Dr. Jack Cush covers the news and journal reports from the past week on RheumNow.com. This week we have Insights NAFLD, overdose deaths, septic arthritis, refractory stills, & when MTX doesn’t work.
- Overdose deaths increased to 107 000 deaths in US in 2021, with significant racial disparity. Higher overdose rates seen in American Indian, Alaska Natives and Blacks. WORSE during COVID – 2020, overdose rates were 7 times higher in Blacks than Whites https://t.co/kuXmskZKbB
- 0NHANES Cross-sectional study of 5672 psoriasis US adults (20-59 yrs) shows more NAFLD in PSO patients (33% vs 27% nonPSO) with an increased risk (OR 1.67) – moreso in men (OR 2.16), age 20-39 yrs (OR 2.48) & those without diabetes (OR 1.70) https://t.co/VfaJbMKboP
- Metanalysis of 9 studies (RCTs, observational) looked @ DMARD effect (most Rx w/ biologics: TNFi, TCZ, RTX, Tofa) on lean & appendicular mass; shows despite bDMARD efficacy – no change in muscle mass! How will UR pts get STRONG? https://t.co/L7bRzPy02i
- French study from 362 septic arthritis pts over 2 yrs., mean age was 64yrs, w/ high Charlson comorbidity index 3.5. Most common was Knee (39%), Staphylococcus (51%), Abx used 47d, surgery in 48%; 28% serious complications & 9.2% died https://t.co/P2nxnhDnut
- 11.5% of Crohns pts have TNFi use contraindications (either MS, CHF, neoplasia, infx risk, TNFi AE, comorbidities, SLE. Alternatively GI survey respondents use ustekinumab (76%), vedolizumab (249%), or tofacitinib (0.5%) https://t.co/NqGOislcIJ
- Metanalysis (48 pubs, 145 refract pts) of JAK inhibitors in myositis (DM, JDM) shows significant improvement in skin lesions, muscle weakness, and ILD. https://t.co/cYZ1YEGBOr
- Leflunomide versus azathioprine in lupus nephritis? Study of 215 bx proven LN given either LEF or AZA – Renal flares were equal (15.7% v 17.8%), as was time to flare (16 mo vs AZA 14 mo); 24-hr proteinuria, creatinine, C3 and C4 improved similarly. https://t.co/FEKwwyoJhZ
- 213 #SLE pts were screened for Cryoglobulinemia (2013 -2017); CG is frequent in SLE (66%), but mostly asymptomatic. Mean levels 40mg/L (0-228). Cryo Vasculitis in 15% w/ purpura, ulcers, digit ischemia, arthritis, GN (5%) or CNS (19%) https://t.co/R6xUJldgC2
- Study of 50 #AOSD pts refractory to steroids (n=11), DMARDs (34) & biologics (n 30): given canakinumab 150–300 mg q 4wk (47) or q8wk(3). W/ 27 mos F/U: 78% complete resp w/in 3 mos (20% partial). Steroid sparing in 1/2, Low WBC 6%, 4%SIE https://t.co/QMCLictdrL
- 0*162 #AOSD or #sJIA criteria+ pts underwent genetic testing – 31% (51/162) had a genetic variant for periodic fever Dx. 4 SJIA pts were confirmed to have FMF or TRAPS. Genetic testing may be smart, esp w/ atypical presentations https://t.co/hwZFgOL4j4
- 2015 NEJM study of 4g acetaminophen vs PBO in 700 critically ill ICU patients with fever ≥38°C, showed Tylenol vs PBO had no differences in mortality, ICU stay or LFTs. Tylenol had small but signif reduction in Temp (38.4±1.0°C vs. 38.6±0.8°C; P<0.001) https://t.co/qnHgFRp20M
- Abatacept Most Effective Early and in Seropositive RA https://rheumnow.com/news/abatacept-most-effective-early-and-seropositive-ra
- Continue the Methotrexate, Leave the Cannoli https://rheumnow.com/news/continue-methotrexate-leave-cannoli
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