Vitamin D and Lupus Outcomes (11.21.2025)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.
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No risk of MACE seen w/ initiation of IL-17(R)A inhib. French study of 34 241 ipts Rx IL-17(R)Ai and 381 MACEs. MACE risk was not elevated (OR, 1.25 [95% CI, 0.75-2.08] vs TNF-α inhibitors. https://t.co/WcjgRhr8mj https://t.co/Gp54eLlXSI
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APEX Study: Inhibition of structural damage progression with Guselkumab in PsA
Guselkumab, a human IL-23 inhibitor, was evaluated in patients with active PsA and shown to have both clinical and radiographic benefits at weeks 24 and 48.
https://t.co/iNEziysnVZ https://t.co/XgFGFfGf3b
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Target emulation trial of 12,145 Pts (87% female; age 80 yrs), shows that compared to teriparatide, Rx w/ romosozumab was assoc w/ significantly lower risk of osteoarthritis (RR 0.79); especially for knee OA (0.79). https://t.co/nEdENoNae7 https://t.co/JiyRd6ThXu
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Cochrane review & metanalysis of Colchicine & CV outcomes. 12 studies, 22,983 prt (11,524 on colchicine). Good evidence colchicine signif. reduces the risk of MI (RR 0.74), stroke (RR 0.67), but does not incr serious adverse events (RR 0.98), but causes GI AEs (RR 1.68) https://t.co/wqOtGLdxep
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Serious infections w/ adalimumab. Marketscan MarketScan claims study (1/17-12/20) of ADA Rx in Hidradenitis Supprativa (n 1650) or psoriasis(8699). Risk of SIE & hospitalization greater w/ HS (HR 1.53); esp for sepsis & GU infxn https://t.co/2qa7O2v6fm
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Lupus Nephritis study of 136 pts followed 121 mos. Median time to wean GC to 7.5 mg/day, 5 mg/day & D/C was 9, 12 & 29 months post-Dx. Predictors of shorter time to D/C= Sustained CR/SLEDAI-2K≤4, membranous LN, & HCQ. Prolonged GC & renal flares increase damage accrual
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Pulse Steroids and Mycophenolate in Juvenile Dermatomyositis
JAMA Dermatology has published a pilot study demonstrating the safety and efficacy of intermittent intravenous methylprednisolone pulse (IVMP) therapy plus mycophenolate in 28 patients with juvenile dermatomyositis (JDM).
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Australian Vaccine study (2019 - 2021) - w/in 12 mos of b/tsDMARD initiation 73% (11,225/15,460) recv influenza vaccination. High-dose Flu vax used in 28% in 60–69 yo, but > 80% older than 70yo. Only 9.7% recv pneumococcal & 2.4% zoster Zostavax or Shingrix) vax w/in 6 months of https://t.co/xoGTWMUi1L
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Metanalysis of 56 articles & 72,677 RA pts w/ a Dz duration of 9.7 yrs looked at biologic persistence. In csDMARD-IR, over 5 yrs TCZ (66%) & golimumab (62%) best. In bDMARD-IR, ABA (45%) & ETN (41%) best. Lower Rx survival predicted by steroids, hi Dz activity, & female https://t.co/tepL0A9Fwb
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Postmenopausal women on estrogen hormone therapy (HT) had a modest incr risk (HR 1.33; 1.32-1.35; P < .001). of a new autoimmune Dz over next 5-10 yrs (vs those not on HT) TriNetX study of 889,413 HT vs 2,6 mill (not HT) - 6.7% vs 5.3% developed autoimmune dz at 5 yrs. https://t.co/fsi32XIzLe
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Hospital Mortality in Dermatomyositis
A cohort study reveals that hospitalized patients with dermatomyositis have a higher in-hospital mortality rate in the presence of active rash, interstitial lung disease, and an elevated neutrophil-to-lymphocyte ratio at admission. https://t.co/6WIFVJT9w7
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In 2024, 77 pts referred to Rheum for possible PMR were ultimately Dx w/ B19 viral infx. 96% had arthralgia & 7% had PMR-like features (5/5 w/ BL shoulder/neck. prolonged AM stiff, fever & Hi CRP/ESR - none had hip pain. 4/5 were male, w/ mean age of 55 yrs. None were RF/CCP+ https://t.co/SsLVEyL8X8
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Treating During Pregnancy (11.14.2025)
Dr. Jack Cush reviews the journal articles, news and guidelines from this past week on RheumNow.com
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Having #RA does not increase mortality in CA pts Rx w/ immune checkpoint inhibitors (ICI). 301 Veterans w/ RA & 2114 nonRA controls were compared: all-cause mortality was similar (HR 1.09; 0.94, 1.25). Most deaths from cancer (90% & 91%), but rarely from infection (<1%) https://t.co/gsXie6HpTu
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SLE Prospect. Observational Study of 826 SLE pts over 3 yr for outcomes& IFN signature (IFNGS). 71% were IFNGS-high. IFNGS-high pts were younger. on GC w/ Hi SLEDAI-2K. SLEDAI-2K decreased over time, regardless of IFNGS. By 36mos, 45% had ≥1 flare; higher in IFNGS. https://t.co/c3zHT2GfR5
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Hospital Mortality in Dermatomyositis
A cohort study shows that hospitalized patients with dermatomyositis have higher in-hospital mortality in the presence of active rash, interstitial lung disease, and elevated neutrophil to lymphocyte ratio at admission.
Dermatomyositis (DM) has significiant
Western Australia study of 1854 SLE pts (median 40 yrs old). Interstitial lung disease was seen in in 3.8% of SLE, 26 fold more than controls. Risk factors for ILD included older age, smoking and serositis. SLE-ILD pts had higher mortality rates (MR 52.0, CI 37.0–71.1).
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More on Methotrexate and ILD Risk
To assess the progression of the interstitial lung disease related to Methotrexate (MTX) exposure, and to evaluate the lung involvement in RA non-ILD patients with MTX exposure, a systematic review was performed to assess whether RA patients receiving methotrexate (MTX) are at greater
IL-1 Inhibition in CPPD
Controlled clinical trials in patients with calcium Pyrophosphate Deposition Disease (CPPD) are scant. Now a metanalysis provides evidence that anakinra, an interleukin-1 inhibitor, is a promising alternative for patients with acute CPPD flares.
The purpose of this analysis is
Biologic use in 5008 IBD pts finds higher serious infxn (SIE) rates (vs, RA or PsO). In UC the SIE rate was 5.5/100PY w/ vedolizumab & 7/100PY w/ other biologics. In Crohns the SIE rate was 7.9/100PY w/ vedolizumab vs 6.5/100PY w/ other biologics (adj HR 1.15; 0.95–1.40) (P .16) https://t.co/R7YC220NnO
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Genetic Risks and Severe Cutaneous Reactions to Allopurinol
A matched cohort study shows that HLA-B*58:01 and HLA-A*34:02 are strongly associated with allopurinol-induced severe cutaneous adverse reactions (SCARs), these alleles were absent in more than one-third of those https://t.co/NLpHVhr9Ww
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Swedish Birth Registry study of adverse preg outcomes (APOs) after SSc Dx [n=941] or w/in 3 yrs [39] or > 3yrs pre-Dx [839]. SSc women have incr APOs post-Dx, including preeclampsia (RR 3.8), preterm (3.3), C-section (2.5); but also incr APO risk w/in 3 yrs of Dx
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NHANES study of 4,622 adults, including 296 w/ RA, shows volatile organic compounds (VOCs) & metabolites (mVOCs) exposures increases the risk of #RA (OR: 1.23 - 1.37), especially in females. https://t.co/pBNLTRkyLn https://t.co/L6nVbYlBhD
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DAHLIAS study - Nipocalimab in Sjögren's Disease
Nipocalimab, a neonatal Fc receptor blocker that reduces circulating IgG and autoantibodies, was shown to be effective in a phase 2 trial in patients with severe Sjögren's disease.
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