ICYMI: Five Takeaways in PsA/SpA at RNL 2024
Continuing with the theme of clinical pearls, the PsA and SpA speakers also provided a wealth of information. Here are my five key takeaways and clinical pearls.
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ICYMI: How do you manage enthesitis?
Enthesitis can be a challenge for clinicians to identify, evaluate, and manage in patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). It affects 27-35% of PsA patients and 36% of axSpA patients. Dr. Lihi Eder discussed the evaluation and treatment of enthesitis at
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TNFi mAbs, JAKi, –IL-17 are protective against Anterior Uveitis (AU) in AxSpA. Metanalysis of 44 RCTs shows AU IR:
- TNF mAbs: 4.1
- etanercept 5.4
- IL-17i: 2.8
- JAKi: 1.5
- placebo: 10.8 https://t.co/qN9UL16YPO https://t.co/5WOjAq9ty6
Dr. John Cush @RheumNow( View Tweet )
ICYMI: Sex Disparities in PsA/SpA
https://t.co/55zwjR8mNR https://t.co/fhhekNpHVA
Dr. John Cush @RheumNow( View Tweet )
BASDAI tends to be higher in women while there is no appreciable difference in ASDAS scoring in men compared to women.
Dr. L. Eder believes this could be due to the pain scoring in both indices.
#RNL2024 @RheumNow @lihi_eder https://t.co/PSnFwX3eHu
Links:
Dr. John Cush @RheumNow( View Tweet )
ICYMI: Sex Disparities in PsA/SpA
Dr. Eder delivered an illuminating talk at RheumNow Live 2024 on sex differences in psoriatic arthritis; the disease may manifest differently in men and women, and therapeutic responses may differ between the sexes.
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#RNL2024 @RheumNow
@AlexisOgdie
Many therapies for SpA - but ONLY TNFi, IL17i, and JAKi for AxSpA
Check out https://t.co/3918uYvdFj to help guide treatment decisions: Prior therapies? enthesitis? concomitant IBD/uveitis? comorbidities? Pt preferences? https://t.co/6ugueBPMTy
Dr. John Cush @RheumNow( View Tweet )
H2H study of secukinumab vs adalimumab biosimilar in axial-SpA pts saw no difference & little change in Xray progression for both Rxs. 859 pts showed no signif diff w/ NO Xray progr (66%, 67%, 66%) or mSASSS (0.54, 0.55, 0.72) change https://t.co/QqB1aCjfN7 https://t.co/Ktfi7xVoC6
Dr. John Cush @RheumNow( View Tweet )
1/600 Falls May Die (4.5.2024)
Dr. Jack Cush reviews the news and Journal reports from this past week on RheumNow.com - including problems w/ falls, pain and treatment of Dupuytren’s contractures.
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Korean biologics registry study 526 Ank Spondylitis pts on TNFi > 1yr and tapered; 24.1% experienced flares. Predictors of flare included B27+, inflammatory LBP, psoriasis, SpA Fam Hx, DM, ≥50% TNFi tapering, Dz activity (ASDAS-CRP, BASFI) at tapering https://t.co/jjyMX3borT https://t.co/u0lbtfCyz1
Dr. John Cush @RheumNow( View Tweet )
Activity & Pain Tolerance (3.29.2024)
Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com, including where you should sit in clinic and why you should worry about secondary Sjogren's in RA.
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Obesiy (& Visceral abdominal fat) in Ankylosing Spondylitis is assoc w/ worse Dz activity, funct disability, & spinal mobility in study of 74 radiographic axSpA treated with bDMARDs. https://t.co/Z5e9cU62nS https://t.co/fD9lhj085B
Dr. John Cush @RheumNow( View Tweet )
Marketing research estimates there were 1,389,116 prevalent cases of Ankylosing Spondylitis in 2017 https://t.co/bn4QHBNxEd https://t.co/BN1aNvgebS
Dr. John Cush @RheumNow( View Tweet )
Naysayers & Disrupters (3.22.2024)
Dr. Jack Cush reviews the news and journal reports from the past week - including a few contrary reports on infection, seropositivity and plasmapheresis.
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Washington Post: Case of Delayed Rheum Diagnosis
The Washington Post recently published a "medical mystery" case titled, "Medical Mysteries: A rolled ankle set this runner down a painful path", which tells the tale of how and why rheumatologists are often not consulted or are consulted too late.
The patient is a 33 year old
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Ides of March (3.15.2024)
Dr. Jack Cush has advice for Caesar and the superstitious, and covers pregnancy, platelets, dialysis and vaccinations in Lupus.
Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory
Long-term safety of Ixekizumab (IXE) - 26 RCTs (22k PYs) in PSO, PsA, AS & nr-axSpA
- nasopharyngitis most common AE; AEs did not incr over time
- D/C from AE 3-5/100Pys
- ISRs: 5.9-11.6/100PYs
- Candida 1.2-2/100PYs
- IBD: 0.1 PsO - 0.8/100PY for axSpA
https://t.co/nOoCE3VOxD https://t.co/F4gP1yR1Je
Dr. John Cush @RheumNow( View Tweet )
Have a Rheumatology question or case for Jack Cush? Record it here and we'll feature it on an upcoming podcast. Tell us your name and where you practice rheumatology.
https://t.co/a3XeAa2lcG https://t.co/dTZa2uQF97
Dr. John Cush @RheumNow( View Tweet )
19% Arthritis Prevalence in the USA
According to the National Health Interview Survey (NHIS), in 2022, the prevalence of diagnosed arthritis in adults was 18.9% (women 21.5%, more than men 16.1%). These numbers are down since the CDC's MMWR report of 2019–2021, where is was estimated 21.2% of U.S. adults (53.2 million) had
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DESIR study: new onset SpA pts followed w/ Xrays x 10 yrs showed progression from nr-axSpA to r-axSpA was 5.8% (in 294 followed 10 yrs), best predicted by baseline SI bone marrow edema, (OR 6.2), male, Sxs >1.5 yr, ASDAS ≥2.1 & smoking (only in HLA-B27+). https://t.co/A3Qqy8Eeym https://t.co/1I4UFI4h92
Dr. John Cush @RheumNow( View Tweet )
Cross-sectional multicenter study of 500 ax-SpA pts on biologics found 25% w/ Irritable Bowel Syndrome (IBS) that was linked to being Female gender, unemployed, higher BASDAI & BASFI, multiple biologics, FM , anxiety, depression & lower physical activity. https://t.co/RSKVcXZwLt https://t.co/RGsw3fHr3H
Dr. John Cush @RheumNow( View Tweet )
How do you manage enthesitis?
Enthesitis can be a challenge for clinicians to identify, evaluate, and manage in patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA).
https://t.co/BlC3onBYSX https://t.co/OXPdZuJHaN
Dr. John Cush @RheumNow( View Tweet )
Five Takeaways in PsA/SpA at RNL 2024
Continuing with the theme of clinical pearls, the PsA and SpA speakers also provided a wealth of information. Click the link to read our five key takeaways and clinical pearls.
https://t.co/ekKUl5WelF https://t.co/IdPXd7LR65
Dr. John Cush @RheumNow( View Tweet )
Five Takeaways in PsA/SpA at RNL 2024
Continuing with the theme of clinical pearls, the PsA and SpA speakers also provided a wealth of information. Here are my five key takeaways and clinical pearls.
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5 yr prospective observational study of 246 pts w/ nonradiographic Axial Spa shows that 16% of nr-axSpA progressed to r-axSpA w/in 5 yrs. SI progression more likely w/ Male sex (HR 3.16), imaging sacroiliitis (HR 6.6), & good NSAID response (HR 4.6) https://t.co/vAoE1CVkUf https://t.co/32r0TXxCDq
Dr. John Cush @RheumNow( View Tweet )
Recent Blogs
With their publication in June 2022 (1), the 3rd iteration of the Group for Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Treatment recommendations for Psoriatic Arthritis (PsA) may have set a record or sorts.
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