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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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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Of 375 #Gout pts D/C pegloticase after a median of 8 infusions (taken 112days (max 1,240d). Only 73% had SUA < 6 during pegloticase. After D/C 84% went on ULT (63% allopurinol; 34% febuxostat; after mean 92d); after ≥ 30 days), 51% achieved SUA < 6 https://t.co/unkvt1whrs https://t.co/DgVpBgKXcm
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Burnout or Retire (4.12.2024)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. Is it time to worry about burnout and those who are leaving healthcare?
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Primary care pop. study pts shows poor health literacy in gout pts assoc. w/ more gout flares. Study of 551pts; 30% w/ 2+ flares in 12 mos; 9.4% w/ poor health literacy. pts had more flares (OR 4.1) & hx of oligo/polyarticular flares (OR 1.93) https://t.co/tDiFqixbLV https://t.co/Kb75iJwTZE
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Pearl: 40% of acute gout attacks will have a normal serum uric acid (that will elevated during intercritical phase) - Draw the lab during and after the attack. https://t.co/CynZOal9jc
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Research on SGLT2 inhibitors in #gout is needed. They have been shown to reduce uric acid & gout flares, and may be uricosuric or be antiinflammatory. Also decreased incident gout (by half) among at-risk patients with type 2 diabetes (HR 0.54) https://t.co/CGG9aFsgoD https://t.co/5O2f3MFL8C
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Research on SGLT2 inhibitors in #gout is needed. They have been shown to reduce uric acid & gout flares, and may be uricosuric or be antiinflammatory. Also decreased incident gout (by half) among at-risk patients with type 2 diabetes (HR 0.54) https://t.co/ZEmhwqyDOv https://t.co/58YKD6pFyt
Dr. John Cush @RheumNow( View Tweet )
4873 gout pts w/ High SUA renally typed: UA overproduct. (ROA 9%); underexcreter (RUE 61%); combined (23%) or normal (7%)
ROL: older, lower SUA, tophi & DM
RUE: lower BMI, No DM
Combined: younger, HighBMI/SUA/eGFR & smoking
Normal: older, Low SUA/eGFR https://t.co/sfcIoR0YTN https://t.co/ulqP6XyKMa
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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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Depression and RA
Dr. Jack Cush reviews the news, journal reports and regulatory approvals from the past week.
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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.
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Depression and RA (3.8.2024)
Dr. Jack Cush reviews the news, journal reports and regulatory approvals from the past week.
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EMR study identified 3.5+ million pts w/ BMI >30 -- 23% had sleep apnea (OSA). OSA had >2 fold risk of gout (7.2% vs 2.8%)vs those without OSA (p<0.0001). The odds of having gout are 2.65 times higher(HR 2.39; (CI) 2.367-2.419, p<0.0001). https://t.co/GgWrAiFPds https://t.co/QuQUk7nwDK
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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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Excess Cardiovascular Risk in Gout
A UK population cohort study has shown that gout carries an increased risk for a wide variety of cardiovascular disorders.
https://t.co/ThDbAkI0VN https://t.co/uYz9Swu6sR
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Excess Cardiovascular Risk in Gout
A UK population cohort study has shown that gout carries an increased risk for a wide variety of cardiovascular disorders.
A matched case–control study examined the electronic health records from the UK Clinical Practice Research Datalink and compared gout (one to five) with controls
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Serial plasma samples assayed for 92 inflammation-related proteins, during and after gout attacks. 21 were differentially expressed. Gout flares assoc w/ increased IL-6, CSF-1, VEGF-A & tumour necrosis factor superfamily 14 (TNFSF14 was highest) https://t.co/2p8vTFcmvD https://t.co/5z1gYdsKJO
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UK Clinical Practice Research Datalink matched cohort study compared Gout (152K) to controls (709K) - CV devlopment higher in gout (21% vs 15%; HR 2.58). Moreso in women (HR 1.88). Gout pt had more CKD, HTN, obesity dyslipidaemia, & NIDDM https://t.co/BXCawnuIfa https://t.co/ZMuK9Msesb
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Taiwan National Health claims data looked at drugs & gout flares. Signif increase flares were seen w/ ASA, thiazides, loop diuretics, ethambutol, pyrazinamide (1.15-3.35) & metformin (SR=1.14). Lower risk w/ fenofibrate (SR=0.60) & losartan (0.92) https://t.co/eBiiM83ei0 https://t.co/296XAbxwkc
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Full read, review of COLCHICINE, a, w/ narrow therapeutic index, & assoc. w/ overdose & fatalities. Discuss Interactions, unauthorized access, overdoses, inappropriate dosing. No dose adjustments w/ Liver dz, but modest changes w/ severe CKD, dialysis https://t.co/53aOA4uqdY https://t.co/fuEwWsXMZG
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Determinants of Gout Flares
Approximately 12 million US adults in the US have gout. Two recent literature reports highlight contributors to gout flares.
https://t.co/F2eiWXOTkF https://t.co/YFftaITmnQ
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VITAL Info on Autoimmune Disease (2.9.2024)
Dr. Jack Cush reviews the journal reports from the past week on RheumNow.com. Highlights are summarized by three songs: "Stairway to Heaven", "You're No Good", and "How Long (has this been going on)".
Many #RA pts remain on Steroids despite b/tsDMARD use! Study 228 #RA pts
Determinants of Gout Flares
Approximately 12 million US adults in the US have gout. Two recent literature reports highlight contributors to gout flares.
In JAMA, a retrospective review of 3613 gout patients with 3104 gout flares over 8.3 years showed an expected high rate of gout flares with higher baseline
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