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Before You Know It (8.25.2023)

Dr. Jack Cush comments on the news and journal articles from the past week on VEXAS scoring, scleroderma sine scleroderma and head scratchers from southeast Asia.

  1. Taiwan Health records research show gout (121,236) patients, when propensity matched (121,236) w/ control, finds gout pts have a signif risk of abd aortic aneurysm (HR= 2.46); that was cut in half with ULR (adjHR= 0.49)

  2. GSK reports Shingrix (Recombinant Zoster Vaccine) phase IV study of 6000 persons >50 yrs in China (ZOSTER-076). NO SHINGLES cases reported in those who received RZV, vs 31 HZ cases on placebo. Confirms (or is better) results of ZOE50 & ZOE70 RCTs

  3. Chinese study, 582 gout pts initiating ULT Rx w/ low or high dose febuxostat; 12.2% had gout flares. Compared w/ colchicine prophylaxis, gout flares were NOT increased w/ low-dose FBX (HR 1.26; 0.58–2.72) but were incr w/ Hi-dose FBX (HR, 3.08; 1.34–7.07)

  4. Cytokine comparison of Kikuchi-Fujimoto disease (KFD) & Stills dz (pts w/ FUO and LN) shows, after excluding HLH/MAS pts, KFD pts had higher serum IFN-γ (> 8.56 pg/mL) & IFN-γ/IL-6 ratio > 0.45. Stills pts had higher serum IL-6 levels than KFD

  5. Japanese study of 98 pts w/ VEXAS syndrome [81M: 8F; age 69.3 yrs) found 45% (40pts) with pathogenic UBA1 variants. VEXAS Dx Score based on: age >50 yrs, skin lesions, lung Sxs, chondritis, macrocytic anaemia (AUC=0.908)

  6. Evaluation of 3 RCTs using steroid (GC) bridging or not -- showed GC bridgers had a more rapid improvement in 6 mos, fewer DMARD changes (IRR 0.59) & similar late use of GC (vs non-bridgers. GC bridging had more GC exposure (2406 mg) over 2 yrs

  7. RISE + Medicare study of 1,426 #AS adults (Mean age 69 yrs; 44% female) w/ 197 Fractures (incidence rate 77/1,000 PYs -- signif risk factors = Older age (OR 2.8), Hx of fracture (OR 5.24), >30 mg morphine (OR 1.86). NEW: Opioids in AS=Hi Fx Risk!

  8. FDA Adverse Event Reporting System (FAERS) data on upadacitinib found the top Serious AE to be UTI (2.7%), H zoster (1.6%), diverticulitis (1.2%), bronchitis (0.7%), nasopharyngitis (0.7%), nephrolithiasis (0.7%), PE (0.7%), PJP pneumonia (0.5%)

  9. Study of 23036 w/ solid organ transplants (43%), autoimmune rheumatic dz (AIRD)(28%) & lymphoid CA (29%), w/ median age 60-69 yrs; al recv 3-5 COVID vax doses. Undetectable IgG spike Abs in 23% transplants, 14% AIRDs, 21% CA

  10. Retro cohort study finds COVID may incr risk of autoimmunity & risk is decr by Vax.  1 mill COVID vs 3mill nonCOVID, HER Study Found Incr rates of SpA(aHR 1.32), RA (1.29), PsO(1.42), Graves' (1.30), APL (2.12), ITP (2.1), MS (2.66), vasculitis (1.46). Vax decr pemphigoid, Graves, APL, ITP, SLE

  11. Cardiovascular Disease Precedes ANCA-associated Vasculitis   A nested case–control study from the Danish Nationwide Registries finds an increased risk of cardiovascular (CV) disease in the months preceding diagnosis of ANCA-associated vasculitis (AAV).

  12. Manifestations of Systemic Sclerosis Sine Scleroderma 


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