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VITAL Info on Autoimmune Disease (2.9.2024)

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

  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

  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)

  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)

  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

  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?

  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)

  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 


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