2 Minute Medicine ® - Rheumatology

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...

1. In this randomized controlled trial, community-based diet and exercise education led to improvement in osteoarthritis associated pain score. 2. Community-based diet and exercise regimen was more effective in lowering mean body weight and mean waist circumstance compared to attention control group.   Evidence Rating Level: 1 (Excellent) Osteoarthritis (OA) is the most common cause of mobility and disability amongst the elderly. Since patients with OA live with symptoms for an average of 26.1 years, optimizing treatment of OA can have a significant impact on quality of life for this population...

1. In this retrospective, cohort, control-matched study, a diagnosis of juvenile idiopathic diabetes was associated with an increased risk of developing obstructive sleep apnea. 2. Additionally, the association between sleep apnea and juvenile idiopathic arthritis was strongest in those aged 18-30 and in males. Evidence Rating Level: 2 (Good) Juvenile idiopathic arthritis (JIA) is a chronic inflammatory condition that affects the temporomandibular joint. JIA can lead to deformities in the joint that can cause upper airway collapse and difficulty breathing, increasing the risk of obstructive sleep apnoea (OSA)...

1. Among patients with primary Sjögren syndrome, therapy with low-dose interleukin 2 significantly improved outcomes as determined by the European League Against Rheumatism Sjögren’s Syndrome Disease Activity Index. Evidence Rating Level: 1 (Excellent) Study Rundown: Primary Sjögren syndrome (pSS) is a debilitating autoimmune disease that is characterized by xerostomia, xerophthalmia, and systemic involvement. While there are currently therapies available for pSS, these are usually corticosteroids and immune-suppressive agents which are used for symptomatic control...

1. Self-administered subcutaneous immunoglobulin therapy in the treatment of immunodeficiencies is significantly less costly compared to clinic-administered intravenous immunoglobulin therapy. Evidence Rating Level: 2 (Good) Immunoglobulin G (IgG) can be administered in intravenous (IVIG) or subcutaneous (SCIG) form to treat immunodeficiency diseases. IVIG is typically performed once monthly in an out-patient setting and administered by a nurse. While IVIG and SCIG cannot be always interchanged, a newer alternative method of SCIG can be self-administered at home...

1. In this systematic review and meta-analysis, moderate certainty evidence suggested that damage to various structures of the knee may increase the odds of symptomatic osteoarthritis (OA). 2. Furthermore, modifiable risk factors for OA remain more established than modifiable risk factors for post-traumatic OA. Evidence Rating Level: 1 (Excellent) OA is the most common joint condition affects millions of people worldwide. Post-traumatic OA represents at least 12% of these cases. Unlike the availability of high-level evidence to guide prevention of post-traumatic knee OA, there is a gap that remains in how to delay or prevent the development of OA after a traumatic injury...

1. The composite score for non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death was comparable between allopurinol (11.0%) and usual care (11.3%). 2. All-cause mortality was similar among both groups (10.1% allopurinol vs. 10.6% usual care). Evidence Rating Level: 1 (Excellent) Study Rundown: Allopurinol is often used for gout prophylaxis given its urate-lowering effect; however, treatment for asymptomatic hyperuricemia is not currently indicated. Studies show that allopurinol may have a positive impact on cardiovascular outcomes; however, current evidence is limited...

1. Litifilimab was associated with a reduction in the number of swollen and tender joints in systemic lupus erythematosus (SLE) patients as compared to a placebo.  2. Compared to placebo, litifilimab did not result in significant changes in skin-related and overall disease activity. Evidence Rating Level: 1 (Excellent) Study Rundown: SLE is an autoimmune disease affecting multiple organ systems. Type I interferons have been shown to contribute to the pathophysiology of SLE. Plasmacytoid dendritic cells (PDCs), a producer of type I interferons, accumulate in many affected tissues in SLE patients...

1. An increased incidence of new cardiovascular disease was seen in individuals with autoimmune disease compared to those without. 2. This increased risk was greatest in younger patients and increased among patients with multiple autoimmune conditions. Evidence Rating Level: 2 (Good) Study Rundown: Autoimmune diseases are known to be associated with cardiovascular disease. This large longitudinal study aimed to evaluate the association between common autoimmune disease and cardiovascular outcomes. Using electronic health records, the study identified individuals with incident autoimmune conditions within a 17-year period...

1. Compared to a control group, patients with knee osteoarthritis who engaged in online yoga had improvements in pain and function at 12 weeks of follow-up. 2. Improvements in pain and function in the online yoga group were not maintained at 24 weeks. Evidence Rating Level: 2 (Good) Study Rundown: Knee osteoarthritis is a significant source of disability as a result of pain, reduced function, and disruption of mood. There is a gap in the literature as to the impact of low-impact exercise on disease burden in knee osteoarthritis patients...

1. The risankizumab group showed greater clinical remission and endoscopic response rates compared to placebo across the ADVANCE and MOTIVATE trials. 2. Treatment-related adverse events were mild and comparable between the three groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Biologics are currently used as the first-line therapy for treatment of moderate-severe Crohn’s disease. However, a significant proportion of patients do not achieve adequate remission or have high rates of relapse despite biologics...

1. Compared to a placebo (withdrawal) group, patients maintained on subcutaneous risankizumab had greater rates of clinical remission. 2. Adverse events were similar between the treatment and placebo group with worsening of Crohn’s disease and nasopharyngitis being the most common adverse events. Evidence Rating Level: 1 (Excellent) Study Rundown: This study is a follow-up to the ADVANCE and MOTIVATE phase 3 drug trials. During the prior trials, participants received induction therapy with IV risankizumab or placebo for moderately to severely active Crohn’s disease...

1. Upadacitinib led to significantly greater percentages of clinical remission compared to placebo for both induction and maintenance studies. 2. Treatment discontinuation due to serious adverse events was more frequent among the placebo group than those receiving upadacitinib. Evidence Rating Level: 1 (Excellent) Study Rundown: This study reported a summary of findings from two induction studies and one maintenance study (U-ACHIEVE, U-ACCOMPLISH, and U-CHIEVE maintenance) of oral daily upadacitinib for moderate to severe ulcerative colitis...

1. This multicenter cohort study of 3922 children with Kawasaki disease (KD) demonstrated that there was a 28.2% decline in KD cases in the United States during 2020 (646 cases), compared with 2018 (894 cases) and 2019 (905 cases). 2. School closures, mask mandates, decreased ambient pollution, and decreased circulation of respiratory viruses during the COVID-19 pandemic overlapped to various extents with the period of decreased incidence of KD. Evidence Rating Level: 2 (Good) Study Rundown: Kawasaki disease (KD) is a self-limited, inflammatory condition affecting blood vessels in children...