Infection

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Review of HLA-B27

Jack Cush, MD

HLA-B27 remains the dominant genetic link to spondyloarthritis (SpA) across the age spectrum, but B27 related clinical expression diverges between children and adults. New mechanistic data on autoreactive T cells, HLA-B27 misfolding, and gut-joint trafficking point to new plausible, targetable

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Dutch single center study of ANCA tests (n 5518) betw 2012-2023; 286 (5.2%) were positive: 63% did not have AAV. ANCA+ Non-AAV pts had other CTD, neoplasia, infxn, or used specific drugs. IIF and ELISA 1st test - good negative predictive values. Performing a second test increased https://t.co/0oAhOg10VL
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Korean retrospective study compared NIDDM pts Rx w/ SGLT2 inhibitor (n 552,065) vs sulfonylurea (1,480,092) showed SGLT2 inhibitors were assoc w/ a signif 11% lower risk of incident autoimmune rheumatic disease (HR 0.89). Diff of −6.50 per 100K PYs over median ~9 mos F/U. https://t.co/uTiCjejkjL
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Japanese study of 101 864 children shows fertility treatments (ovulation induction, intrauterine insemination, invitro fertilization) increases the risk of Kawasaki Dz. Incidence rates per 100K PYs - 274 for spont conception vs 391 for assisted conception (adj HR 1.42; https://t.co/Ro0beSXAAq
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Retrospective Medicare comparison 450 paired #PMR cohorts Rx w/ IL-6 inhib or csDMARDs. At 1 yr, IL-6i pts (vs csDMARD) had signif more GC D/C (adj HR 1.28) or minimal GC use (<3mg/d) (aHR 1.28). Hosp. infxn 2X higher in IL-6i (12.2 vs 5.7 per 100 PY) in year 1, but not year 2 https://t.co/G4eIusHDPa
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Retrospective Medicare comparison 450 paired #PMR cohorts Rx w/ IL-6 inhib or csDMARDs. At 1 yr, IL-6i pts (vs csDMARD) had signif more GC D/C (adj HR 1.28) or minimal GC use (<3mg/d) (aHR 1.28). Hosp. infxn 2X higher in IL-6i (12.2 vs 5.7 per 100 PY) in year 1, but not year 2 https://t.co/YgqLjD9nvM
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US TriNetX EHR study of of seropositive RA:  31,932 without ILD; 115 RA-ILD on antifibrotic Rx & 1885 RA-ILD not Rx w/ antifibrotics. MTX was used more in RA w/o ILD (52%) vs RA-ILD (12%) on antifibrotics. RA-ILD was assoc w/ heterogeneous antifibrotic use. https://t.co/eBJBXbnQLN
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CDC warns of an association betw severe CNS arboviral disease, w/ neurologic sequelae in pts receiving anti-CD20 mAbs (rituximab, ocrelizumab, ofatumumab, obinutuzumab, etc). West Nile virus was the most common arbovirus, but there are others; mortality up to 40%. Most arbovirus https://t.co/7eMoNgWbB4
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British Dermatology Biologics registry (BADBIR) 18976 #PSO pts had incidence serious infxns (SIE) 28 SEI/1000 Pt-Yrs; higher if they had prior infxn (79/1000 PYs). SIE signif lower w/ RIZankizumab (HR 0.74-.80) vs BROAD, ETN, other standards Rxs. SIE deaths rare (1.81/1000 PYs) https://t.co/GTr3DLCVXs
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JAMA Case Quiz - A 57 yoF w/ #RA has a new vesicular rash. 9mos prior ETN change to ADA. Rash (painful, pruritic) started 2 wks ago. Exam: PIP swelling, & ulcerated plaques on neck, chest, & erythroderma on hands, CRP 15.0 mg/L , ESR 111 mm/h. What would you do? order?
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British Dermatology Biologics registry (BADBIR) 18976 #PSO pts had incidence serious infxns (SIE) 28 SEI/1000 Pt-Yrs; higher if they had prior infxn (79/1000 PYs). SIE signif lower w/ RIZankizumab (HR 0.74-.80) vs BROAD, ETN, other standards Rxs. SIE deaths rare (1.81/1000 PYs) https://t.co/5HqJ3zpO0g
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STOP-HZ trial - 30 #RA pts going on tofacitinib given Shingrix (RZV) on day 1 & wk 8 & started Tofa on d1 or wk8. @wk 12 VZV responses incr in both (2.66 & 2.91 fold incr). @wk 4, d1 Tofa had fewer ≥1.5-fold VZV vs wk8 (44.8% vs 80%); BUT can you wait 8wks to start JAKi? https://t.co/tH0zPgBbHQ

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