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Great and Not So Great (9.30.2022)

Sep 30, 2022

This week it's the great and not-so-great on gout, chondrocalcinosis, osteoporosis and misdiagnosis. We are good at many of those things - what's not so great? Let's review the news and journal reports from the past week on RheumNow.

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Metanalysis of 57 studies, 227,812 RA & 64,290 OP pts. Finds the OP prevalence in RA to be 27.6% (95%CI 23.9–31.3%). Despite significant advances in prevention, treatment & imaging, OP prevalence remain high. https://t.co/SxAJ8cGU8b https://t.co/91D6rtW9bF
ASBMR 2022 study shows Patients w/ serum ferritin > 1000 µg/L or Dx hemochromatosis or thalassemia — were 60% more likely to have an osteoporotic fracture (2X risk vertebral Fx) during an up to 10-year follow-up https://t.co/uLf8zTiMml https://t.co/9KnApUxxTF
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ACR's State-by-State Report Cards for Rheumatic Disease

Sep 19, 2022

New report examines access, affordability, and activity and lifestyle factors in all 50 states and the District of Columbia, evaluating how easy it is to live with a rheumatic disease in your state. No state scored an "A" or "F", and only two states improved their 2018 grades.

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CD19 CAR T Cell Therapy in SLE (9.16.2022)

Sep 16, 2022

The big news this week: the approval of deucravacitinib (a new class of drug?) for psoriasis; the 2022 ACR guidance on glucocorticoid-induced osteoporosis; a national poll of older adults over the age of 50 who claimed self-reported or doctor-diagnosed arthritis; and much more. Let's review

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2022 New ACR Guidance on Glucocorticoid-Induced Osteoporosis (GIOP)

ACR
Sep 14, 2022

The ACR has updated this guideline and includes recommendations on abaloparatide (PTHrP) and romosozumab, which are newly available since the ACR’s 2017 GIOP guideline.



It also addresses sequential therapy, which was not addressed in the past. Patients need to understand that when

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Hyaluronic Acid Knee Injections Equivalent to Placebo

Aug 25, 2022

In the United States, where over $300 million is spent annually on intraarticular hyaluronic acid injections, yet another study shows such therapy to be no better than placebo.



BMJ has published a metanalysis of the efficacy and safety of viscosupplementation (intraarticular

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Weight Loss Slows Knee OA Progression

MedPage Today
Aug 23, 2022

Declines in body mass index (BMI) were linked with slower worsening of knee osteoarthritis (OA), according to data from three large longitudinal cohort studies.

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Supplemental Vitamin D Fails to Lower Fracture Risk

Aug 02, 2022

NEJM has published study results showing that vitamin D3 supplementation does not significantly lower fracture risk (vs. placebo) when used in generally healthy adults.

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Krill Oil Effective in Knee Osteoarthritis

Aug 02, 2022

Krill oil supplements in knee osteoarthritis (OA) was shown to be superior to placebo in reducing knee pain, stiffness and function while increasing the omega-3 index. Krill oil, rich in anti-inflammatory long-chain (LC) omega-3 ( ω–3) PUFAs and astaxanthin, is thought to be safe and now

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Best of

U.S. News & World Report’s 2022–23 Rheumatology Rankings

Jul 27, 2022

The Johns Hopkins Hospital has repeated its top rank among US Rheumatology centers - ranking #1 for the 18th year in a row, according to U.S. News & World Report’s 2022–23 Best Hospitals list released yesterday.



U.S. News and World Reports ranking of U.S. Hospitals and

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Achilles,ankle,heel

Treating Enthesitis in Psoriatic Arthritis Patients

Jul 20, 2022

A large prospective psoriatic arthritis (PsA) study examined the enthesitis outcomes when PsA patients received conventional (cDMARDs) or targeted disease-modifying antirheumatic drugs (tDMARDs) and showed an overall 86% response rates, regardless of the medication used.

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Viscosupplementation Ineffective in Knee Osteoarthritis

Jul 13, 2022

The BMJ has published the results of a metanalysis showing strong conclusive evidence that viscosupplementation in knee osteoarthritis (kOA) has minimal effects on kOA pain, and also reveals strong evidence of an increased risk of serious adverse events. 



The review encompassed 169

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Achilles,ankle,heel

Steroid Injection for Chronic Achilles Tendinopathy

MedPage Today
Jul 12, 2022

Adding a corticosteroid shot to exercise therapy significantly improved symptoms of chronic Achilles tendinopathy, a 100-person randomized trial found.



At 6 months, mean improvement from baseline on the Victorian Institute of Sports Assessment-Achilles (VISA-A) scale was a significant

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Are You Wasting Money on Supplements or Vitamins?

Jun 27, 2022

The US Preventive Services Task Force (USPSTF) has updated its recommendations regarding the efficacy of supplements or multivitamins for reducing the risk of cardiovascular disease, cancer, and mortality in the general adult population.



The USPSTF concluded there is insufficient

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Simultaneous Versus Staged Knee Arthoplasty?

Jun 23, 2022

Aside from cost, there are significant concerns regarding efficacy and safety outcomes and recovery time. These issues are compounded with the need for bilateral TKR, wherein the patient and surgeon need to decide whether to have both TKRs done simultaneously or staged (single TKR one after

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From OP Internationa: The Clinician’s Guide to prevention & Rx of OP -concise recommendations regarding prevention, risk assessment, diagnosis, and treatment of osteoporosis in postmenopausal women & men >50 yrs of age https://t.co/z3ZJ3lIplG
ice cubes

Topical therapies take centre stage

Topical treatments have so often been the low level “sure you can try this” option. However there are exciting data that these approaches may become part of our main armamentarium. 

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Adami et al Real world fracture prevention with osteoporosis meds. 30% lower risk with bisphosphonate, 60% denosumab, 90% teriparatide. Bisphosphonates only showed effect after 1 year. Not sure I buy it, very different to RCTs. @RheumNow #EULAR2022 OP0239 https://t.co/6qaYAVw73Q https://t.co/bNwWmxxSeF
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Methotrexate Monitoring (5.13.2022)

May 13, 2022

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Bad news for digitial ulcers in Systemic sclerosis, Readmissions in Lupus and Thrombocytopenia in APL patients.




  1. Risk factors for readmission among 132,400 #SLE hospitalizatiions included

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Wiki Guidelines Approach to Pyogenic Osteomyelitis

May 12, 2022

A crowd sourced, WikiGuidelines approach to clinical treatment guideline development for pyogenic osteomyelitis yielded 7 important clinical questions, 2 clear treatment recommendations and 5 topic reviews to inform future treatment or investigations.



Some clinical scenarios may be

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Liver,hepatic,red

Arthritis Predicts Hepatic Fibrosis in Hemochromatosis

Apr 25, 2022

Mayo Clinic Proceedings reports the results of a retrospective, cross-sectional of patients with HFE hemochromatosis showing that advanced hepatic fibrosis is primarily seen in those with arthritis due to HFE hemochromatosis. 



A total of 112 patients with a liver biopsy confirmed

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What I learned... always get an ALP and phosphorus level in people with chronic bony pain. https://t.co/nE0xYwODmC
OP is worse w/ Inflammation; would biologics reduce OP and Fx risk? Swedish study of 24,678 RA pts, 4265 on biologics - Over time, the OP Fx rates were 12.1 vs 13.0 per 1000PY with and without biologics (HR 0.97; 0.78-1.20); Thus no Fx benefit https://t.co/d2zGd0WWoa https://t.co/Z9HVMUQd5U
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ACR Guidelines for the Treatment of Systemic Juvenile Idiopathic Arthritis

Mar 03, 2022

The ACR has updated its clinical guidelines for the management of juvenile idiopathic arthritis (JIA), with this update focusing on oligoarthritis, TMJ arthritis, and systemic JIA (with and without macrophage activation syndrome); only the latter, systemic JIA recommendations are reported

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