Relapsing Polychondritis (RP) in 2021
Relapsing is characterised by recurrent inflammation of cartilaginous tissues and proteoglycan-rich structures. This condition can be fatal. PET-CT can help determine disease severity and therapy options. Mild joint, ear, and nose inflammation is treated with NSAIDs, Dapsone and Colchicine. Acute exacerbations require systemic corticosteroids. Biological medicines are modestly effective in RP.
Recent Progress in Targeted Therapy for SLE
The number of patients with SLE is increasing and there are substantial unmet medical needs for this disease. The heterogeneous nature of SLE manifestations remains a substantial burden for many patients. New evidence is guiding towards an understanding of the molecular and cellular pathways that are involved in the disease.
Axial psoriatic arthritis - Is it different from Axial Spondyloarthritis?
Ax PSA is heterogeneous and a proportion of patients appear to have axial disease distinct from axSpA. In addition to genetic, clinical, and imaging differences, axPsA may respond differently to treatment than axSpA. Right sacroiliac arthritis was statistically more severe than left sacroililiac arthritis. Secukinimab reduced total berlin MRI score for the entire spine and SI joints.
Update on Future Therapeutics in Osteoarthritis Treatment
Canakinumab is a monoclonal Ab to IL-1B that treats inflammation underpinning atherothrombosis. It reduced the chances of joint replacement significantly as compared to placebo in the CANTOS trial. In PROMOTE trial which compared Methotrexate and placebo, WOMAC pain, stiffness, & function improved significantly with MTX. Many new promising therapies have come up about inflammation.
Living Recommendations Paradigm in OA Treatment Guidelines
Living guidelines provide updated recommendations & need to understand why recommendations diverge. The final arbiter comes through shared clinical decisions between healthcare provider and patient. Common recommendations for osteoarthritis:Self-managementWeight lossCane overshoe wedge and other forms of bracesTopical NSAIDsOral non-selective or selective NSAIDs with caution
RA special interest group Symposium - Early RA criteria
Very early rheumatoid arthritis (VERA) was defined as a disease with symptoms of less than 12 weeks. By the early 1990s, it has decreased to 24 months with greater emphasis on the first 12 months. Detection of ERA and VERA is important for improving outcomes. MRI/USG are adjunctive tools in the detection of ERA and VERA. New ERA criteria are validated and need to be used in routine practice.
RA special interest group Symposium - Clinical Deep Remission
Remission is the main target of RA and DAS28 criteria is inadequate. Clinical deep remission includes no swollen joints, no tender joints, normal ESR, and normal CRP. Longitudinal RA cohort from Peking University People's hospital included patients with 3 or more than 3 visits per year. It was found in this study that CliDR has better practicality.
Cardiovascular Comorbidity in Axial Spondyloarthritis- What's new?
Axial Spondyloarthritis (AS) patients have an increased risk of death, stroke, & CVD. The author shows that Canakinumab 150 mg every 3 mnths reduced recurrent CV events compared to placebo, regardless of lipid lowering. Inflammation control & therapy of CV risk factors may slow progression of subclinical atherosclerosis and events.
Management of Pregnancy in Rheumatic Disease
Modern therapeutics, including biologic and targeted synthetic DMARDs, have enabled substantial improvements in the control of rheumatic diseases, resulting in more patients with severe disease considering pregnancy. Risk assessment & planning are strongly recommended along with a multidisciplinary approach. And therapy should be adjusted as pre-pregnancy, during pregnancy and post-pregnancy
Chikungunya Infection and Arthritis
Ongoing musculoskeletal complications from Chikungunya infection create personal, social and economic misery which can last months or years. DMARDs have shown significant improvements in chronic Chikungunya arthritis sufferers. There are currently no universally recognised therapeutic recommendations or established care regimens for treating acute and persistent post-chikungunya arthritis.
Co-morbidities in Psoriatic arthritis (PsA)
Anxiety showed an impact on DAPSA, PsAID, and HAQ-DI in a study that highlights the impact of co-morbidities on disease activity, patient global assessment, and function in psoriatic arthritis. FM PsA patients had higher mean BMI than non-FM ones. In PsA, fibromyalgia reduces the effectiveness of biologic drugs. Patients with PsA have higher levels of FeNO & SLE comorbidity.
A Single course Rituximab - What does it achieve?
From 2014 to 2020, all RA patients who received a single course of rituximab with a minimum of 1 yr post-injection follow-up were included in the study. The baseline DMARDS, steroid & lab investigations available were compared . A single course of low dose rituximab leads to better disease control which decreased steroids and stable dmards dosage even after one year.
The Proportion of Regulatory T cells in Patients with Sjogren's syndrome: A Meta-Analysis
Sjogren's syndrome is a common autoimmune condition marked by eye dryness, exhaustion, and pain. Regulatory T cells play a role in the disease pathogenesis. Patients with SS had a lower proportion of Tregs in their peripheral blood (P0.001). The number of CD4+ and CD25+ Treg cells in SS patients was considerably lower than in the control group.
Upadacitinib or Adalimumab in Patients with Rheumatoid Arthritis: Safety and Efficacy
In phase 3 trial of SELECT-COMPARE, upadacitinib 15 mg daily showed improvement in clinical symptoms of RA compared to adalimumab plus MTX at week 12. Over a 3-year period, the trial compared the safety and efficacy of UPA versus ADA with an added dose of MTX. A higher proportion of patients taking UPA achieved disease activity & higher rates of ACR responses. UPA+MTX showed better response .
Replacing the pill: Future of CVD therapy
Gene replacement therapy involves augmenting calsequestrin in cDNA plasma & injecting in AAV virus and delivered to heart. It leads to reduced percentage of arrhythmias. Although gene therapy has advanced in several fields, cardiac gene therapy has been slowed down due to challenges faced by CUPID studies. Further studies are needed to understand delivery/vectors/dosing.
Quantum Genomics Firibastat (QGC001) or Ramipril to prevent left ventricular dysfunction
The primary objective of QUORUM trial was to compare the effects of two oral doses of Firibastat to those of Ramipril in Left Ventricular Ejection Fraction (LVEF). The study concluded that Firibastat (100mg or 500mg BID) was not superior to active comparator ramipril (5 mg BID) to prevent left ventricular dysfunction after first acute anterior MI
ACCOST-HH: Adrecizumab in cardiogenic shock
Cardiogenic shock is a serious medical condition with high mortality and morbidity. ACCOST-HH trial evaluated the safety, tolerability and efficacy of Adrecizumab on top of standard of care in patients with cardiogenic shock. Adrecizumab was found to be well-tolerated in patients with cardiogenic shock. But it did not reduce the need for cardiovascular organ support or improve survival.
Effect of Dapagliflozin on mortality in HFrEF patients
The DAPA-HF trial examined the effect of Dapagliflozin on ventricular arrhythmia, resuscitated cardiac arrest or sudden death in HFrEF patients. The study shows the beneficial impacts of SGLT2i in HFrEF and generates one prospective procedure for how these drugs reduce mortality in HFrEF.
Relationship between different IGG and IGA Anti-Modified Protein Autoantibodies in RA
The study analyzes 30 different IgG and IgA AMPA reactivities to Cit, Carb, KAc, and MAA antigens. It concludes that autoantibodies exhibiting different patterns of ACPA fine-specificities as well as Carb & KAc reactivity are present in RA. MAA is not related to citrulline reactivity. While Carb & KAc reactivities could belong to same autoreactivity family as ACPA fine-specificities.
Eular Recommendations for Implementation of Self-Management Strategies in Patients with IA
The recommendations include: patient education should be the start point; HCPs should promote physical activity; emotional and mental health should be assessed; encourage self-management interventions into the daily routine including problem solving, goal setting, and cognitive behavioural therapy. These should be used alongside the medical management guidelines to support patients in their care.
