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Want to Go Far, Go Together (4.21.2023)

This week on the podcast Dr. Jack Cush reviews the news, regulatory announcements and novel journal reports including a profile on pseudogout, the safety of immune checkpoint inhibitors in RA patients and the diagnostic importance of neutrophils.

  1. CIRCS study: Comparison of 3188 Gout (733 M: 355 F) and ~10K non-gout. Found that the risk of gout in men linked to HTN (HR 1.41)and alcohol (HR 1.23 & 1.41), but that only smoking was a risk factor among women (HR 1.66).

  2. 12 mos. serial study of 71 pts with gout found 42% with at least 1 gout flare (median=2) over 12 mos. US eval. showed "Flare" pts had signif more MSU deposits (6.7 vs 2.9) & power Doppler (3.73 vs 0.82)vs controls. By US- were 17-29% more likely to flare.

  3. Renal Function Safe With Pegloticase-MTX Combo for Gout For patients with uncontrolled gout, estimated glomerular filtration rate (eGFR) remained stable with combination pegloticase (Krystexxa) and methotrexate treatment, researchers reported.

  4. Brigham review (2018-2022) of 47 CPPD pts: M=F, mean age 72 yrs 68% w/ acute CPP arthritis 40% w/ CPP inflammatory arthritis 62% w/ OA with CPPD. Compared to Gout, CPPD Significant unmet Rx need & lower RAPID3 (8.1 vs 12.1)

  5. NIH sponsored nationwide survey assessed 1,462 SLE pts (9% men; 81% women). Male SLE pts had more MI & difficultly w/ medical forms than F. Female SLE had more fatigue and higher educational levels. (almost more Lupus GN and APL)   Both had barriers to health care access (40-47%)

  6. Immune Checkpoint Inhibitor Safety with Pre-existing Rheumatoid Arthritis Lancet Rheumatology has published a retrospective analysis showing patients receiving ICI for cancer have the same outcomes even when they have pre-existing RA.

  7. 6 specialties saw a pay drop in 2023 - #6 on the list was Rheumatology at -3% (based on Medscape survey of 10,011 physicians 1022-1/23. Biggest drop was Ophthalmology -7% (then EM -6%, PM&R -5%, Nephrology -5%, Allergy -5%, RHEUM -3%)

  8. Real world interchangeabilty study compared rituximab to biosimilar ( CT-P10) in 128 Rheum pts (CT-P10= 64; RTX= 64), with 41% of pts switched from RTX to CT-P10. Both Rx had Comparable Gr 2 infuxion Rxs, infection #s & hypogammaglobulinemia (p > 0.05)

  9. Retrospective study on prescribing by male vs female RHEUMs, found that women (in private practice, >10 yrs) were less likely to be High steroid prescribers. RA Pts more likely to Rx steroids = male sex, >prior biologics, opioid use, w/ comorbidities & freq infx

  10. The European Commission has approved upadacitinib (Rinvoq) for the Treatment of Moderately to Severely Active Crohn's Disease

  11. Lillys IL-23 inhibitor (Mirakizumab) has suffered a minor setback receiving a "complete response letter" from the FDA regarding MIRA application (BLA) for use in ulcerative colitis. The CRL hold up is related to the manufacturing issues (not data/safety)

  12. Retrospective study of 147 THA and TKA pts w/ acute/chronic complaint - 39 pts Dx w/ prosthetic joint infection (PJI). Absolute numbers of neutrophils (PMNs) best predicted PJI (THA > 3,600 PMN/µl; TKA >2,000 PMN/µl (sensitivity 97%; specificity 93.5%)

  13. Sex-Specific Differences in Psoriatic Arthritis

  14. The Power of Collaboration: Building Relationships to Amplify Your Impact and Have More Fun…

  15. "If you want to go fast, go alone. If you want to go far, go together." (African proverb)


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