2 Minute Medicine ® - Rheumatology

1. Following total knee replacement (TKR) for osteoarthritis, patients randomized to a combined digital intervention experienced less pain, less disability, and increased physical activity at 12 months follow-up, compared to care usual. Evidence Rating Level: 1 (Excellent) Patients who undergo total knee replacement (TKR) for osteoarthritis (OA) may continue to have ongoing pain and limited function, with some reports showing that 10% of patients are dissatisfied at 2 years of follow-up. Digital interventions are one strategy shown to improve pain and increase activity after TKR...

1. Time to disease flare was significantly shorter in the placebo group versus baricitinib. 2. There was no difference in serious adverse events between the baricitinib and placebo groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Juvenile idiopathic arthritis (JIA) is defined by the onset of polyarticular joint pain before age 16 and can severely affect an individual’s quality of life. First-line treatment for JIA includes nonsteroidal anti-inflammatory drugs (NSAIDs) and biologic disease-modifying antirheumatic drugs (DMARDs), however, many patients with JIA continue to experience refractory symptoms...

1.  In this pooled analysis of randomized controlled trials, low-dose glucocorticoids taken over a two-year period did not increase patient blood pressure. 2. Low-dose glucocorticoid use was associated with an increase in weight of one kilogram on average.  Evidence Rating Level: 1 (Excellent) Study Rundown: Glucocorticoids are commonly used in the management of rheumatoid arthritis (RA), though are often associated with adverse events such as weight gain and hypertension. However, there is a gap in knowledge as to understanding whether glucocorticoids are truly the cause of these adverse events...

 1.  In a prospective cohort study, white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and procalcitonin (PCT) were elevated in pediatric patients with a musculoskeletal infection. 2. WBC count, ANC, CRP, ESR, and PCT were distinguished musculoskeletal infections from Lyme arthritis and other types of inflammatory arthritis. Evidence Rating Level: 2 (Good) Study Rundown: Bacterial musculoskeletal infections (MSKI) are serious conditions that require rapid recognition and treatment...

Effect of Dexmedetomidine on Posttraumatic Stress Disorder in Patients Undergoing Emergency Trauma Surgery: A Randomized Clinical Trial : https://read.qxmd.com/read/37326991 1. Intraoperative and postoperative dexmedetomidine significantly decreased the incidence of post-traumatic stress disorder (PTSD) in patients with trauma undergoing emergency surgery. Evidence Rating Level : 1 (Excellent) The incidence of PTSD after trauma hospitalization is reported to be as high as 23%. Once PTSD develops, it is highly debilitating, difficult to manage, and associated with increased suicide risk...

1. In this randomized controlled trial, there was a significant reduction in the Disease Activity Score of rheumatoid arthritis patients taking peresolimab compared to a placebo. 2. Peresolimab had a comparable adverse event profile to the placebo. Evidence Rating Level: 1 (Excellent) Study Rundown: Rheumatoid arthritis is a systemic, autoimmune inflammatory disease for which remission and sustained remission are challenging. Disease-modifying antirheumatic drugs (DMARDs) have been a cornerstone in treating rheumatoid arthritis...

1. Patients in sparsentan group reported a 50% reduction in proteinuria compared to 15% in the irbesartan group at week 36. 2. Complete remission of proteinuria was significantly higher in the sparsentan group. Evidence Rating Level: 1 (Excellent) Study Rundown: IgA nephropathy is the most common cause of primary glomerulonephritis worldwide. Although renin-angiotensin blockers (ARBs), such as irbesartan, have been primarily used for treatment, some patients continue to have persistent proteinuria. Sparsentan, a novel single-molecule, angiotensin II receptor antagonist, may have improved efficacy in patients with refractory proteinuria although existing trials suggest mixed results...

1. Patients in the ritlecitinib group showed significant improvements in alopecia symptoms, with Severity of Alopecia Tool (SALT) scores ≤ 20, compared to placebo. 2. Adverse events between groups were comparable; there were no reported deaths. Evidence Rating Level: 1 (Excellent) Study Rundown: Alopecia areata is an autoimmune form of hair loss that affects both children and adults. Intralesional corticosteroids and Janus kinase (JAK) inhibitors serve as first-line treatment options for the disease. Ritlecitinib is a dual JAK3 and tyrosine-kinase expressed in hepatocellular carcinoma (TEC) inhibitor which may be more effective than conventional therapy, although little is known to date...

1. The price increase of Colchicine in the United States led to greater use of alternative medications for gout treatment, as well as greater ED and rheumatology visits for gout.  Evidence Rating Level:  2 (Good)  Prices of prescription drugs have an important impact on the ability of patients to adhere to recommended medical treatments. The price of colchicine, a prescription medication used to treat gout, was increased in 2010 in the United States. This retrospective cohort study assessed MarketScan data from patients with gout and employer-based insurance between 2007 and 2019...

1. Participants reporting a greater number of chronic pain sites had a higher proportion of developing incident all-cause dementia, AD, and vascular dementia than those without chronic pain in this prospective cohort study. Evidence Rating Level: 2 (Good) Dementia is a major public health concern, and there is no current cure or effective disease-modifying agent. Therefore, identifying and targeting modifiable risk factors continues to be a mainstay in preventive care. Existing literature supports a link between chronic musculoskeletal pain and accelerated cognitive and memory decline, though current evidence is still lacking...

1. High-sensitivity C-reactive protein increased the risk of all-cause mortality by two- to three-fold among all three randomized trials. 2. The effect of residual cholesterol on major cardiovascular events, cardiovascular mortality, and all-cause mortality was insignificant. Evidence Rating Level: 1 (Excellent) Study Rundown: Statins are first-line therapy in patients with clinical atherosclerosis. While inflammation and hyperlipidemia may contribute to atherothrombotic disease, their effects on cardiovascular events and mortality following statin initiation are unclear...

1. In both ELEVATE UC 12 and ELEVATE UC 52, significantly greater patients in the etrasimod group achieved clinical remission compared to placebo. 2. Majority of adverse events were mild-to-moderate in nature with no reported fatalities. Evidence Rating Level: 1 (Excellent) Study Rundown: Ulcerative colitis is a chronic, autoimmune disease of the gastrointestinal tract that affects many patients worldwide. Etrasimod, a sphingosine 1-phosphate receptor modulator, may play a role in treating ulcerative colitis, although little is known to date...

1. In this retrospective cohort study, individuals with diabetes treated with metformin had a significantly lower risk of developing osteoarthritis compared to those treated with sulfonylurea. Evidence Rating Level : 2 (Good) Osteoarthritis (OA) affects 32.5 million people in the United States and is a major contributor to global years lived with disability. Currently, there are no effective medications that can stop, slow, or reverse the progression of OA. In addition to its use as a first-line treatment for type 2 diabetes, there is emerging evidence that metformin may be useful in preventing OA...

1. Patients receiving secukinumab every 2-weeks showed superior clinical response rates compared to those receiving placebo. 2. Secukinumab was well-tolerated, and the most common adverse effect was a headache. Evidence Rating Level: 1 (Excellent) Study Rundown: Hidradenitis suppurativa is an inflammatory dermatological condition that leads to abscesses and scarring of the skin. Current treatment typically includes topical medication and surgical intervention. There is only one biologic therapy (adalimumab) approved for the treatment of moderate-to-severe hidradenitis...

1. An oral dose of sebetralstat increased the time to conventional treatment use and lead to faster symptom relief in acute hereditary angioedema attacks compared to control. 2. Sebetralstat was well tolerated and was demonstrated to rapidly reduce activity of plasma kallikrein. Evidence Rating Level: 1 (Excellent) Study Rundown: Hereditary angioedema is a rare disease that causes episodic attacks of tissue swelling. Current treatments include on-demand and prophylactic medications, but these are parenterally administered...

1. In this retrospective cohort study, there was an increased prevalence of age-, race-, and body mass index (BMI)-adjusted cardiovascular, musculoskeletal, and neurodegenerative diseases in former professional American-style football (ASF) players compared to the general population. 2. Additionally, the proportion of individuals without any chronic diseases was lower in former ASF players compared to the general population. Evidence Rating Level: 2 (Great) Participation in American-style football (ASF) has been shown to have several health consequences...

1. In this network meta-analysis, there was no difference between exercise, oral non-steroidal anti-inflammatory drugs (NSAIDs), and paracetamol with respect to pain relief associated with osteoarthritis (OA) at up to 24 weeks of follow-up. 2. Furthermore, there was no significant difference between the three groups with respect to functional improvement at up to 24 weeks of follow-up. Evidence Rating Level: 1 (Excellent) Osteoarthritis (OA) represents a significant disease burden in older individuals and current pharmacological therapy such as oral non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol may lead to adverse side effects...

1. In this retrospective cohort study, the incidence of hydroxychloroquine retinopathy was 2.5% at 10 years, increasing to 8.6% at 15 years in adults with rheumatic or dermatological diseases.  2. The risk of hydroxychloroquine retinopathy increased to 21.6% after 15 years of use for those receiving greater than 6mh/kg per day compared to 2.7% at 5mg/kg per day or lower. Evidence Rating Level: 2 (Good) Study Rundown: Hydroxychloroquine is a disease-modifying anti-rheumatic drug (DMARD) commonly used to treat rheumatological or dermatological conditions such as lupus and rheumatoid arthritis...

1. At week 16, all rocatinlimab groups reported significant improvements in eczema severity. 2. Most treatment-related adverse events were mild-to-moderate, with no fatalities reported. Evidence Rating Level: 1 (Excellent) Study Rundown: Despite advances in biologic therapy, there remains a lack of safe and effective treatment for moderate-to-severe atopic dermatitis. OX40 is a receptor known to be important for T-cell differentiation and its inhibition may potentially lead to improvements in immune function...

1. Significantly more patients in the bimekizumab group reached ACR50 at week 16 compared to the placebo. 2. Fungal infections occurred with a higher frequency in the bimekizumab group. Evidence Rating Level: 1 (Excellent) Study Rundown: Psoriatic arthritis is a complex, immune-mediated inflammatory disease that is managed using synthetic disease-modifying antirheumatic drugs (DMARDs). Studies suggest that biologic therapies may play a role in reducing disease burden, although the extent to which they do so is unclear...