Safety Warnings for Higher Dose Tofacitinib

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Pfizer has issued a press release regarding the safety of tofacitinib, citing higher rates of pulmonary embolism and death associated with the use of higher dose tofacitinib 10mg bid in rheumatoid arthritis (RA) patients treated in a long-term safety trial.  

Remission Unlikely in RA

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Dr. Marwan Bukhari (editor of Rheumatology) has written an editorial wherein he suggests that true remission is hard to achieve. He notes that "remission as a target is a noble objective that we should all aspire to but we should not chastise our practice if we do not achieve it, as more and more evidence suggests that we should consider it the ideal but not the norm."

TKR - One or Two at a Time?

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His would-be surgeon tried mightily to talk him out of a bilateral knee replacement. At 340 pounds, the patient's BMI -- above 43 -- was a significant contraindication. 

Older Men Less Likely to be Assessed and Treated for Osteoporosis

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A study from the University of Washington in Seattle find that men with osteoporosis were less likely to be assessed by dual-energy X-ray absorptiometry (DXA); vitamin D measurements and were less like to receive calcium/vitamin D and bisphosphonate prescriptions. 

Hip Replacements Lasting 25 Years

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Lancet reports that, based on a literature review and metanalysis, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients.

RheumNow Podcast - MTX vs. Etanercept in Psoriatic Arthritis (2.15.19)

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Dr. Jack Cush discusses the news from the past week on RheumNow.com - including the SEAM trial, MRI guided T2T, biologics and infection, contraceptive use, ANA negative lupus, etc.

Stopping Biologics Before Joint Surgery: Is Earlier Better?

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Withholding intravenous abatacept (Orencia) for longer than a month before hip or knee arthroplasty among patients with rheumatoid arthritis (RA) did not lower the risk for postoperative infection, a retrospective claims-based analysis found.

Mortality and Hospitalization with Pulmonary Hypertension in Systemic Sclerosis

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PHAROS is a prospective cohort studying the natural history of pulmonary hypertension (PH) in systemic sclerosis (SSc). They have shown that risk factors for poor outcomes in this cohort included male sex, DLCO < 50%, exercise oxygen desaturation, and pericardial effusions. 

Noninfectious Proximal Aortitis Needs Serial Follow-ups

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A Cleveland Clinic review of patients undergoing thoracic aortic surgery (1996‐2012) identified 196 patients with histopathology‐proven non‐infectious aortitis.

No Added Benefit to MRI-Guided Therapy in Rheumatoid Arthritis

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A treat-to-target (T2T) strategy to manage rheumatoid arthritis hinges on clinical metrics to optimize therapy. But investigators from Denmark have shown that using magnetic resonance imaging–guided T2T failed to improve disease activity remission rates or reduce radiographic progression.

Differing Effects of Smoking and HLA-DRB1 in Seropositive Rheumatoids

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Analyses from the Swedish EIRA incident rheumatoid arthritis cohort study shows that smoking and HLA-DRB1 exert differential effects on serologically defined RA subsets - but that the strongest influence was seen in double positive (CCP+, RF+) individuals.

SEAM-PsA Study - Does Monotherapy MTX Win Despite Losing to Etanercept in Psoriatic Arthritis?

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The SEAM-PsA study examined the efficacy of methotrexate monotherapy, etanercept monotherapy or the combination of MTX and ETN in psoriatic arthritis patients, and found that ETN monotherapy was equivalent to combination therapy - and that both were superior to MTX alone in clinical (ACR and MDA) and radiographic responses.