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Mono- and Oligo- are Different (8.18.2023)

Jack Cush, MD

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

  1. Glucocorticoid Affects Weight, but not Blood Pressure in RA A pooled analysis of 5 RCTs shows that the effects of 2 years of low-dose glucocorticoid (GC) treatment in RA can significantly increase increase body weight, but not blood pressure.

  2. Do TNF inhibitors work in cardiac sarcoid (CS)? PET scan study of 31 CS pts Rx w/ infliximab 13, adalimumab 15, adalimumab 3. Mean pred dose dropped 18.6 to 7.7mg, p = 0.018) & PET improved w/ TNFi and only 4 pts had CV hospitalization during F/U

  3. Tildrakizumab, IL-23 mAb) was well tolerated in ankylosing spondylitis (AS) pts but did NOT improve ASAS20 responses vs PBO. 101 pts given TIL or PBO. ASAS20 response was 74% TIL vs 80% PBO. Study was terminated at week 24 for lack of efficacy.

  4. A review of Myositis-associated ILD prevalance is 50% (Asia), 23%(N. Amer) & 26% (EU) & is increasing. ILD is more common/severe w PL-7/-PL-12 Abs (vs Jo1). MDA5 Abs higher in Asians (11-60%), assoc w/ rapidly progressive ILD

  5. Retrospective cohort study (2009-2022) found that #SLE is a risk factor for myelodysplastic syndrome (MDS) among RMD pts. Found 64 MDS in 55 841 PYs F/U (1.15/1000 PY). SLE was risk factor for MDS (adj HR 2.61). Lower Hgb could be an early clue!

  6. Nailfold videocapillaroscopy (NVC) in 1356 #SSc registry pts classified as early, active or‘late. Late pattern seen in 40%: signific. assoc w/ dcSSc (OR=1.96), ILD (OR=1.29), renal crisis (OR=3.46), digital ulcer (OR=1.29), & topoisomerase I Abs (OR=1.39)

  7. UK study of 1,.3 million RMD (RA, PsA, FM) pts looked at opioid Rx 2006-2021. New opioid Rx incr 2006 to 2019, but incr most (4.5 fold) in FM from 3.4/10K in 2006 to 8.7 in 2018/2019 (falling to 5.9 in 2021). Overall less opioid use during the pandemic

  8. Monoarticular JIA – a Distinct Clinical Entity Monoarticular Juvenile Idiopathic Arthritis (monoJIA) is typically classified under oligoarticular JIA, but a recent study suggests it is a separate entity.

  9. 10% of a Single center cohort (n 38) Systemic JIA pts developed MAS. Only1 had recurrent MAS(3 times), mostly Male (3M:1F) w/ mean Dx age=8 ± 6 yrs. Stills w/ MAS had less arthritis (51 v 91%), more Rash (75 v 55%), HSM (50 v 5%), serositis (25 v 5%)

  10. Both Lupus Nephritis and Cutaneous lupus erythematosus (CLE) show evidence of tissue infiltrating T cells expressing hi amouts of hypoxia-inducible factor-1 (HIF-1); HIF-1 inhibition improves skin/systemic disease & decreases T cell cytotoxic activity

  11. Lung is involved in pre-clinical ACPA+ RA! Lung-resident B cells from BAL of 12 untreated at-risk or Dx early RA pts found T cell–driven B cell differentiation resulting in local class switching and somatic hypermutation B cells, esp w/ ACPA+

  12. The Adalimumab Biosimilar Glut

  13.  Miracle Larry Podcast


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