Rheum Chapter Notes (4.26.2024)
Dr. Jack Cush reviews this past week’s news and journal articles from RheumNow.com.
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Predicting CKD Outcomes in Lupus Nephritis
An observational cohort study suggests that proteinuria levels in lupus nephritis (LN) patients did not predict their histologic class.
A multicentre observational study of patients with biopsy-proven LN; either proliferative (PLN) or membranous (MLN) lupus nephritis were compared regarding
High risk medications for pregnancy:
MTX- 40% pregnancy loss, 6-10% birth defects
MMF/CYC - 40% pregnancy loss, 25% birth defects
Recommend 2 forms contraception on MMF
Change meds slowly to safe Rx and monitor disease activity at least 3 mos before pregnancy
#RNL2024 @RheumNow
Dr. John Cush @RheumNow( View Tweet )
Hyperpigmentation from Hydroxychloroquine. From 316 HCQ pts, 26% got hyperpigmentation; delayed onset of 12 mos (6–30mos) after median cum. dose of 108 g. Seen on face (602%), Legs (36%) & hands (20%). Daily sun exposure decrease in the incidence (P=0.02) https://t.co/UX8hnwJjhs https://t.co/xU9RWCcr9C
Dr. John Cush @RheumNow( View Tweet )
Canary in a Coal Mine (4.19.2024)
Dr. Jack Cush reviews regulatory reports, news and novel journal articles - this week focusing on Sjogren's, ILD, Gout and Uveitis.
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SGLT2 Inhibitors Lowers Gout Risks in Type 2 Diabetes
A population-based cohort has demonstrated that sodium-glucose cotransporter-2 inhibitors (SGLT2i) use in gout patients is superior to sulfonylurea therapy in lowering the risk of incident gout and recurrent flares among patients with type 2 diabetes (T2D).
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This study examined the risk of neuroinflammatory disease after initiation of b/tsDMARDs
Overall risk of neuroinflammatory events among new users of TNF inhibitors did not differ substantially as compared to new users of other b/tsDMARDs
In AC&R
https://t.co/8rGgZmpq9c https://t.co/5gxuWBctBL
Links:
ACR_Journals @ACR_Journals( View Tweet )
Korean National Insurance claims study (2010-18) of NSAID use and CV events found among 19,775 RA pts (F/U 98290 PYs); there were 1663 cases of CV evens. Increasing NSAID doses incr incident CVD(adjHR 1.10); including CVA (aHR 1.09). CHF (aHR 1.12) https://t.co/mdRKYMQq1s https://t.co/36i2KT4j5A
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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Neuropsychiatric SLE - 2/3 Improved at 12 Months
The management and outcomes of neuropsychiatric systemic lupus erythematosus (NPSLE) can be challenging as there is limited data.
A retrospective cohort study identified 350 NPSLE events (between 1999-2015) defined by ACR definitions and categorized as being:
JAMA: SLE Review
Drs. Caroline Siegel and Lisa Sammaritano (from HSS in NYC) have published an impressive overview of systemic lupus erythematosus (SLE) in JAMA. This timely, well-written review covers the many complexities of this multi-organ disorder that affects nearly 3.4 million people worldwide.
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ICYMI: Co-management of Psoriatic Disease
It is a common clinical scenario to see someone with both severe psoriatic arthritis and skin psoriasis. In an ideal world this would involve a combined clinic with our local friendly dermatologist. For many of us, however, this is not practical for many reasons. The excellent Saturday morning
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337 PMR pts studied by FDG PET, followed 6 mos - 9% (31) had subclinical vasculitis (GCA)
- 21 had isolated LG vessel
- 3 isolated cranial vasculitis
- 7 both cranial & LG vessel vasculitis.
Steroid use higher w/ subclinical vasculitis, but not relapse https://t.co/uwXf4ucVnQ https://t.co/AOacTnQZaS
Dr. John Cush @RheumNow( View Tweet )
We must consider this clinically, we must protect our aging patients without over immunosuppressing them." Dr. Weyand #RNL2024
Dr. John Cush @RheumNow( View Tweet )
Among 3.2 million people who starting opioids, there were 506 573 serious fall, esp w/ increasing age; Opioid use associated with increased risk of serious falls, esp. if >85 yrs (adj IRR 6.35) and within the first 28 days of commencing opioid use https://t.co/IifmEE9Q5n https://t.co/N2PkLofA4r
Dr. John Cush @RheumNow( View Tweet )
Oral Surveillance study revisited: the risk of Venous thromboembolism & Pulmonary emboli were higher with tofacitinib (10>5 mg BID) versus TNFi and were generally consistent over time. VTE & PE risk incr by age, BMI, and VTE Hx https://t.co/v7ISjw5Rvd https://t.co/10oE7MiAAj
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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Polycyclic Aromatic Hydrocarbons Increase Lupus Risk
A case-controlled study shows environmental exposure to polycyclic aromatic hydrocarbons (PAH) may increase the risk of developing systemic lupus erythematosus (SLE).
Korean claims study of #RA & pregnancy (& adverse preg outcomes (APO), shows MTX or LEF use w/in 3 mos of conception assoc w/ incr. in APOs (aOR 2.14-.68). In 5728 preg: 1152 APOs, HCQ most commonly used, DMARD use decreased during preg. https://t.co/7UBsNdpRgx https://t.co/cY1N73FG8Q
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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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7 Updates on Prosthetic Joint Infections
These are excerpts and takeaway summaries from several literature reports addressing the diagnosis and outcomes of prosthetic joint infections (PJI).
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Higher Rates of Childlessness in Rheumatic Diseases
A large Finnish population study shows that several rheumatic diseases may impair reproduction and pregnancy outcomes, with significantly higher rates of childlessness or fewer children overall for women.
A nationwide cohort study of 5 339 804 Finnish citizens, born 1964–1984,
According to CDC, drug overdose deaths increased in 2022 - up to 107,941, ~1% higher than the nearly 107,000 overdose deaths in 2021. 70% of these are males. 2023 numbers are not yet final but appear to be stable... https://t.co/esTuwpp4YP https://t.co/Ap5XanllU9
Dr. John Cush @RheumNow( View Tweet )
Window of Opportunity in Psoriatic Arthritis
A Dutch Early Psoriatic Arthritis cohort study shows that psoriatic arthritis (PsA) patients treated early (referred and diagnosed within in less than 12 weeks) had the best clinical outcomes.
Infection and Rituximab-linked Immunoglobulin Deficiency
A recent cohort analysis suggests that RTX-induced Ig deficiency was not associated with an increased risk of severe infection in IMID patients.
https://t.co/bNmYyYi2Vs https://t.co/MXKRbrrIJS
Dr. John Cush @RheumNow( View Tweet )
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