When Less (Drug) is More (Activity) (3.4.2022) Save

Dr Jack Cush reviews the news and journal reports from the past week on RheumNow.com.

This podcast is sponsored by RheumNow.live. The great future of rheumatology education is at RNL 2022.

1. With H. Zoster on JAK inhib; you can continue JAKi @ low risk. Study of 416 RA pts on JAKi, 8% HZ reactivation (age 60 yrs, 42% Pred) after 11 mos. 72% cont JAKi during HZ, 15% temporarily D/C & resumed. Only 1 pt had HZ re-reactivation https://t.co/dJqhlhGEda

2. Psoriatic fingernail onycholysis and hyperkeratosis, rather than nail pitting, are significantly & independently assoc w/ PsA. Study of 1985 pts w/psoriasis, 11.5% were Dx w/ PsA. Only onycholysis (OR 2.34) and hyperkeratosis ) were assoc w/ PsA https://t.co/X3JHUFtGdD

3. CRP! Dr John Reveilles review of potential biomarkers in axial spondyloarthritis, includes cytokines, adipokines, MMPs, calprotectin, CD74, bone turnover markers & protein fragments of cartilage degradation - But none can outperform C-reactive protein https://t.co/pmIDZkuOuP

4. INBUILD Study of 170 pts with autoimmune related ILD showed nintedanib signifi. slowed the rate of FVC decline in FVC decline over 52 wks (NIN -75.9 mL/yr vs PBO -178.6 mL/yr). AE's (mostly diarrhea) leading to D/C was NIN 17.1% vs PBO 10.2% https://t.co/VG5oPBU0VCDiabetes (HR 1.29), bad glycemic control (HR 1.41), and long-term diabetes (>5yrs HR 1.49) are potential risk factors of symptomatic knee OA, independent of age and BMI. Targeting blood glucose, in addition to obesity, may prevent knee  OA. https://t.co/6XXVfLumqG

5. Retrospective study of juvenile dermatomyositis shows 1st line Rx w/ MTX is not effective, esp in MSA Ab+ pts. 45 JDM pts (2/3 severe) Rx w/ 6 mos MTX + steroids; inactive dz seen in 31%, with 42% muscle and 33% skin responses. MSA neg pts did better https://t.co/PDubjbcMe2

6. Downside of Holding MTX with COVID-19 Vax A recent clinical trial has shown that a 2 week hold of MTX following COVID-19 vax resulted in greater anti-SARS-CoV-2 immunogenicity; but there was an increase in flare rates after the second dose of vaccine. https://t.co/a7XfBxVkvJ

7. Drug Safety Advisories from regulators appears to reduce physician prescribing by 5.8%. Data from a study of 2 dozen advisories in 4 countries, Canada, Denmark, US, and UK between 2009 and 2015. https://t.co/TB6IeH9eGS

8. Pharma payments to rheums. Study of 4822 rheums in Medicare, 77% recv some pharma payment. For every $100 in food/beverage payments, prescribing increased 1.5-14%. For every $1000 in consulting, prescribing increased <5%.  https://t.co/tKsRIBbFdt

9. Downside of Holding Methotrexate with COVID-19 Vaccination

10. Increased SLE Flares with Hydroxychloroquine Reduction

11. Spondyloarthritis in Early Crohn's Disease

12. ACR Guidelines for the Treatment of Systemic Juvenile Idiopathic Arthritis