What Worries You, Masters You (7.1.2022) Save

Dr. Jack Cush reviews recent news, regulatory and guideline updates from the past week on RheumNow.com.  Studies on methotrexate use, COVID vaccination, Supplements and vitamins, and arthrocentesis despite anticoagulation are discussed.

1. FDA approved Abbvies risakizumab-rzaa (Skyrizi) as the 1st interleukin-23 inhibitor for use in adults with moderately to severely active Crohn's disease (600 mg IV at wk 0, 4, 8, &q8wk @ 360 mg SC). Approval based on ADVANCE, MOTIVATE & FORTIFY RCTs https://t.co/Y6FVcjHGr2

2. EMA has approved Secukinumab for the expanded approvals for use in pediatric patients with enthesitis-related arthritis (ERA) and psoriatic arthritis (PsA) . Approvals based on the JUNIPERA trial, showing reduced the risk of flare & Dz activity w/ SEC https://t.co/fN01V1PBfY

3. The EMA's CHMP has positively recommended upadacitinib for use in Non-radiographic axial spondyloarthritis (nr-axSpA) based on Phase 3 SELECT-AXIS 2 study showing superior ASAS40 responses at week 14 https://t.co/54btcIz2J1

4. New Updated GRAPPA Psoriatic Arthritis Recommendations

5. Danish IBD+RA registry study of TNFi induced Psoriasis in 109k non-PSO pts (20K on TNFi). PSO risk equal betw non-TNFi & conventional Rx. Compared to latter, TNFi increased nonpustular PSO (HR 2.12; NNH 342 PY) & pustular PSO (HR 6.5; NNH 909 PY) https://t.co/5l3qlyYoFy

6. Jakne (acne) with upadacitinib: review of 857 Psoriasis pts on UPA by wk 16 9.8-15.2% c/o mild/moderate acne; only 2 D/C for acne. Higher rates seen among younger, female, non-White patients. (This rare in RA!) https://t.co/cN6NU7e5sb

7. Two Week MTX Hold with COVID-19 Vaccination A cohort study of RA patients evaluated immunogenicity of COVID vaccination with and without holding MTX for and 2-weeks and showed better immunogenicity, but more RA flares with the second MTX withdrawal. https://t.co/Kqa8Uy9tDm

8. Patients in the COVID-19 Global Rheumatology Alliance were Surveyed; responses from 9300 Rheum Dz adults (RA 39%, SLE 31%) showed that 27% had a change in employment status during COVID (w/ 13.6% decrease in full-time employment) https://t.co/exi6KDmMGT

9. JAMA Patient Page on "What is Carpal Tunnel Syndrome ? A great patient resource, full read with graphics https://t.co/5MT63IG0um

10. No science to F/U visit scheduling. Study of 114 outpt SpA visits, 34% considered unnecessary (fewer Rx change 15 v 52%) & clinical actions (23 v 63%) visits) vs. "necessary" visits (predict by ASDAS ≥2.1 & PtGA ≥3 >80%). Remote monitoring role? https://bit.ly/3nw0C1G

11. It's time to exonerate methotrexate in causing or exacerbating fibrotic interstitial lung disease in #RA patients https://t.co/AuEIWn8Pc4

12. Military biobank of serial serum samples was used to identify biomarkers of imminent RA (vs reactive arthritis or healthy controls). Soluble programmed cell death receptor-1 (sPD-1) best predicted seropos. RA w/in 6mos of Dx. Specif >89%; sensitivity 48%  https://t.co/djOGhLeCIi

13. Multinational recs. on Rx of JIA assoc. Uveitis: - Topical steroids are 1st line Rx - Systemic Rx if above fails or w/ poor prognosis or persistence - Options MTX, MMF then Humira EOW, then weekly ADA - Consider non-ETN TNFi's, then TCZ, ABA, JAKi or RTX https://t.co/76DcbeYj8a

14. Study of 1778 #SLE pts, of whom 121 had refractory thrombocytopenia (TP)(Plt <50K, unresp. to pred), Risk factors included pregnancy, Autoimmune hemolytic anemia, decreased C3, severity of TP and elevated ACL-IgG. https://t.co/ZNqQfUoYUq

15. Study of contoured foot orthoses vs sham shoe insoles in 1st MTP #OA pain: 87 pts completed 12 wk trial that showed no differences in 1st MTP walking pain or other 2nd outcomes. Hard orthoses are no more effective than flat sham insoles https://t.co/XAFWwpSjHm

16. Metanalysis of 7 studies shows that oral anticoagulants need not be discontinued for joint injections or aspiration. Only pts w/ hemorrhage after 5427 procedures, over 32-yrs. INR values of 3 bleeding cases was 1.9, 2.3, and 3.4. https://t.co/l130TsksVi

17. Simultaneous Versus Staged Knee Arthoplasty? There are an estimated 900,000 knee replacements (TKR) performed in the U.S. every year. This number is up from 754,000 TKRs in 2017, according to the Agency for Healthcare Research and Quality. https://t.co/KuLEaI3r0d

18. Placebo Works Best in Combination

19. Are You Wasting Money on Supplements or Vitamins? 

20. Inferior IL-17 Inhibitor Responses in Psoriatic Women