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Great and Not So Great (9.30.2022)

Jack Cush, MD

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

  1. Joint Flares extend disease & show joint specific memory. Study of 95 JIA pts, 12.5 yrs F/U: 95% got to inactive dz, 81% flared 1+ times. 74% flares in prior joints, usual side 83%, contralateral 17%, 40% new Jt; more likely off meds
  2. 2 open-label reports of JAK inhibitors in Systemic sclerosis (SSc) – 59 SSc pts: significant decr in mRSS in 88%. 28/29 w/ ILD had no progression. Overall responses better in treatment naïve SSc patients. 20% had side-effects. More studies needed
  3. #Gout Guidelines–> great outcomes! French study of 300 pts; 95% followed French Rx Guidelines, T2T SU < 6 mg/dL in 59% @6mos, 79% @24 mos & @2 yrs hald were Rx w/ allopurinol (313 mg/d) and 48% febuxostat (84 mg/d) 
  4. RCT of allopurinol in 183 #gout pts. After 6.5 yrs 30% (60) were dead. Survivors 82% Rx w allopurinol, 4% febuxostat, 8% not on ULT. Urate levels only available in 72%!! & only 58% achieved SU T2T <6 mg/dl (<0.36 mmol/L) Dont you think we should do better?
  5. Study of 67 OA TKR pts looked for CPPD – defined as “appears as linear/punctate opacities w/in cartilage, synovium, Jt capsule or tendons/entheses”. Xrays had specificity of 92%, sensitivity 54%, PPV 88%, NPV 66% (needs to be distinguished from BCP)
  6. 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.
  7. 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
  8. VTE Risk from Swedish Rheumatology Quality Register – VTE Prevalence/1000PY TNFi 5.15; JAKi 11.33; Gen Pop 3.3. VTE adj HR JAKi vs TNFi =1.73 (1.24, 2.42); PE HR 3.21 (2.11, 4.88) and DVT HR 0.83 (0.47,1.45)
  9. Analyses of data from the Nurses Health Study (1986-2016) & NHSII (1989-2017) cohorts shows chronic low sleep duration (< 5hrs/night vs >7hr/night) was assoc w/ increased SLE risk (adj HR 2.47). Low sleep also assoc w/ body pain(2.13), depression(HR 2.82)
  10. IL-18 is a proinflammatory cytokine involved in innate &adaptive immune responses. IL-18 is a key mediator in autoinflammatory diseases, MAS, Still’s disease. Serum IL-18 levels may be useful in diagnosis and monitoring of disease activity
  11. Cancer Risk with Scleroderma Spanish Scleroderma Registry examined a large cohort of systemic sclerosis (SSc) patients showing an increased cancer risk, especially breast, lung, hematologic and colorectal cancer.
  12. Uncommon Misdiagnosis of Rheumatoid Arthritis    ARFOT (Better Anti-Rheumatic PharmacOTherapy) study enrolled early RA patients. This analysis included 2543 pat  (1.8%) were rest misdiagnosed
  13. ACA – Ask Cush Anything
  • Dr Venkatram – steroids in OA
  • Dr Vasudevan – biological after breast cancer

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