A new guideline developed by the ACR and the American Association of Hip and Knee Surgeons addresses the perioperative use of antirheumatic drug therapy. Specifically, it provides recommendations on the use of traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib and glucocorticoids in adults with RA; SpA, including ankylosing spondylitis and psoriatic arthritis; JIA; or SLE undergoing elective THA or TKA. The guideline provides recommendations regarding when to continue, when to withhold and when to restart these medications, and the optimal perioperative dosing of glucocorticoids…
Articles by Arthritis & Rheumatology
Rituximab for Fatigue & Oral Dryness in Primary Sjögren’s Syndrome
These researchers investigated whether rituximab, an anti-B cell therapy, improves symptoms of fatigue and oral dryness in patients with primary Sjögren’s syndrome (SS). The multicenter, randomized, double-blind, placebo-controlled, parallel-group trial included a health economic analysis. There were no significant improvements in any outcome measure with rituximab except for unstimulated salivary flow. The study concludes that rituximab is neither clinically effective nor cost effective in this patient population…
The Biomarkers of Lupus Disease Study
Most SLE clinical trials continue standard background medications being taken by patients at entry, based on assumptions that this minimizes the risk of serious flares and that immunologic interference is minimal. These assumptions are not evidence based, but eliminating polypharmacy in trials studying patients with active lupus remains controversial. These researchers tested the withdrawal of immunosuppressants to make SLE trial results more interpretable…
RA Prevention: A Trial of Methotrexate Vs. Placebo in Patients with Undifferentiated Arthritis
Disease outcomes in rheumatoid arthritis (RA) have improved dramatically since the introduction of biologic agents and improved treatment strategies. Nevertheless, the majority of patients still require prolonged, if not lifelong, therapy. Therefore, the ultimate goal would be to prevent RA. This study analyzed the effect of a one-year course of methotrexate in high-risk UA patients (studied in a previous trial) after post-randomization exclusion of patients without a high risk of developing RA…
Immune-Related Adverse Events with Use of Checkpoint Inhibitors for Immunotherapy of Cancer
Introduction: Major advances in the past two decades have enhanced our understanding of the complex interactions between the immune system and cancer cells and their environment. Genetic and epigenetic alterations in tumor cells result in the expression of diverse antigens that can elicit an immune response, primarily mediated by T cells. Immune responses are regulated…
Herpes Zoster & the Risk of Stroke in Patients with Autoimmune Diseases
Herpes zoster (HZ) infection, also known as shingles, is caused by reactivation of latent varicella-zoster virus infection generally acquired decades earlier. This study was designed to test the hypothesis that the incidence of stroke immediately following HZ infection is increased in patients with autoimmune diseases compared with the incidence of stroke at later time points. Results: In patients with autoimmune diseases, incident HZ was associated with as much as a twofold increased risk of stroke. Prompt antiviral therapy was associated with lower incidence of subsequent stroke…
Lesinurad with Allopurinol When Allopurinol Alone Is Insufficient
Current guidelines for the long-term management of gout recommend a combination of lifestyle management and/or pharmacotherapy to lower serum UA levels to <6.0 mg/dL in most patients or <5.0 mg/dL in patients with more severe disease. Allopurinol is the most widely used xanthine oxidase inhibitor and is recommended in treatment guidelines as a first-line urate-lowering…
Effect of Diet & Sodium Intake on Serum Uric Acid
Serum uric acid (UA) is an important factor in the causal pathway for gout. It has also been implicated as a potential risk factor and/or mediator of cardiovascular disease outcomes and mortality in a large number of observational studies. Although many of the clinical trials targeting serum UA reduction have focused on pharmacologic interventions, diet…
Pregnancy Outcome in Early Rheumatic Disease
Systemic autoimmune rheumatic diseases are associated with increased rates of adverse pregnancy outcomes, including spontaneous abortion, preeclampsia, fetal growth restriction (FGR) and prematurity. In this study population, preclinical rheumatic disorders were associated with an increased risk of FGR, preeclampsia and small-for-gestational-age infants. The impact of these findings and their utility in screening for fetal growth restriction/preeclampsia need to be confirmed in population studies…
Clazakizumab for Adults with Active PsA
This is the first clinical trial of an IL-6–targeted therapy in PsA. Clazakizumab may be an effective treatment option for musculoskeletal aspects of PsA, but because of the lack of a dose response in this study, further studies are required to confirm the appropriate dose. The safety profile is consistent with the pharmacology of IL-6 blockade and prior clinical experience with this antibody in rheumatoid arthritis…
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