You are here:

You are here:

Heavy Metal Rheumatology (9.23.2022)

Jack Cush, MD

Thanks to all of you for your kind comments and great reviews of our weekly podcast. Please let us know how we can improve by emailing me ( or recording your suggestion using the “Ask Cush Anything” link on our website.

Below are this week’s highlights from RheumNow, as discussed by Dr. Jack Cush.

  1. Is PMR the Next Indication for Tocilizumab? About half of patients with steroid-dependent PMR were able to get off steroids altogether when they were started on tocilizumab (Actemra) infusions, a randomized phase III trial showed.
  2. IL-6i in Behcets? Lit Review finds 25 articles papers, 74 pts (31 TNFi naive, 45 TNFi prior Rx). Pts Rx w/ tocilizumab IV. TCZ given for vascular, CNS , ocular & mucocutaneous. TCZ was effective in 87% TNF naive & 80% in TNFi Experienced pts.
  3. Yoga Fails to Benefit Knee Osteoarthritis The Annals of Internal Medicine has published a study showing online yoga education and an unsupervised yoga program may improve physical function did not improve knee pain after 12 weeks and 24 weeks.
  4. Cohort Hip & Cohort Knee (CHECK) study of biomarkers (serum hs-CRP, sCOMP, sPINP sOC and urine uCTX-2) in1002 pts w/ hip or knee OA. Shows CRP, uCTX-2 & sPINP (OR 1.11-1.40) were assoc w/ nocturnal & walking pain, but not fatigue
  5. Are we set for the next “Twindemic”? – Continuation and evolution of COVID BA.5 to? – Flourishing Influenza in a population who has vaccine burnout? Some predicting severe flu based on Australia’s 2022 flu season, climate change, more
  6. Metanalysis of 25 studies examined effects of NSAID therapy on COVID-19 outcomes and confirms NSAIDs do not increase the likelihood of SARS-CoV-2 infection and do not worsen outcomes in patients with COVID-19.
  7. Colchicine vs cimetidine in PFAPA (Periodic fever, aphthous stomatitis, pharyngitis, adenitis) syndrome. 72 pts given COL vs CIM x 3 mos: # of febrile attacks was significantly decreased by both Rx (noninferior to each other)
  8. NIH: 27 pts w/ ROSAH (retinal dystrophy, optic N. edema, splenomegaly, anhidrosis, headache) syndrome, due to dominant mutation ALPK1 – an autoinflammatory Dz w fevers, HA, Abnl CNS MRI, deforming arthritis, AA amyloidosis .
  9. Retrospective study of PFAPA < 18yrs, 336 pts, Boys=Girls, peak onset ~age 1 yrs (less w/ yrs); 90% 1st Sxs under 5 yrs & <3% after age 10 yrs, Common Sxs: pharyngitis w fever, Cx adenitis, aphthous stomatitis, atyp skin rash. Incidence 0.86/10K/Yr
  10. Is there link between PsA & autoinflammatory Dz? Study of 120 #PsA pts found 31% w/ AID gene variants (AP1S3, PLCG2, NOD2, NLRP12, all monoallelic variants adn 1/2 genes assoc w/ autosomal dominant disorders.
  11. Italian study of Apremilast in 356 #PsA (age 60yrs) pts Followed ~17 mos, shows retention rate @ 12, 24 & 36 mos to be 85.6%, 73.6%, & 61.8%. D/C primarily for inefficacy (18-34%), GI Sx (24%). Best persistence w/ oligoarthritis
  12. Clinical Profiles Seen with NXP-2 Antibodies A recent review of the myositis associated autoantibody NXP-2 profiles its clinical associations with dermatomyositis (DM), calcinosis, severe myositis and, in some reports, with cancer.
  13. STAR-RA study – real world claims data shows tofacitinib doesnt increase malignancy risk. Study of 83,295 pts (10,504 TOFA). Risk of malignancy w/ TOFA not increased (HR 1.01) w/ RWE or RCT-duplicate cohort (HR 1.1; 95% CI 0.85, 1.62)
  14. Deep Vein Thrombosis reviewed in current Annals of Internal Medicine – VTE is the 3rd most common CVD, seen in 5% of population. Half of VTE assoc w/ transient preventable risk factors. Direct oral anticoagulants are effective and safer
  15. RINOMAX Trial studied single dose of 500 mg rituximab IV in myasthenia gravis – 47 MG pts randomized to RTX or PBO, after 4 mos RTX response (71% vs 29%) superior to PBO. Further studies are needed
  16. Propensity matched pairs (n=237 872) of perioperative pts – gabapentin users and nonusers shows perioperative gabapentin use had significantly more delirium (RR 1.28), antipsychotic Rx (1.17 ) & pneumonia (1.11) vs nonusers post surgery
  17. Metals & Hyperuricemia (HU) (20 studies, 63,283 participants): Increased HUA risk arsenic (OR 1.7), calcium (OR 1.76), cadmium (OR 1.19), & lead (OR 1.56), BUT lower w/ molybdenum (OR  0.8). No effect w/ Cu, Fe, Mg, Zn, Cd, Co, Al, Hg, Tl
  18. Hydroxychloroquine Dosing and SLE Flares JAMA cohort study examining HCQ dosing in patients with SLE suggests that HCQ doses of 5 mg/kg per day or less, was associated with a higher risk of lupus flares, including moderate or severe lupus flares.
  19. USPSTF Recommends Screening for Anxiety and Depression 

Related Content