The RheumNow Week in Review - 30 June 2017 Save
The RheumNow Week in Review - 30 June 2017 by Dr. Cush
Transcription
This is the RheumNow we can review. It's the 06/30/2017. I'm Jack Cush, executive editor of rheumnow.com. I'm coming to you from Boulevardia Airport Food Court. What better way to do a recording?
This week on RheumNow, a number of interesting items. ACE levels. I don't know if you consider using ACE levels diagnostically. We always talk about them. We certainly know that ACE levels are correlated well with pulmonary involvement in patients with sarcoidosis.
But I've encountered some patients recently with very high ACE levels and researching the subject come up with a few citations that show that high ACE levels are not unique to sarcoidosis. Certainly you can have sarcoidosis, very active sarcoidosis, and have normal ACE levels including sarcoidosis with lung involvement. But very high levels can also be seen in other granulomas disorders, in lymphoma, in cancer, in hyperparathyroidism, even Crohn's disease and hepatitis B. There's a wide differential diagnosis with high ACE levels. A study of 200 patients with rheumatoid arthritis showed that carotid plaques were seen in over half the patients.
Interestingly plaque was correlated with ACCA. Again, the idea that rheumatoid arthritis is uniquely primed to lead to cardiovascular disease is something that's probably much more obvious than just disease activity. A national study looked at ER visits for shingles and showed that in the pre Zostavax year prior to 2007, there was a sort of steady incline. But that actually that rate dropped significantly, not in younger groups, but in the older age group. The group that would likely get the shingles vaccine, there was significant significant drop drop nationwide nationwide in ER visits for zoster.
A nice study, I think, in the analysis of paramedicine looked at the, comparative roles of yoga and physical therapy and other modalities in treating chronic low back pain showing that yoga is actually equal to physical therapy in those outcomes. Whole genome sequencing is popping up here and there and it seems to be a promising tool to identify patients who have really strange disorders, undiagnosed disorders. And a study in animals looked at 100 patients and looked at the utility of whole genome sequencing and showed that in only about twenty percent would whole genome sequencing reveal a gene that may be associated with disorder. Unfortunately, the number of those patients who actually had the disorder was even lower, suggesting that this is probably not a, not yet for prime time test, in patients, who have undiagnosed disorders. Again, back to sarcoidosis, there is a strange, study, but nonetheless, study looked at the risk of fracture with sarcoidosis.
I don't know why one would assume there's a risk of fracture, and it showed, guess what, no risk of fracture unless of course you're on steroids and then the risk is related to steroids. A recent study looked at Americans and Europeans and showed that Americans sleep on average six point five hours a night. Europeans do a little bit better, seven hours per night, but that historically we're sleeping about an hour and a half less than our grandparents. This is a strong message I think for many of us. Should be counseling our patients on proper sleep because sleep is being associated with many bad outcomes, diabetes, obesity, cardiovascular disease.
A meta analysis of 35 studies looked at nonsteroidals and back pain, and guess what? These meta analyses for common drugs that we commonly use in low back pain don't ever fare very well, and this one didn't either. It did show that they have a modest benefit, but nonetheless a two and a half full increased risk of GI toxicity. The FDA has recently approved Rituxan subcutaneously for use in lymphoma and CLL, but is not yet approved for use in rheumatoid arthritis and other rheumatic disorders. But nonetheless, this it's an interesting advance.
It can be given subcutaneously. It's called Rituxan Hysella, like the train, but nonetheless is out there and now available for use. A study of a 100 ANAs who had pair testing, ANAs done by multiple methods showed that the agreement between pair testing is actually not very good. It's only about eighteen to forty two percent. They're using different criteria.
Now the patients who actually had an ANA associated connective tissue disease, there was even less agreement. So again, there's a lot of variability. With the increased sensitivity of ANAs, we have a lot of a loss of specificity. Interesting report, about why maybe osteoarthritis patients, may preferentially affect women. Researchers looked at, synovial fluid exomes and looked at specifically microRNA from those exome analyses and showed there was a major discrepancy between men and women with regard to the types and numbers of microRNAs that were upregulated and downregulated and that some of this activity was related to estrogen.
And then more importantly, they showed that if you use aromatase inhibitors, can actually reduce the amount of those micro RNAs in women that may be associated with osteoarthritis. Maybe this is why there's more osteoarthritis in women. A small review looked at breastfeeding amongst lupus patients who've delivered. Not surprisingly, breastfeeding is down in patients with lupus. The number who elected to not initiate breastfeeding was higher in lupus, about twenty percent versus six percent in non lupus control.
More importantly, the duration of breastfeeding was also lower in patients with lupus. And the last report coming from ULAAR 2017 was about IV golimumab. This was a very surprising trial. It showed that golimumab in the Go Vibrant study Mhmm. Four hundred and eighty patients given two milligrams per kilogram of Symphony versus a placebo.
Rates were really stunning. At week fourteen, seventy five percent versus twenty two percent. A very important result and and a nice result for Golumumab. That's it for this week on rheumnow.com. Go to this website.
See the citations. Next week, we're on vacation. Enjoy the holidays. Take care.
This week on RheumNow, a number of interesting items. ACE levels. I don't know if you consider using ACE levels diagnostically. We always talk about them. We certainly know that ACE levels are correlated well with pulmonary involvement in patients with sarcoidosis.
But I've encountered some patients recently with very high ACE levels and researching the subject come up with a few citations that show that high ACE levels are not unique to sarcoidosis. Certainly you can have sarcoidosis, very active sarcoidosis, and have normal ACE levels including sarcoidosis with lung involvement. But very high levels can also be seen in other granulomas disorders, in lymphoma, in cancer, in hyperparathyroidism, even Crohn's disease and hepatitis B. There's a wide differential diagnosis with high ACE levels. A study of 200 patients with rheumatoid arthritis showed that carotid plaques were seen in over half the patients.
Interestingly plaque was correlated with ACCA. Again, the idea that rheumatoid arthritis is uniquely primed to lead to cardiovascular disease is something that's probably much more obvious than just disease activity. A national study looked at ER visits for shingles and showed that in the pre Zostavax year prior to 2007, there was a sort of steady incline. But that actually that rate dropped significantly, not in younger groups, but in the older age group. The group that would likely get the shingles vaccine, there was significant significant drop drop nationwide nationwide in ER visits for zoster.
A nice study, I think, in the analysis of paramedicine looked at the, comparative roles of yoga and physical therapy and other modalities in treating chronic low back pain showing that yoga is actually equal to physical therapy in those outcomes. Whole genome sequencing is popping up here and there and it seems to be a promising tool to identify patients who have really strange disorders, undiagnosed disorders. And a study in animals looked at 100 patients and looked at the utility of whole genome sequencing and showed that in only about twenty percent would whole genome sequencing reveal a gene that may be associated with disorder. Unfortunately, the number of those patients who actually had the disorder was even lower, suggesting that this is probably not a, not yet for prime time test, in patients, who have undiagnosed disorders. Again, back to sarcoidosis, there is a strange, study, but nonetheless, study looked at the risk of fracture with sarcoidosis.
I don't know why one would assume there's a risk of fracture, and it showed, guess what, no risk of fracture unless of course you're on steroids and then the risk is related to steroids. A recent study looked at Americans and Europeans and showed that Americans sleep on average six point five hours a night. Europeans do a little bit better, seven hours per night, but that historically we're sleeping about an hour and a half less than our grandparents. This is a strong message I think for many of us. Should be counseling our patients on proper sleep because sleep is being associated with many bad outcomes, diabetes, obesity, cardiovascular disease.
A meta analysis of 35 studies looked at nonsteroidals and back pain, and guess what? These meta analyses for common drugs that we commonly use in low back pain don't ever fare very well, and this one didn't either. It did show that they have a modest benefit, but nonetheless a two and a half full increased risk of GI toxicity. The FDA has recently approved Rituxan subcutaneously for use in lymphoma and CLL, but is not yet approved for use in rheumatoid arthritis and other rheumatic disorders. But nonetheless, this it's an interesting advance.
It can be given subcutaneously. It's called Rituxan Hysella, like the train, but nonetheless is out there and now available for use. A study of a 100 ANAs who had pair testing, ANAs done by multiple methods showed that the agreement between pair testing is actually not very good. It's only about eighteen to forty two percent. They're using different criteria.
Now the patients who actually had an ANA associated connective tissue disease, there was even less agreement. So again, there's a lot of variability. With the increased sensitivity of ANAs, we have a lot of a loss of specificity. Interesting report, about why maybe osteoarthritis patients, may preferentially affect women. Researchers looked at, synovial fluid exomes and looked at specifically microRNA from those exome analyses and showed there was a major discrepancy between men and women with regard to the types and numbers of microRNAs that were upregulated and downregulated and that some of this activity was related to estrogen.
And then more importantly, they showed that if you use aromatase inhibitors, can actually reduce the amount of those micro RNAs in women that may be associated with osteoarthritis. Maybe this is why there's more osteoarthritis in women. A small review looked at breastfeeding amongst lupus patients who've delivered. Not surprisingly, breastfeeding is down in patients with lupus. The number who elected to not initiate breastfeeding was higher in lupus, about twenty percent versus six percent in non lupus control.
More importantly, the duration of breastfeeding was also lower in patients with lupus. And the last report coming from ULAAR 2017 was about IV golimumab. This was a very surprising trial. It showed that golimumab in the Go Vibrant study Mhmm. Four hundred and eighty patients given two milligrams per kilogram of Symphony versus a placebo.
Rates were really stunning. At week fourteen, seventy five percent versus twenty two percent. A very important result and and a nice result for Golumumab. That's it for this week on rheumnow.com. Go to this website.
See the citations. Next week, we're on vacation. Enjoy the holidays. Take care.
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