RheumNow Podcast Gout Spot Light (1.11.19) Save
RheumNow Podcast Gout Spot Light (1.11.19) by Dr. Cush
Transcription
This is the Room Now podcast for January 1139. The Room Now podcast is brought to you by Room Now Live. Hi, I'm Doctor. Jack Cush, executive editor of roomnow.com. In this week's news, we'll talk about big buyouts in medicine, gout making the headlines and what happens when all bones are confronted with steroids.
Our first report is about Sapho, synovitis, acne, pustular lesions and hyperostosis, an unusual almost spondyloarthritic condition, all really has no relation to spondyloarthritis. This particular analysis of one hundred and fifty seven patients really looked to cluster patients by their clinical profiles. And these authors came up with three distinct patterns or types. One type is called the spinal type. Those are people who have spinal and sacral lesions.
They get spondylodiscitis, they rarely get sacroiliitis. That type accounts for about forty five percent of patients. The costal type, this involves the ribs, the sternum, the manubriosternal joint, that's a third of patients. And the last is the sternoclavicular type, which is about twenty two percent of patients. Again, what's interesting about this syndrome is that they have pustular disease, usually severe pustular acne or other kinds of pustular skin disease.
In association with chest wall, arthritis, what almost appears to be enthesitis, but it's usually arthritis and synovitis of amphiarthrosis meaning sliding joints, usually in the SC joint, nubriosternal joint, the AC joint, etc. Again, what they found was, that there's distinct clustering, that there's similarities amongst those clusters, and that the disease course tends to be longest in those who have involvement of the SC joints compared to the other two types. Again, if you see enough patients, I think you'll see some of these. This is a rare syndrome in North America. It is more common amongst the Japanese, Southeast Asians and actually in northern, Scandinavian countries as well.
An interesting study looked at ankylosing spondylitis patients from the Medicare population specifically to look at their frequency of hip arthritis leading to hip arthroplasty. Same thing for knee arthritis leading to knee arthroplasty. I would assess a guess, a priori that, a higher incidence of hip arthritis in spondyloarthritis patients, specifically ankylosing spondylitis patients will lead to a higher rate of hip replacement and maybe not the same for a knee replacement and turns out that actually both are twofold increased in patients who have ankylosing spondylitis means a twofold increased relative risk for, hip arthroplasty and for knee arthroplasty in ankylosing spondylitis at the age of, 65 or older from Medicare population. So it's partly their disease, partly their age, but it's something worth noting. Obesity, we keep talking about obesity, it is a bad player, and this particular study looked at obesity in lupus.
Now we have data saying what? That obesity patients don't respond well to biologics, they don't respond well to DMARDs, that it is a risk factor for developing inflammatory arthritis, including rheumatoid arthritis. It worsens psoriatic disease, the arthritis, and the skin disease, and worsens the outcomes and comorbidity associations. Well, guess what? It makes everything else worse in lupus.
A study of one hundred and forty eight patients, a third of the patients were in fact obese, and the obese patients with lupus tended to have worse disease activity measures, more depression, more pain, more fatigue. Obesity makes everything worse. Maybe one of the things we should specialize in, in rheumatology is basically counseling our patients on weight loss and how to achieve that. I know a few rheumatologists actually do that in their clinic. It's a big part of their business.
It's a smart part of their business. We should learn from that. The big blockbuster news at the end of last week before we went to press on last week's, podcast was that BMS made an offer to buy out Celgene for a total of $74,000,000,000 This would make this one of the largest mergers in pharmaceutical history. Both drugs are big players in, inflammatory diseases and also the Celgene portfolio in cancer therapies, CAR T therapies, checkpoint inhibitors, and other Revlimid, a whole bunch of other drugs. If this were to happen and it's not final yet, we have the details in the report in this week in OnRoomNow.
If this were to happen, they would be a major player with having both Otezla and, Orencia in the management of inflammatory disease and psoriatic disease. Wait and see what happens here. A very interesting study also comes from, again from, Haiyan Choi and his colleagues who looked at the NHANES database from, up to 2016 and they specifically looked at again, gout in the NHANES dataset and looked at the frequency of gout, the prevalence of gout in men and women and also the prevalence of hyperuricemia and also urate lowering therapy. What they found was the number of patients with gout in The United States, which once was eight point three million Americans and is now nine point two by most recent estimates. Although they said this, the rates of gout remained stable over the last decade, the number is now higher.
It was eight point three, now it's nine point two. But to me, the headline here was that only a third of gout patients are taking urate lowering therapies. And I think that's a major, major problem. Of course, these are not patients taken care of by rheumatologists, but honestly, I don't think rheumatologists are doing that much better than the primary care sector in managing gout. We may be using urate lowering therapy more frequently, but this is a major hurdle that needs to be overcome.
Gout is vastly undertreated in United States. Since I'm on gout, I'll tell you that, today, January 11, the FDA is having a joint meeting of the Arthritis Advisory Committee and the Drug Safety and Risk Management Advisory Committees in Bethesda to discuss gout and specifically discuss, recent studies, on febuxostat comparing it to allopurinol in cardiovascular outcomes, what's called the CARE study, C A R E S. Tune in next week for more details about how that hearing went. At issue here is whether or not there is an increased cardiovascular risk with febuxostat compared to allopurinol, especially when given to high risk individuals. Tune in next week for more news about that.
Lastly, we'll end with a report from New England Journal. Lenore Buckley and colleagues had a nice review in the New England Journal, on glucocorticoid induced osteoporosis. They cover those at risk, how to manage it, how to monitor it. Some of their key reminders and takeaways are that GIOP, glucocorticoid induced osteoporosis, results in fractures, especially in those over the age of 55 who those were female, white, and have long term prednisone use at a dose of more than seven point five milligrams a day. A screening for osteoporosis should begin before the initiation of steroids if possible, and at the risk of fracture in those over the age of 40 can be estimated based on, monitoring their FRAC scores serially over time.
Those who are on glucocorticoids must receive calcium and vitamin D and be encouraged to do to avoid smoking and excessive alcohol intake and to, engage in weight bearing exercise. They do recommend pharmacologic treatment strongly for anyone who has a fracture or for those who are over the age of 40 and have a high risk or a moderate risk by FRACS. The first line of therapy should be bisphosphonate, and then move on from there. And then lastly, the risk of fracture decreases when the glucocorticoids are discontinued. So that should be the goal in such patients.
That's it for this week on RheumNow and our podcast. Be sure to check out rheumnow.live. You know when you go to a great restaurant and you find a real find, you wanna tell your friends and your peers and your family. Same for a great movie, a great book. I'm telling you this is a great meeting that you want to tell your colleagues about.
It's going to be different than the other meetings, the other books, the other movies, and the other calzones that you had. Rheumnow.live, check it out. We'll see you next week.
Our first report is about Sapho, synovitis, acne, pustular lesions and hyperostosis, an unusual almost spondyloarthritic condition, all really has no relation to spondyloarthritis. This particular analysis of one hundred and fifty seven patients really looked to cluster patients by their clinical profiles. And these authors came up with three distinct patterns or types. One type is called the spinal type. Those are people who have spinal and sacral lesions.
They get spondylodiscitis, they rarely get sacroiliitis. That type accounts for about forty five percent of patients. The costal type, this involves the ribs, the sternum, the manubriosternal joint, that's a third of patients. And the last is the sternoclavicular type, which is about twenty two percent of patients. Again, what's interesting about this syndrome is that they have pustular disease, usually severe pustular acne or other kinds of pustular skin disease.
In association with chest wall, arthritis, what almost appears to be enthesitis, but it's usually arthritis and synovitis of amphiarthrosis meaning sliding joints, usually in the SC joint, nubriosternal joint, the AC joint, etc. Again, what they found was, that there's distinct clustering, that there's similarities amongst those clusters, and that the disease course tends to be longest in those who have involvement of the SC joints compared to the other two types. Again, if you see enough patients, I think you'll see some of these. This is a rare syndrome in North America. It is more common amongst the Japanese, Southeast Asians and actually in northern, Scandinavian countries as well.
An interesting study looked at ankylosing spondylitis patients from the Medicare population specifically to look at their frequency of hip arthritis leading to hip arthroplasty. Same thing for knee arthritis leading to knee arthroplasty. I would assess a guess, a priori that, a higher incidence of hip arthritis in spondyloarthritis patients, specifically ankylosing spondylitis patients will lead to a higher rate of hip replacement and maybe not the same for a knee replacement and turns out that actually both are twofold increased in patients who have ankylosing spondylitis means a twofold increased relative risk for, hip arthroplasty and for knee arthroplasty in ankylosing spondylitis at the age of, 65 or older from Medicare population. So it's partly their disease, partly their age, but it's something worth noting. Obesity, we keep talking about obesity, it is a bad player, and this particular study looked at obesity in lupus.
Now we have data saying what? That obesity patients don't respond well to biologics, they don't respond well to DMARDs, that it is a risk factor for developing inflammatory arthritis, including rheumatoid arthritis. It worsens psoriatic disease, the arthritis, and the skin disease, and worsens the outcomes and comorbidity associations. Well, guess what? It makes everything else worse in lupus.
A study of one hundred and forty eight patients, a third of the patients were in fact obese, and the obese patients with lupus tended to have worse disease activity measures, more depression, more pain, more fatigue. Obesity makes everything worse. Maybe one of the things we should specialize in, in rheumatology is basically counseling our patients on weight loss and how to achieve that. I know a few rheumatologists actually do that in their clinic. It's a big part of their business.
It's a smart part of their business. We should learn from that. The big blockbuster news at the end of last week before we went to press on last week's, podcast was that BMS made an offer to buy out Celgene for a total of $74,000,000,000 This would make this one of the largest mergers in pharmaceutical history. Both drugs are big players in, inflammatory diseases and also the Celgene portfolio in cancer therapies, CAR T therapies, checkpoint inhibitors, and other Revlimid, a whole bunch of other drugs. If this were to happen and it's not final yet, we have the details in the report in this week in OnRoomNow.
If this were to happen, they would be a major player with having both Otezla and, Orencia in the management of inflammatory disease and psoriatic disease. Wait and see what happens here. A very interesting study also comes from, again from, Haiyan Choi and his colleagues who looked at the NHANES database from, up to 2016 and they specifically looked at again, gout in the NHANES dataset and looked at the frequency of gout, the prevalence of gout in men and women and also the prevalence of hyperuricemia and also urate lowering therapy. What they found was the number of patients with gout in The United States, which once was eight point three million Americans and is now nine point two by most recent estimates. Although they said this, the rates of gout remained stable over the last decade, the number is now higher.
It was eight point three, now it's nine point two. But to me, the headline here was that only a third of gout patients are taking urate lowering therapies. And I think that's a major, major problem. Of course, these are not patients taken care of by rheumatologists, but honestly, I don't think rheumatologists are doing that much better than the primary care sector in managing gout. We may be using urate lowering therapy more frequently, but this is a major hurdle that needs to be overcome.
Gout is vastly undertreated in United States. Since I'm on gout, I'll tell you that, today, January 11, the FDA is having a joint meeting of the Arthritis Advisory Committee and the Drug Safety and Risk Management Advisory Committees in Bethesda to discuss gout and specifically discuss, recent studies, on febuxostat comparing it to allopurinol in cardiovascular outcomes, what's called the CARE study, C A R E S. Tune in next week for more details about how that hearing went. At issue here is whether or not there is an increased cardiovascular risk with febuxostat compared to allopurinol, especially when given to high risk individuals. Tune in next week for more news about that.
Lastly, we'll end with a report from New England Journal. Lenore Buckley and colleagues had a nice review in the New England Journal, on glucocorticoid induced osteoporosis. They cover those at risk, how to manage it, how to monitor it. Some of their key reminders and takeaways are that GIOP, glucocorticoid induced osteoporosis, results in fractures, especially in those over the age of 55 who those were female, white, and have long term prednisone use at a dose of more than seven point five milligrams a day. A screening for osteoporosis should begin before the initiation of steroids if possible, and at the risk of fracture in those over the age of 40 can be estimated based on, monitoring their FRAC scores serially over time.
Those who are on glucocorticoids must receive calcium and vitamin D and be encouraged to do to avoid smoking and excessive alcohol intake and to, engage in weight bearing exercise. They do recommend pharmacologic treatment strongly for anyone who has a fracture or for those who are over the age of 40 and have a high risk or a moderate risk by FRACS. The first line of therapy should be bisphosphonate, and then move on from there. And then lastly, the risk of fracture decreases when the glucocorticoids are discontinued. So that should be the goal in such patients.
That's it for this week on RheumNow and our podcast. Be sure to check out rheumnow.live. You know when you go to a great restaurant and you find a real find, you wanna tell your friends and your peers and your family. Same for a great movie, a great book. I'm telling you this is a great meeting that you want to tell your colleagues about.
It's going to be different than the other meetings, the other books, the other movies, and the other calzones that you had. Rheumnow.live, check it out. We'll see you next week.
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