The RheumNow Week In Review May 19%2C 2017 Save
The RheumNow Week In Review May 19%2C 2017 by Dr. Cush
Transcription
Hey now. I'm Doctor. Jack Cush, executive editor of rheumnow.com. It's the May 19, and this is the RheumNow we can review. This week announcements, Doctor.
David Felsen has actually been awarded a very prestigious honor with the Nachman Prize, which is Germany's highest honor and award for research in rheumatology. Congratulations, Doctor. Felsen. A report out of multiple countries looks at the worldwide prevalence of rheumatoid arthritis in low to middle income countries and showed that from 2000 to 2010, the prevalence of rheumatoid arthritis has steadily increased, such that at this point in 2010, there's three point two million males who have rheumatoid arthritis and fourteen point nine million women worldwide who have rheumatoid arthritis. Rheumatoid arthritis is increasing, that's interesting.
I thought it was getting milder. A report shows that fragility fractures in RA, not an uncommon event, is actually associated with significantly higher risk of cardiovascular events. That hazard ratio is one point eight one, so an eighty one percent increase in such patients. This affects males and females equally and speaks to probably the influence of inflammation on bone loss. Olga Petrina tweeted this week that SubQ Symphony has actually failed its primary endpoints in a trial polyarticular JIA.
That's an interesting finding, one you wouldn't expect it. But, again, Symphony sometimes doesn't do quite as well as far as its the longevity and duration of effect, and maybe that had something to do with a lower response rate in polyarticular JIA. A study of one hundred and eighty nine lupus patients followed over thirteen years showed quite expectedly that the use of either aspirin or hydroxychloroquine was associated with a fifty three percent to fifty nine percent reduction in cardiovascular events. This has been seen before, especially for hydroxychloroquine, but for both and for low dose aspirin, that's a sobering issue. Aspirin a long time ago used to be the only treatment for lupus, maybe that's one of its benefits.
It turns out that in lupus patients, the presence of an antiphospholipid antibody or hypertension is associated with a much higher risk of cardiovascular events and as much as an eighteen fold risk of cardiovascular events. A study of seven thirty six lupus patients has shown that poverty has significant downstream effects, meaning that those who had poverty were more likely to suffer organ damage when looked at five years and more later. Again, showing you a substantial influence of socioeconomic status on outcomes in these chronic inflammatory diseases. Drug induced hyperuricemia review article shows you the things you should know that these drugs are associated with higher uric acid levels and a higher rate of gout. So drug induced hyperuricemia can come from diuretics, especially thiazide diuretics, but also the TB drugs ethambutol and pyrazinamide, EMB and PZA, low dose aspirin, cyclosporine, the sugars fructose, xylitol, and lactate all contribute to risk, as does cytotoxics, alcohol, and lastly nicotinic acid.
A review of almost seventeen thousand patients who visited the emergency room showed that there was a large number of patients who had septic arthritis. Of those who were evaluated in the emergency room, eighty three percent of them resulted in hospitalization, especially those who had pre existing comorbidities and pre existing arthritis. So septic arthritis, first pathway usually is through the ER, many of them get hospitalized, and they should be identifiable because they have preexisting inflammatory degenerative disease that puts them at risk. The British Society of Rheumatology had its meeting last month and or earlier this month, I should say, April, and had a lot of good reports that came out of that meeting. One report comes from the BSRBR Registry on Biologics that specifically looks at ankylosing spondylitis patients and they showed that smoking was associated with more severe ankylosing spondylitis and SPA.
Not surprising as this has been seen in other disorders including JIA, including RA, including psoriatic arthritis. I don't know if you're aware of CADM, clinically amyopathic dermatomyositis. These are what we used to call dermatomyositis, cinemyositis. There's a new antibody that's characterized as part of the characterization of this condition, and that's the MDA-five antibody. It is commercially available and its presence is associated with CADM.
It is also associated with interstitial lung disease, especially rapidly progressive interstitial lung disease. It's also associated with lower CPK and lower aldolase levels. Many of these patients are often ANA negative and many of them have cytoplasmic staining on the ANAs that are done. So there is a profile that is associated with CADM. CADM is a bad marker.
It is again associated with a lot of severe skin and very, very severe progressive lung disease. I found a nice little report, a review of the University of California at San Francisco Moffitt Center had a lecture on scleroderma and the heart, and I tweeted a bunch of things from the UCSF Moffitt Center. I'll give you two, that symptomatic pericarditis is seen in twenty percent of scleroderma patients but that eighty percent have pericardial disease on autopsy. And then pericardial disease, whether be pericardial effusion, pericarditis, and heart disease in itself is a poor prognostic factor for the development of renal disease, especially for the development of renal crisis and scleroderma. There were a number of reports that were very interesting this week.
A non prescribed opioid abuse being seen in young adults, we wrote about that. This was a review of young adults who were declared to have non prescribed opioid use and found out, not surprisingly, many of them used pain as a reason why they were achieving it. This is more often seen in young men, many of whom didn't have insurance, many of whom cited that other doctors had seen them and denied them access to pain medications and hence their reason for seeking out these illicit drugs for pain control. It's a rising problem, one that's not a good one in the current milieu of fear about opioids and their dangers. The Northswitch study was published this week in or actually two weeks ago in Lancet.
And the Northswitch study is a very important study about biosimilars and how biosimilars are going to be adopted in and around the world. This was a study that was part of Norway's taking on the new biosimilar for infliximab. They're called REMSMA. In The United States, it's called Inflectra. The it is the generic is called CTP-thirteen.
And as a condition of their initial introduction and sixty nine percent discount for such therapy, They did a study of over four fifty patients with all the indications for infliximab that includes RA, PSA, psoriasis, ankylosing spondylitis, ulcerative colitis and Crohn's. And the objective was to take patients who are well controlled on Remicade or infliximab and then switch them over to either the new biosimilar or blindly keep them on the same therapy. And in the endpoint, they were looking for flares being different between the groups and hence this is a non inferiority study. At the end of, I believe, six months, there was no change, there was no increased flare rate in those who switched over to the biosimilar. The side effects, the efficacy profiles all look the same.
These the outcomes which was measured as the number of people who had increases in activity as determined by the standard measure of activity in that disease were not different between the two groups. There was a trend maybe towards maybe more flares in the Crohn's disease group, but again the study was powered to look at all these chronic immune mediated inflammatory disease patients together and again achieve the endpoint of non inferiority. Hence, this is going to be one of the pivotal trials that will be used to explain the utility and the safety of a switchover from the existing originator biologic to these new biosimilars. Two studies this week looked at the what's going on inside the knees of people with degenerative disease. And one looking at steroid injections in patients who have osteoarthritis in the knee looked at both the acute and long term benefits.
There really were none. And they also noticed long term that there was more cartilage loss in patients who received corticosteroid knee injections suggesting against the use of these injections to manage patients with knee OA. And then the idea of using arthroscopy to treat patients with degenerative knees and meniscal tears, another study looked at that and showed really no benefit to arthroscopy in such patients, whether that be for clean out or whatever. And lastly, there's a nice review of what happened in a large cohort, a single center study of patients who received rituximab and they compared those patients to those who didn't receive rituximab and they showed that rituximab did have a substantial benefit in reducing the development and or progression of interstitial lung disease in patients with RA. That's RA lung, again patients who have severe disease and progressive interstitial lung disease that there may be a significant role for rituximab in such patients.
I'll end with a quote from my patient when I asked him this week, Are you taking Voltaren gel? He said, I went to the pharmacy and I didn't fill it because it was $750 and his quote was, I may be sick in my joints, but I'm not sick in the head. Sounds like brilliance to me. That's it for this week at roomnow.com. Go to the website to find the citations for these reports and more interesting news from the wonderful wide world of rheumatology.
That's it for this week. We'll see you next week. Bye.
David Felsen has actually been awarded a very prestigious honor with the Nachman Prize, which is Germany's highest honor and award for research in rheumatology. Congratulations, Doctor. Felsen. A report out of multiple countries looks at the worldwide prevalence of rheumatoid arthritis in low to middle income countries and showed that from 2000 to 2010, the prevalence of rheumatoid arthritis has steadily increased, such that at this point in 2010, there's three point two million males who have rheumatoid arthritis and fourteen point nine million women worldwide who have rheumatoid arthritis. Rheumatoid arthritis is increasing, that's interesting.
I thought it was getting milder. A report shows that fragility fractures in RA, not an uncommon event, is actually associated with significantly higher risk of cardiovascular events. That hazard ratio is one point eight one, so an eighty one percent increase in such patients. This affects males and females equally and speaks to probably the influence of inflammation on bone loss. Olga Petrina tweeted this week that SubQ Symphony has actually failed its primary endpoints in a trial polyarticular JIA.
That's an interesting finding, one you wouldn't expect it. But, again, Symphony sometimes doesn't do quite as well as far as its the longevity and duration of effect, and maybe that had something to do with a lower response rate in polyarticular JIA. A study of one hundred and eighty nine lupus patients followed over thirteen years showed quite expectedly that the use of either aspirin or hydroxychloroquine was associated with a fifty three percent to fifty nine percent reduction in cardiovascular events. This has been seen before, especially for hydroxychloroquine, but for both and for low dose aspirin, that's a sobering issue. Aspirin a long time ago used to be the only treatment for lupus, maybe that's one of its benefits.
It turns out that in lupus patients, the presence of an antiphospholipid antibody or hypertension is associated with a much higher risk of cardiovascular events and as much as an eighteen fold risk of cardiovascular events. A study of seven thirty six lupus patients has shown that poverty has significant downstream effects, meaning that those who had poverty were more likely to suffer organ damage when looked at five years and more later. Again, showing you a substantial influence of socioeconomic status on outcomes in these chronic inflammatory diseases. Drug induced hyperuricemia review article shows you the things you should know that these drugs are associated with higher uric acid levels and a higher rate of gout. So drug induced hyperuricemia can come from diuretics, especially thiazide diuretics, but also the TB drugs ethambutol and pyrazinamide, EMB and PZA, low dose aspirin, cyclosporine, the sugars fructose, xylitol, and lactate all contribute to risk, as does cytotoxics, alcohol, and lastly nicotinic acid.
A review of almost seventeen thousand patients who visited the emergency room showed that there was a large number of patients who had septic arthritis. Of those who were evaluated in the emergency room, eighty three percent of them resulted in hospitalization, especially those who had pre existing comorbidities and pre existing arthritis. So septic arthritis, first pathway usually is through the ER, many of them get hospitalized, and they should be identifiable because they have preexisting inflammatory degenerative disease that puts them at risk. The British Society of Rheumatology had its meeting last month and or earlier this month, I should say, April, and had a lot of good reports that came out of that meeting. One report comes from the BSRBR Registry on Biologics that specifically looks at ankylosing spondylitis patients and they showed that smoking was associated with more severe ankylosing spondylitis and SPA.
Not surprising as this has been seen in other disorders including JIA, including RA, including psoriatic arthritis. I don't know if you're aware of CADM, clinically amyopathic dermatomyositis. These are what we used to call dermatomyositis, cinemyositis. There's a new antibody that's characterized as part of the characterization of this condition, and that's the MDA-five antibody. It is commercially available and its presence is associated with CADM.
It is also associated with interstitial lung disease, especially rapidly progressive interstitial lung disease. It's also associated with lower CPK and lower aldolase levels. Many of these patients are often ANA negative and many of them have cytoplasmic staining on the ANAs that are done. So there is a profile that is associated with CADM. CADM is a bad marker.
It is again associated with a lot of severe skin and very, very severe progressive lung disease. I found a nice little report, a review of the University of California at San Francisco Moffitt Center had a lecture on scleroderma and the heart, and I tweeted a bunch of things from the UCSF Moffitt Center. I'll give you two, that symptomatic pericarditis is seen in twenty percent of scleroderma patients but that eighty percent have pericardial disease on autopsy. And then pericardial disease, whether be pericardial effusion, pericarditis, and heart disease in itself is a poor prognostic factor for the development of renal disease, especially for the development of renal crisis and scleroderma. There were a number of reports that were very interesting this week.
A non prescribed opioid abuse being seen in young adults, we wrote about that. This was a review of young adults who were declared to have non prescribed opioid use and found out, not surprisingly, many of them used pain as a reason why they were achieving it. This is more often seen in young men, many of whom didn't have insurance, many of whom cited that other doctors had seen them and denied them access to pain medications and hence their reason for seeking out these illicit drugs for pain control. It's a rising problem, one that's not a good one in the current milieu of fear about opioids and their dangers. The Northswitch study was published this week in or actually two weeks ago in Lancet.
And the Northswitch study is a very important study about biosimilars and how biosimilars are going to be adopted in and around the world. This was a study that was part of Norway's taking on the new biosimilar for infliximab. They're called REMSMA. In The United States, it's called Inflectra. The it is the generic is called CTP-thirteen.
And as a condition of their initial introduction and sixty nine percent discount for such therapy, They did a study of over four fifty patients with all the indications for infliximab that includes RA, PSA, psoriasis, ankylosing spondylitis, ulcerative colitis and Crohn's. And the objective was to take patients who are well controlled on Remicade or infliximab and then switch them over to either the new biosimilar or blindly keep them on the same therapy. And in the endpoint, they were looking for flares being different between the groups and hence this is a non inferiority study. At the end of, I believe, six months, there was no change, there was no increased flare rate in those who switched over to the biosimilar. The side effects, the efficacy profiles all look the same.
These the outcomes which was measured as the number of people who had increases in activity as determined by the standard measure of activity in that disease were not different between the two groups. There was a trend maybe towards maybe more flares in the Crohn's disease group, but again the study was powered to look at all these chronic immune mediated inflammatory disease patients together and again achieve the endpoint of non inferiority. Hence, this is going to be one of the pivotal trials that will be used to explain the utility and the safety of a switchover from the existing originator biologic to these new biosimilars. Two studies this week looked at the what's going on inside the knees of people with degenerative disease. And one looking at steroid injections in patients who have osteoarthritis in the knee looked at both the acute and long term benefits.
There really were none. And they also noticed long term that there was more cartilage loss in patients who received corticosteroid knee injections suggesting against the use of these injections to manage patients with knee OA. And then the idea of using arthroscopy to treat patients with degenerative knees and meniscal tears, another study looked at that and showed really no benefit to arthroscopy in such patients, whether that be for clean out or whatever. And lastly, there's a nice review of what happened in a large cohort, a single center study of patients who received rituximab and they compared those patients to those who didn't receive rituximab and they showed that rituximab did have a substantial benefit in reducing the development and or progression of interstitial lung disease in patients with RA. That's RA lung, again patients who have severe disease and progressive interstitial lung disease that there may be a significant role for rituximab in such patients.
I'll end with a quote from my patient when I asked him this week, Are you taking Voltaren gel? He said, I went to the pharmacy and I didn't fill it because it was $750 and his quote was, I may be sick in my joints, but I'm not sick in the head. Sounds like brilliance to me. That's it for this week at roomnow.com. Go to the website to find the citations for these reports and more interesting news from the wonderful wide world of rheumatology.
That's it for this week. We'll see you next week. Bye.
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