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Rheum Manpower Needs - More Programs! (12.2.2022)

Dec 02, 2022 5:00 am

Dr. Jack Cush reviews the news and journal articles from the past week on

  1. NRMP Results for rheumatology 2022 : - Adult Rheum: 97.8% of 272 fellow positions filled (41% US grads) (371 applied) - Pediatric Rheum: 69.2% of 39 positions filled (54% US grads) (29 applied) WE NEED MORE ADULT PROGRAMS AND MORE INTEREST IN PEDI RHEUM

  2. Low Dose IL-2 Therapy in Sjögren’s There is a large, unmet need in treating Sjögren’s syndrome, yet a new randomized clinical trial has shown that lLD-IL-2 was effective and well tolerated in patients with pSS, with evidence of restored immune balance.

  3. 1602 pemphigus pts Rx w/ rituximab vs azathioprine or MMF. RTX pts had lower risk of MI (RR 0.45; P = .01), CVA (RR, 0.42; P < .001), PVD (0.47), HTN (0.48), hyperlipidemia (0.45), NIDDM (0.63), obesity (0.49). Mortality equal betw groups

  4. Estimated worldwide market for DMARDs in 2022 was $20.7 billion USD and is expected to rise at a 3.5% annual growth rate to $ 272 billion USD by 2030

  5. Estimated Global SLE market size was $1.46 billion in 2020, with a global (7 Major countries) prevalence of 651,965 in 2020; and a USA prevalence of 351,176 SLE cases.

  6. Study of 1207 joints in 55 RA pts shows that Xray progression over 2 yrs is significantly assoc w/ US Power Doppler (OR 2.92), erosions (OR 4.74), but also with Joint tenderness w/o swelling (OR 1.85) ! (Less signif w/ PsA)

  7. Mayo LUMEN study looked at SLE nephritis incidence betw 1976 -2018, & showed that LN increased over past 4 decades. LN patients have poor outcomes w/ higer rates of ESRD & mortality rates (SMR 6.33); @10 yr survival =70% & 13% ESRD

  8. Study of 294 SLE pts on HCQ (2005-2021): 37 (13%) developed CHF w/ low EF (HFrEF), arrhythmia or cardiac death. After adjustments, wt-based dosing of HCQ not assoc w/ cardiac events(sHR 0.62; 0.41,0.92) & may decrease risk in non-smokers

  9. RCT data on BTK inhibitor evobrutinib shows it to be well tolerated. Ph 2 RCT data on 1083 pts (RA, MS, SLE) Rx w/ evobrutinib(861) or placebo(271) for ~ 6 mos. No diff in TEAEs or EAIR , 2 deaths (SLE), SIE 2-3/100PY

  10. JAMA - Update/Review of Hemochromatosis Dx and Rx. - 5 gene defects in hepcidin. 95% HFE & the C282Y variant - 90%are asymptomatic - Suspicion w/ arthralgias, LFTs, hepatomegaly, cardiomyopathy, 1st degr relative - Untreated, 9% risk of cirrhosis

  11. 1st quarter of 2022, only 29% of Medicaid and Medicare users had at least one telehealth visit - down from 46% in all of 2021. (Data from Centers for Medicare & Medicaid Services)

  12. FDA is investigating risk of severe hypocalcemia in dialysis patients taking Prolia (denosumab). After an interim safety data review reports of hypocalcemia w/ advanced CKD. Monitor Ca, use Ca & vit D supplements. Await further FDA information

  13. Do oral JAKs in atopic dermatitis cause VTE? Meta-analysis (15 RCTs, 466 993 pts) does NOT show increased risk of VTE associated with AD & JAK inhibitors (HR 0.95) w/ low VTE incidence (0.05%) w/ JAKi and (0.03%) placebo.

  14. RheumNow Rheumatology Roundup Dr. Jack Cush and Dr. Arthur Kavanaugh discuss, dissect and deliberate the sessions and data presented at the #ACR22 meeting in Philadelphia.

  15. Recent CDC/MMWR report shows Paxlovid x 5days (including those w/ prior COVID or vaccination), had a 51% lower hospitalization rate within 30 days after diagnosis than those not prescribed Paxlovid. Use it irrespective of vaccination status

  16. A great read from Dr. Anthony Fauci as he steps down from leading the NIH NIAID research for nearly 40 years. He writes on pundits, need for specialty growth, evolution of vaccines and "it aint over till its over" is now "its never over"

  17. TIME Mag - "Why Masks Still Matter". 1) COVID is still out there; 2) Influenza on the rise. Authors write "With limited yet mixed data, we would be wise to ...err on the side of masking in high risk, indoor crowded public settings..."

The author has no conflicts of interest to disclose related to this subject

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