Landmark Potpourri
Let's all AGREE that this medication works almost just as well to treat gout in low-doses as high-doses with far less diarrhea
What is colchicine?
Arthritis Rheum. 2010 Apr;62(4):1060-8. doi: 10.1002/art.27327.
This study from Wichita Arthritis Center in 2002 demonstrated that this medication provides a substantial mortality benefit in the treatment of rheumatoid arthritis and argues that it should be the standard to which upcoming DMARDs ought to be compared with
The Canadian Study Group showed in the mid 90s that this medication should be continued indefinitely as the backbone of treatment of systemic lupus to prevent flares after disease quiescence is achieved
What is hydroxychloroquine? NNH 3 for any flare and 5 for organ-threatening flare
The IDEA trial demonstrated that in knee osteoarthritis, just a 10% improvement in this body metric produced up to a 50% improvement in pain
What is weight?
Mixed cryoglobulinemia is overwhelming associated with this virus
What is HCV?
The first scleroderma lung study compared these two randomized groups in the treatment of SSc-ILD
What is oral cyclophosphamide and placebo? (improvement in FVC of about 2.5% at 12 months)
FIN-RACo, NEO-RACo, TEAR, TICORA, and the BeSt trial are all randomized trials over a decade of research that have repeatedly emphasized the importance of this strategy to control rheumatoid arthritis
What is treat to target?
The ALMS trial showed that this medication is superior to azathioprine in the maintenance treatment of lupus nephritis (and this efficacy is especially pronounced in patients of hispanic or African American descent)
What is mycophenolate mofetil?
The PALACE-III trial compared this non-biologic medicine to placebo in the treatment of psoriatic arthritis
What is apremilast?
NNT of 5 for an ACR20 and NNT of 13 for an ACR50
This rare rheumatic disorder may be a contributing reason for micro-thrombi formation in COVID-19
What is APLS?
The second scleroderma lung study which compared oral cyclophosphamide to oral mycophenolate had these durations of therapy for the two arms of the study
What is: Oral cytoxan given for 12 months, oral mycophenolate for 24 months
Primary outcome (% change in FVC) at 24 months. No major difference between the two groups. More deaths in the oral cytoxan group.
This snakey study suggested there may be some validity to treating rheumatoid arthritis with high intensity steroids, methotrexate, and SSZ all in combination as opposed to just SSZ at onset of disease
What is COBRA?
Arthritis Rheum. 2002 Feb;46(2):347-56.
The original trials for Benlysta in the treatment of SLE showed that response was best in patients with skin and musculoskeletal disease but also this concomitant laboratory finding
What is hypocomplementemia?
The GiACTA trial showed that tocilizumab was very efficacious compared to placebo in keeping a steroid free remission despite a steroid taper that only lasted this long
What is 26 weeks of glucocorticoids? (Primary outcome was performed at 52 weeks)
This is the most prominent virus implicated with reactive arthritis
What is HIV?
In most fibromyalgia studies including a 2004 study from the University of Cincinnati showing the efficacy of duloxetine, this is the primary outcome measured at 12 weeks
What is the fibromyalgia impact questionnaire?
Only an improvement of 5 points on an 80 point scale
Arthritis Rheum. 2004;50(9):2974.
The randomized, double-blind COMET trial showed in 2008 that combination therapy with methotrexate and this medication in early mod-severe rheumatoid arthritis was superior to monotherapy with methotrexate
What is etanercept?
DAS 28 remission 50% vs 38%. NNT ~5
The recent TULIP 1 and TUPLIP 2 studies demonstrated the stark contrast of these two validated measures of lupus in assessing the efficacy of anifrolumab
What is BILAG and SRI-4 (SLE responder index)?
The CARES trial studying the safety of febuxostat vs allopurinol in gout did not meet its composite primary outcome of cardiovascular events but raise concern for this safety signal(s) leading to an FDA black-box warning
What is increased all-cause mortality and increased cardiovascular death? (NNH ~100)
This is a genetic risk factor to develop long-term polyarthritis after Chikunguya
What is HLA-DR4
These were the four groups in the PEXIVAS trial
What is standard dose GC + PLEX, low-dose GC + PLEX, standard dose GC no PLEX, and low-dose GC no PLEX
The landmark randomized, double-blind TEAR trial in 2012 had these four groups in a 2x2 design to study combination or mono therapies in the treatment of RA
What is ETN+MTX, immediate triple therapy, mono-MTX to ETN+MTX at 24w, mono-MTX to triple therapy at 24w?
No difference between triple therapy vs ETN+MTX. Initial combination therapy had better primary outcome of DAS28 <3.2 by the 102nd week. There were statistically improved radiographic changes in the ETN+MTX group.
The 2012 LUNAR trial showed that despite some modest reduction in complements and anti-dsDNA levels, this medication could not meet the primary endpoint of remission in lupus nephritis
What is rituximab?
What is DAH severe enough to need ventilatory support and advanced renal dysfunction (Cr >4)
Multicentric Castleman's is most frequently associated with this virus
What is HHV-8