Wednesday, 20 Nov 2019

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RheumNow Podcast – Believe in Vitamin D or Rituximab? (9.20.19)

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

  1. Prospective ankylosing spondylitis cohort - 628 without HTN followed for12 mos; 200 treated with NSAIDs; of these 129 developed incident HTN. NSAID use associated with increased risk of HTN (HR 1.12; CI, 1.04‐1.20), not effected by age, biologics, dz activity
  2. Southern Sweden study of ANCA Assoc Vasculitis (GPA, MPA, EGPA) 195 pts followed x8 yrs: found all cancers increased (SIR=2.8). SIR for squamous cell CA=12.9; 4.3 bladder cancer, & 7.0 for pancreatic CA. CYC total <10g were not associated w/ higher CA risk
  3. Metanalysis of 16 studies- Systemic Sclerosis pregnancies have a higher risk of miscarriages (OR 1.6), IUGR (OR 3.2), preterm births (OR 2.4) and low birth weight (OR 3.8). SSc pts have 2.8 fold higher rate of gestational HTN & 2.3x more C- sections.
  4. Statin use was associated with reduced risk of radiographic knee osteoarthritis joint space narrowing progression in patients with nodal osteoarthritis. Data from the Osteoarthritis Initiative, 832 knees of 602 participants (statin initiators vs nonusers)
  5. Administrative data from British Columbia examined the role of NSAIDs in OA and their risk of cardiovascular dz. Overall OA patient have a higher risk of CVD than do matched controls (adj HR 1.23) & 41% of that CVD risk was mediated through NSAID use.
  6. Despite several Vitamin D intervention RCTs in SLE failing; a metanalysis shows Vit D levels low in SLE, especially in pts with SLEDAI >10. Deficiency of Vit D incr SLE risk (OR=4.37) and Vit D levels were inversely correlated with SLEDAI (correlation coefficient = −0.50)
  7. Despite RCTs showing RTX doesnt work in SLE - rheums still use it. Review of 147 SLE pts on RTX shows better outcomes in those with a low # prior DMARDs & low C4 levels. >1/2 had prior MMF, AZA, HCQ; 1/3 CTX or MTX.  Lesser responses seen with Joint disease.
  8. Risk of HCQ/CQ Retinal toxicity was 5.5% in 326 SLE pts F/U x 12.8 yrs. None occurred in 1st 5 yrs; earliest 8 yrs (max =33 years). Retinal toxicity cases tended to have more renal disease (22% vs 15%) and were slightly less likely to be Caucasian
  9. 90 SLE patients (SLEDAI<6) on immunosuppressives were given PBO or the live virus zostavax - Vax pts had significantly higher anti-VZV IgG by Wk 6; also more injection site reactions (31% vs 7%). 3 pts flared (1PBO; 2 Zostavax) and no one developed zoster postvaccination
  10. ACR Survey Shows Half of Patients Cannot Afford Treatments  
The author has received compensation as an advisor or consultant on this subject

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