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RheumNow Podcast – Rheum Lives Matter (8.28.20)

Aug 28, 2020 12:06 am

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

  1. Study of 4 refractory juvenile dermatomyositis (6-20yrs) treated with baricitinib (4–8 mg/day) Significant improvement noted by week 4 in global activity, skin scores, weakness but little change in muscle enzymes or calcinosis. Steroids/other meds lowered
  2. Non-Radiographic Axial Spondyloarthritis has Its Own Diagnostic Code; As of October 2020, nr-axSpA will be officially included in the 10th version of the International Classification of Diseases (ICD-10) coding manual as M46.8
  3. Flexible polymers (PET) can be used for point-of-care diagnostics & analytics. A uric acid biosensor made to detect SUA in saliva, using PET, coated w/ uricase to detect UA; shows sensitivity, low detection limit, & wide linear range. Is this the future?
  4. Metformin as cotherapy in RA? It lowers RA risk in animal models. >2500mg/d lowers risk incident RA in women. Japanese study shows it suppresses osteoclastogenesis and upregulation of inflammatory cytokines, protease and growth factor genes.
  5. Successful treatment of refractory palmoplantar psoriasis in a psoriatic arthritis patient with the JAK inhibitor tofacitinib
  6. President Trump took HCQ/Azithromycin.... Lancet Rheumatology reports that HCQ in RA has no cardiac risk but long term HCQ increases risk cardiovascular mortality, that may be further augmented by azithromycin.
  7. Study of 1,631 incident RA & 3283 controls shows respiratory disease assoc with risk of RA, irrespective of RF & CCP and mostly in nonsmokers. aOR increased for chronic upper (1.4), acute lower (2.4) & chronic lower (1.6) Resp Dz, stronger for ACPA/RF+
  8. Stanford grows new cartilage in mice OA knees using resident skeletal stem-cells generated using microfracture (MF) surgery. MF-activated SSCs Rx w/ BMP2 and soluble VEGFR1 skewed differentiation toward articular cartilage.
  9. Mayo case controlled study of 212 autoimmune pts - half w/ CNS inflamm dz and half without. TNF inhibitor use was associated with an increased risk of inflammatory CNS dz (adj OR, 3.01; 1.55-5.82; P = .001); most of these occurred in RA pts (aOR, 4.82)
  10. Fibromyalgia & Exercise? Systematic review of 50 trials, shows that, compared to usual care, exercise had moderate effect on fatigue, small effect on sleep and meditative exercise programs were the most effective for improving sleep quality.
  11. Responses to switching TNFi in SpA go down w/ the 2nd TNFi. 1st TNFi @ 3 mos ASAS CII 51%; 2nd TNFi 41%; BASDAI @6 mo, 1st 46%, 2nd TNFi 33%. Compared to primary failure, pts w/ 2nd failure (OR 7.3 ) or toxicity (OR 9.1) had better ASDAS-I
  12. Hepatitis C Anti-Viral Drug-Induced Arthritis 
  13. Back Talk – send in your podcast question
The author has received compensation as an advisor or consultant on this subject

Rheumatologists’ Comments

It is a bit stunning to see you wade into social-political issues in this forum with your commentary on BLM. This foray suggests strongly that you too are from the ‘60s and maintain a consciousness beyond the day-to-day machinations of our profession. As your colleagues warned you, it is treacherous to cross-over into these topics without knowing audience perspectives. Perhaps there is a better place for this, but I admire your apparent conviction that all of us should be having these discussions with open minds, listening and trying to empathize with others’ lives and fears. Your equating BLM with RheumLM is interesting, if curious. Movement titles can indeed be self-defeating. For example, Black Lives Also Matter (BLAM) seems better to me, but would need some comparative marketing research. Defunding police? Probably most would rather see “Balanced Funding for Social, Psychiatric, and Order Functions in Security – BFSPOFS”. Good luck with that! My parallel would be that SLE, translated as the bloody red wolf, seems grossly off the mark, yet we continue to use is as if it is rational and scientific. Let us not miss the point by arguing about cockamamie titles.

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