Systemic Sclerosis is Problematic 

11. Poly-Refractory Rheumatoid Arthritis