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RheumNow Podcast – #ACA: Ask Cush Anything (10.8.2021)

Oct 08, 2021 12:22 am

Dr. Jack Cush reviews the news and journal reports from this past week on; plus questions & cases from viewers in (#ACA) Ask Cush Anything.

  1. Upadacitinib RA program (5306 pts) the risk of H. zoster by Rx and dose (HZ/100PYs) MTX = 0.8/100PY ADA+MTX= 1.1/100PY UPA 15 mg= 3.0/100PY UPA 30 mg = 5.3/100PY Hence there is a 4-5X risk of HZ w/ JAKinhibitors
  2. Epi-4 studies of 4,376 military service persons shows the prevalence of fibromyalgia = 2.9% predeployment, but was significantly higher in those with postemployment PTSD (10.8%) (not without PTSD-0.8%) but higher if in PTSD RCTs (40%)
  3. Having both Cancer & Systemic sclerosis (SSc) is rare. Study of 1481 SSc pts saw cancer Dx w/in 2, (1.35), 3 (2.1%) & 5 yrs (3.5%;mostly breast, GYN, Heme CA). Higher 2 yr risk w/ topoisomerase I Ab (OR 3.43), U1-RNP (5.54), but not RNA polymerase III)
  4. Study of 52 pts with Juvenile Systemic Sclerosis (JSSc) -10% were without skin dz (SSc sine scleroderma). 7 pts reviewed, all had cardiac dz (86 vs 16%; 3 cardiomyopathy, 3PAH), longer Dx delay (20 vs 8 mos), worse outcomes, (42 v 6%)
  5. SLE hospitalized with ARDS from COVID-19 have significantly higher risks of death and poor outcomes (RR=1.7), compared 319 SLE vs 251,800 nonSLE - SLE was more impactful than other comorbidities in such poor outcomes
  6. Metabolic syndrome (MetS) is associated with radiographic & nodal hand OA (HOA). 896 MetS positive & 1613 w/o MetS assessed w/ propensity matching. MetS had more xray HOA ((OR 1.32), PIPs (OR 1.52), DIPs (1.38), hand pain (1.25)
  7. Erosive Hand Osteoarthritis Portends Worse OA
  8. The AAOS has published their Clinical Practice Guideline for Management of Osteoarthritis of the Knee (Non-Arthroplasty); updating 19 of the 29 evidence-based recommendations and focuses on nonsurgical treatments to provide pain and patient function.
  9. EHR record study: prevalence of Psoriatic arthritis (#PsA) was increased w/ psoriasis severity. PsA prevalence=2.9 per 100 PY; Based on severity - Mild 2.1/100PY; Moderate 9.9/100PY & severe PSO: PsA risk was 17.6/100PY
  10. Several studies have suggested that biologic Rx of Psoriasis may lower risk of later PsA. New study of nearly 2 million PSO (15k given biologic, 20K given oral Rx). The risk developing PsA higher w/ biologic (aHR 4.48) vs oral or phototherapy
  11. Prevalence of Arthritis Rising in the USA
    • Best biologic for PsA with pulmonary Histoplasmosis
    • Can you give COVID-19 vaccine during disease flares?
    • Elderly PsA and severe gouty tophus/erosion in spine
    • How to consume 2000 abstracts at Virtual ACR 2021
The author has received compensation as an advisor or consultant on this subject

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