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RheumNow Podcast – Quackademia (10.15.2021)

Oct 14, 2021 10:02 pm

Dr. Jack Cush reviews the FDA approvals, news and the latest journal articles from the past week on

  1. Risk of anterior uveitis w/ secukinumab is equal to etanercept; but both inferior to mAb TNFi (infliximab, adalimumab) ~ 5000 Rx starts, AU risk/100PY = SEC 6.8; ETA 7.5; INFLIX 2.9; ADA 4. SEC has a 2.3 fold greater risk than ADA/INFX

  2. CXCL13 predicts worse Xray status in early #RA. Study of 158 pts, followed 11-years. Baseline CXCL13 correlated with Xray progression (ΔTSS) at 11 years. CXCL13 was superior to CRP, DAS28CRP, SJC28, CCP predicting 11-yr Xray damage

  3. Among 2359 RA & PsA pts (3169 TNFi courses 1778/1391), serious infection (SIE) rates were higher in RA 4.17/100PY vs PsA 2.16/100PY. PsA had 41% lower SIE risk (HR 0.59, p=0.004) - Registry data from the NOR-DMARD study

  4. Retrospective study hospitalized new-onset systemic JIA (2008-19):52 children’s hospitals & 534 sJiAshows 29% rx w/ biologics & 58% steroids. Over time Biologic use increased & MTX decreased. Biologic correlated w/ Hi hospital volume, ICU stay, later years

  5. Comparative study of 46 AOSD, 9 MAS & 31 adult HLH pts, shows that serum IL-18 was signif higher in AOSD than HLH (closely correlates w/ ferritin, sIL-2R). IL-18, sIL-2R, ‘arthralgia or arthritis’ independently distinguished AOSD from HLH

  6. Smoking worsens adult-onset Still’s disease. 185 AOSD pts, found 45 smokers who had higher risk of pericarditis (36 vs 16%), pleuritis (33 vs 14%), abd pain (18% vs 6%), higher systemic score (6.4 vs 5.4 ), More MAS (29% vs 6%), lung disease (18% vs 13%)

  7. Catastrophic Still's dz occurs early; compares 20 AOSD w/ organ failure vs 40 AOSD without. CAT-AOSD had shorter Dz duration, earlier Rx need; risks: younger; splenomegaly, liver, cardiac,lung involvement; ferritin level, no arthralgia

  8. Anakinra appears to lower mortality risk (OR 0·32 vs historic controls) in hospitalized severe COVID-19 pneumonia (esp w/ hyperinflammation, CRP >100 mg/L). Metanalysis of nearly 2000 pts; better resp if given w/ dexamethasone (OR 0·23)

  9. Still’s Disease Following COVID-19 Vaccination

  10. Hepatitis B Reactivation with Rituximab and Abatacept 

  11. Cancer Risk in Systemic Lupus Erythematosus

  12. Decline in the incidence of Behcets Dz? Between 2004 to 2017 Korea has seen BD decreased from 8.15/100K (2004) to 1.51/100K (2017), an 81.5% decrease, greater for women and middle-aged people, but no change survival or mortality

  13. FDA Approves Avacopan for ANCA-Associated Vasculitis

  14. RETRO - Taper or Not: You Decide

  15. Triple DMARD Rx - MSH vs MLH (Lef). 136 active #RA pts given OL MTX/SSZ/HCQ vs MTX/HCQ/LEF. Equal efficacy (EULAR-Good) was seen at wk 12 (54% vs 59%) and wk 24 (65% vs 62%) - hence LEF substitution was noninferior.

  16. Low dose #methotrexate in primary cardiac prevention #CIRT. Trial had LESS decline in GFR in those with mild renal impairment than placebo. ?meaningful or a fluke. Either way MTX can be used safely in mild CRF! Just follow creatinine/GFR. #ClinicalPearl @RheumNow

  17. Upadacitinib was shown to be effective in two Phase 3 SELECT-AXIS trials. 1st trial: in bDMARD-IR AS pts the ASDAS resp was 44% vs 10% PBO at wk 14). 2nd trial: in nr-axSpA, the ASDAS response at wk 14: 42% vs 18% PBO.

  18. 498 axSpA (62%M: 38% F): Compared to men, women had higher Dz activity, joint counts, enthesitis scores (all P ≤ 0.01), more pain, worse fatigue and Functional scores; all P < 0.05), less full time work, More DMARDs/pred, Depression & FM

  19. A case of reactive arthritis following COVID-19 infection; manifest as dactylitis, psoriatic skin/nail lesions, painful oral & vaginal ulcers, subungual hyperkeratosis, but no oligoarthritis, or lumbar pain.

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