Wednesday, 20 Nov 2019

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Frequent DMARD Discontinuations During Rheumatoid Pregnancies

A Canadian population-based study shows that pregnant women with rheumatoid arthritis (RA) frequently discontinue their DMARD medications, especially in the first trimester.

An administrative data study looked at women with RA with a singleton pregnancy who were studied for utilization of RA medications, including conventional synthetic DMARDs, biologics, glucocorticosteroids and NSAIDs.

Psoriasis Risk Increased with TNF Inhibitors in Juveniles

Children with inflammatory diseases who were treated with tumor necrosis factor (TNF) inhibitors had a higher rate of incident psoriasis than those not exposed to these biologics, a single-center retrospective study found.

Methotrexate and the Risk of Lung Disease

Rheumatology has a comprehensive overview of methotrexate (MTX) and the risk of lung injury, MTX-related pneumonitis and interstitial lung disease (RA-ILD) with rheumatoid arthritis (RA). Past reports suggest the frequence of MTX-pneumonitis to be between 0.3 and 11.6%; recent studies suggest it may be much lower.

Novel Inhibition of MSU Crystal Inflammation

Researchers from Washington State University have shown that inhibition of tumor growth factor-β (TGF-β)-activated kinase 1 (TAK1) can effectively downregulate inflammatory mediators and suppress inflammation caused by gout.

Monosodium urate (MSU) crystals directly activate the inflammasome to produce a plethora of pro-inflammatory cytokines, including interleukin-1β (IL-1β). 

The Shame Behind Adalimumab Biosimilars

JAMA has an article this week on the shift from biologic drugs to less expensive therapeutic biosimilar agents. The impact of biosimilars can be easily represented by the shift from adalimuamb - a biologic with nearly $19 billion in sales in 2018 - to any one of the four FDA approved biosimilars for adalimumab (see the daily download for slides on new adalimumab and other biosimilars).

Common Physician HIPAA Violations

A nice review by Physician Sense and MDLinx discusses potential physician violations of current HIPAA law, largely driven by the digital age and common work flows. Several mistakes you you be aware of and avoid, include:

Forwarding PHI to a personal email account

RheumNow Podcast – The Shoes Maketh the Doctor (10.25.19)

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.

FDA Issues Boxed Warning and Recommendations for Breast Implant Use

The U.S. Food and Drug Administration has issued a new draft guidance document calling for a boxed warning and delineation of risks with breast implants.

Patients Prefer Nurse Led Care for their Gout

Despite the well known, well publicized treat-to-target (T2T) goal of a serum uric acid (SUA) level < 6 mg/dl, this goal is seldom achieved (< 40%) in clinical practice and patient adherence has been unacceptably low. A recent study shows that nurse-led care led to better outcomes in gout including patient acceptability, long-term adherence, and less flares.

Voluntary Recall of Zantac by Sanofi/FDA

Sanofi has initiated a voluntary recall of all Zantac OTC (over-the-counter) products in the United States. This includes Zantac 150®, Zantac 150® Cool Mint, and Zantac 75®. Zantac tablets are an oral, over-the-counter product to prevent and relieve heartburn associated with acid ingestion and sour stomach.

FDA Approves Ustekinumab for Ulcerative Colitis

Ustekinumab (Stelara) is now FDA-approved to treat moderately to severely active ulcerative colitis, said drugmaker Janssen on Monday, in addition to its indications for psoriasis, psoriatic arthritis, and Crohn's disease.

Pain Persists Despite TNF Inhibitor Use

Control of pain in patients with rheumatoid arthritis (RA) often focuses on control of inflammation as a means to better control pain. However, a new claims data study shows that while anti-tumor necrosis factor inhibitor (TNFi) may lower the use of opioids, the reduction is nominal, suggesting that a substantial amount of pain is not adequately addressed by TNFi - a potent anti-inflammatory approach.