This Tuesday Night Rheumatology panel discussion on "Methotrexate Decisions" features Drs. Michael Weinblatt, Grace Wright, Richard Conway and Joel Kremer. The​ Panel discussed folate & MTX dosing, side effect management, MTX & lung disease and optimal monitoring, with many audience questions.

The FDA quietly approved the interleukin (IL)-1 inhibitor canakinumab (Ilaris) for gout 10 days ago, with no announcement from either the agency or the drug's manufacturer, Novartis -- leaving outsiders to guess at what changed in the dozen years since the company's first attempt to gain approval fell short.

Dr. Jack Cush is joined by Dr. Michael Weinblatt as they discuss this weeks news and journal reports, including difficult RA, HLA typing and abatacept responses and new regulatory decisions. 

1. UCB has issued a press update on its pending application for the approval of their dual IL-17A/F inhibitor, Bimekizumab. A regulatory decision slated for 3rd quarter 2023 has been pushed back. The FDA is continuing its review of the BLA for bimekizumab https://bit.ly/3POHUB2

In a recent randomized clinical trial of patients with fibromyalgia, cognitive-behavioral therapy (CBT)—which uses structured techniques to alter distorted thoughts and negative moods—was superior to a matched education treatment in reducing the interfering effects of pain and other aspects of fibromyalgia on daily living.

While comorbidities, including an increased cardiovascular (CV) risk, are associated with severe psoriasis, less is known about subclinical CV disease and when it occurs in patients with psoriasis. 

Coronary microvascular dysfunction (CMD) has been shown to be predictive of future cardiovascular outcomes and was studied in a cohort of 448 psoriasis patients, who underwent transthoracic Doppler echocardiography to evaluate coronary microcirculation.

In June 2023, RheumNow surveyed US and non-US rheumatologists (Rheums) about how they consider and manage pre-clinical rheumatoid arthritis (RA) in their practice. 

In the last few years there have been numerous well designed and appropriately powered randomized clinical trials of pre-clinical RA patients receiving either a placebo or active intervention.  Such trials of common or targeted therapies studies named PRAIRI (rituximab), TREAT-EARLIER (methotrexate), STOP-RA (hydroxychloroquine), ARIAA and APIPPRA (both with abatacept).

What’s your next best approach to the rheumatoid arthritis (RA) patient who has failed several DMARDs and biologics?  In such cases you have to either reconsider the diagnosis (especially if seronegative) or reach into your bag of tricks.  

As many of us struggle with multi-drug failures in RA, I reached out to the RA therapy mavens, trialists and teachers and asked, “Can you write a few words on  Multi-drug failures in RA.” 

Physician members of the American College of Rheumatology (ACR), care team members of the Association of Rheumatology Professionals (ARP), and patients living with rheumatic diseases convened on Capitol Hill this week for the annual Advocates for Arthritis conference and to support legislative solutions to issues impacting patient access to care.

This week on the podcast, Dr. Jack Cush is joined by special guest, Dr. Kathryn Dao to review the news and journal reports from the past week on RheumNow.com. They discuss unmet needs in gout, obesity and CV disease in PsA and should you check ANCA antibodies in SLE?

1. Painful Truth of #Gout - affects 2–4% adults in USA, UK, & Europe; >10% Asia-Pacific pts. The global burden of gout is increasing. - Majority of pts not on ULT - Majority not T2T monitored - health literacy on gout is vital https://t.co/ypomR2hhFX

Flare prophylaxis is the standard when initiating urate-lowering therapy (ULT) in patients with gout. A new study suggests that colchicine, more so than non-steroidal anti-inflammatory drug (NSAID) prophylaxis, may increase the odds of adverse events, when initiating allopurinol for gout.

A matched retrospective cohort study, using data from the UK Clinical Practice Research Datalink and Hospital Episode Statistics datasets, examined adults starting ULT with allopurinol for gout and who either received no prophylaxis or colchicine or NSAID. 

NEJM reported today that polymyalgia rheumatica (PMR) patients who fail to respond to standard doses of prednisone therapy, were significantly better when given the IL-6 inhibitor sarilumab (than placebo).

The study was undertaken as there is a subset of patients who have relapsing PMR and because there are several studies suggesting the efficacy and safety of interleukin-6 blockade in PMR and giant cell arteritis.

In patients with rheumatoid arthritis (RA) treated with infliximab (Remicade), increases in body mass index (BMI) scores over time were not associated with increased disease activity or faster radiographic progression.

In fact, erosions were less severe in those with rising BMI, according to Theresa Burkard, PhD, of Eidgenössische Technische Hochschule Zürich in Switzerland, and colleagues.

Annals of Internal Medicine reports that the use of 18F-fluorodeoxyglucose (FDG) PET imaging at the time of a giant cell arteritis (GCA) diagnosis may help estimate the risk for aortic aneurysm formation.

This week the CDC's MMWR reports that during 2019–2021, 21.2% of U.S. adults (53.2 million) reported "diagnosed arthritis". And that over half (52.2%–62.4%) of adults with self-reported dementia, chronic obstructive pulmonary disease, stroke, heart disease, diabetes, or cancer also report having been diagnosed with arthritis.