Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic syndrome (VEXAS) took the centre stage when it was first introduced at ACR20 last year. It got everyone’s thinking that they might have encountered one or two patients in their rheumatology lifetime who might have this condition. One year on, more cases have been reported and this article summarises some breakthroughs pertaining to research in VEXAS.

Annals of Internal Medicine has reported the results of a randomized clinical trial showing that telehealth-delivered exercise and diet programs improved pain and function in knee osteoarthritis patients who were overweight.  While both were beneficial, exercise had a greater effect than dietary instruction delivered by telehealth.

This Australian study assessed if a telehealth-delivered exercise program would be further enhanced by also providing a dietary intervention.

Should we start considering therapeutic drug monitoring when prescribing TNFi for treatment of our rheumatologic conditions?

The NOR-DRUM trials (A and B) are the first randomized trials to assess the impact of proactive therapeutic drug monitoring of infliximab in the treatment of multiple immune-mediated inflammatory diseases (abstract 1946). 

Excess adiposity and genetic predisposition both contributed to risk of gout among U.S. women, with the risks being highest when both factors are present, a large prospective study found.

Analysis of data from the Nurses' Health Study (NHS) found that the relative risk for incident gout was 1.49 (95% CI 1.42-1.56) per 5 kg/m2 increase in BMI and was 1.43 (95% CI 1.35-1.52) per standard deviation increase in genetic risk score, according to Hyon K. Choi, MD, of Massachusetts General Hospital in Boston, and colleagues.

The 2021 Nobel Prize in Medicine and Physiology was jointly awarded to Drs. David Julius and Ardem Patapoutian for their discoveries of receptors for temperature and touch. Their work on neural signaling of heat and touch (tactile) relate to many physiologic conditions including chronic pain.

Drs. Jack Cush and Martin Bergman review the topic of treat-to-target (T2T) management in rheumatology.

Both will debate the pro's and con's of the T2T strategy at the upcoming RWCS meeting on Feb. 17, 2022.

You can register and learn more about the meeting at: https://r-w-c-s.com/2022/

Systemic onset juvenile idiopathic arthritis (sJIA) is a dramatic onset inflammatory condition marked by spiking fevers, intermittent rash, polyarthritis and a host of other hyperinflammatory manifestations. The condition may be well controlled in many through the use of high dose corticosteroids often with inhibitors of IL-1 or IL-6.  The problem is that we can therapeutically supress inflammation, but are often left wondering when and how to stop these aggressive and extensive therapies.

The numbers on treatment adherence is disappointingly low in RA, with a number of psychological, communication and logistical factors that outweigh the potentially negative influence of sociodemographic or clinical factors.

A 6-month prospective cohort study of RA patients assessed drug adherence; with one-third each falling into the following treatment groups:

The FDA has approved upadacitinib (Rinvoq) today for use in the treatment of adults with active psoriatic arthritis (PsA) who have had an inadequate response or intolerance to one or more tumor necrosis factor (TNF) blockers.

Safety analysis of over 1000 adverse events associated with the use of tocilizumab in the treatment of COVID‐19 infection shows both rare expected and some unexpected AE.

Tocilizumab, an interleukin-6 receptors monoclonal antibody, is currently authorized for emergency treatment of hospitalized COVID-19 patients. The World Health Organization (WHO) pharmacovigilance database, called vi, was studied to identify 1005 adverse drug events (ADEs) reported among 513 COVID patients treated between April and August 2021.

The FDA approved tofacitinib (Xeljanz, Xeljanz XR) for treating active ankylosing spondylitis in adults, Pfizer announced on Tuesday.

Tofacitinib is the first Janus kinase (JAK) inhibitor approved for ankylosing spondylitis, the drugmaker said, and is indicated specifically for individuals who cannot tolerate or fail to adequately respond to tumor necrosis factor (TNF) inhibitors.

A recent study of drugs used in type 2 diabetes (T2DM) shows that SGLT2 inhibitors have a lower risk for gout compared with those receiving DPP4 inhibitors.

The sodium–glucose cotransporter-2 inhibitors (e.g., Invokana, Jardiance, Farxiga) are reported to lower the risk of gout in T2DM patient.  Yet, the use of dipeptidyl peptidase-4 (DPP-4) inhibitors (e.g., Januvia, Trajenta) may cause arthralgia or arthritis, especially over time.

The U.S. Centers for Disease Control and Prevention (CDC) yesterday recommended Americans has recommended the two authorised mRNA COVID-19 vaccines over Johnson & Johnson's adenovirus COVID-19 vaccine, primarily due to the rare reports of thrombosis with thrombocytopenia syndrome (TTS).

The CDC Advisory Committee on Immunization Practices (ACIP) met to consider recent safety data regarding the J&J vaccine.

Currently, of the 200 million fully vaccinated people in the United States, only 16 million have received J&J's vaccine.

EULAR has published evidence-based recommendations on the use of intra-articular therapies (IAT) based on the literature review and recommendations of a multidisciplinary international task force. These IAT recommendations apply to adult patients with peripheral arthropathies.

The committee published 5 overarching principles and 11 recommendations addressing procedure and setting, accuracy, routine and special aseptic care, safety issues, precautions, special populations, repeated joint injections, local anaesthetics use and IAT aftercare.

Since the COVID vaccine rollout, more people have been eligible to receive the vaccine. However, not everyone chooses to get one. I have heard many reasons (aka excuses) from my patients who are vaccine hesitant. 

Most come from people who are highly intelligent, and claimed that they will receive the vaccine but not yet.  While I am not trying to force people to get vaccinated, I wanted to hear their side of the story and also ask that they hear mine. 

Genentech announced March 4th that the US Food and Drug Administration approved tocilizumab (Actemra) for the treatment of Systemic Sclerosis-associated Interstitial Lung Disease (SSc-ILD), specifically indicated for slowing the rate of decline in pulmonary function in adults SSc-ILD.

Tocilizumab is the first biologic, but second drug (following ninteninib), to be approved to curtail the worsening of SSc-ILD.

As many of you are aware, I have written and spoken on COVID-19 extensively over these past 20 months, and just last month wrote about the dangers of the delta variant. In July, things took an unexpected turn when I developed a breakthrough infection with the delta variant.