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CBT or Naltrexone in Fibromyalgia (12.8.2023)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from the past week on  Be sure to catch the early registration break for 2024 RheumNow Live.

  1. Palmoplantar pustulosis (PPP) is difficult to treat; w/ few reports of JAKi efficacy. Now a report of 21 PPP pts given bimekizumab and 17 patients showed complete clearance in 1 to 4 months. SAPHO pts had complete clearance of skin & improved joint pain

  2. UK Dermatology Registry of 13 699 Psoriasis pts on biologics (25K biologic exposures) found 1% risk of paradoxical eczema. Biologics included inhibitors of TNF, IL-17, IL12/23, IL-23. Lowest risk w/ IL-23i (0.56/100kPY), and higher w/ IL-17i (1.22)

  3. Systematic review (3 studies) RA pts shows bariatric surgery (n=6700) can significantly lower disease activity at 12 mos and reduce comorbidities (OR=0.45) and in-hospital mortality (OR=0.41). BMI at baseline and after BS was 43.1 & 29.7kg/m2, respectively

  4. Kuwait #RA registry study – shows in RA, the Uric acid level is inversely proportional to RA disease activity. 1054 RA pts, 15% had high UA level; lower DAS28 score associated w/ higher UA (p=0.032) OR 1.39; but higher HAQ assoc w/ higher UA

  5. RCT 114 fibromyalgia pts Rx w/ cognitive behavioral Tx (CBT) vs control education. CBT had significant reduction in pain catastrophizing, pain interference & Sxs w/ improved function; neuroimaging in 98 pts also showed comparable improvement

  6. Naltrexone was NOT superior to placebo in a blinded RCT of 99 Fibromyalgia pts. Pain decreased –1·3 points w/ NAL vs –0·9 in PBO (p=0·27). D/C were similar (8% vs 6%). NAL may improve improve memory problems in FM pts.

  7. Polands disease study (sarcoidosis 78.6K; #AOSD 3294; systemic sclerosis 35.5K) betw 2009-2018. Avg hospitalization was 5.39 days sarcoidosis, 6.22 days scleroderma, & 7.44 days for Still’s (latter decr 11.7 to 5.8, betw 2008-2014)

  8. Difficult-to-treat (D2T) axSpA seen in 88/311 axSpA pts. D2T axSpA= failure of ≥2 b/tsDMARDs (Very D2T-axSpA: same in <2yrs). D2T had signif more periph arthritis (35 vs 21%), higher BASDAI (64 v 59) & more FM. Very D2T had more CRP, IBD, no FM

  9. 2023 EULAR #PMR referral recommendations: 1 Suspected/Dx pts: consider Rheum eval 2 Do full Hx+PE+Labs before referral 3 Refer Severe Sx PMR to rapid access 4 Defer steroids til rapid Rheum eval 5 Rheum Dx PMR w/ +steroid response can be Rx by PCP

  10. Risk of Hepatitis B reactivation is assessed by serology – Resolved HBV (low risk reactiv): HBsAg-neg, HBcAb–pos & Pos HBsAb – If HBcAb(+), HBsAb negativity incr risk; – HBsAg(-), HBcAb(+), HBsAb(-) negative= resolved infx, occult infx, chronic hepatitis

  11. Resolved HBV (HBsAg-, HBcAb+, HBsAb+) are at low risk of reactivation (~2%) w/ TNFi or biologics. But in a high risk endemic region (ie, Korea) this risk is higher. Study of 416 such pts HBV reactivation rate 3.5% @5 yrs, 6.1% @10 yrs & 24.2% @17 yrs

  12. FDA Warning on CAR-T Cell Therapy

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