Does Abatacept Increase Postoperative Adverse Events in Rheumatoid Arthritis Compared with Conventional Synthetic Disease-modifying Drugs?
CONCLUSION: Compared with csDMARDs and/or steroids without ABT, adding ABT to the treatment does not appear to increase the incidence rates of postoperative adverse events in RA patients undergoing orthopedic surgery. Large cohort studies should be performed to add evidence for the perioperative safety profile of ABT. PMID: 31203226 [PubMed - as supplied by publisher]
A 69-year-old man with a history of rheumatoid arthritis and pulmonary fibrosis presented with an incidentally discovered 11.5 cm left renal mass with a level 3 inferior vena cava (IVC) tumor thrombus, including involvement of the left adrenal and lumbar veins. The thrombus was highly vascularized as shown in Figure 1A-C. Preoperative evaluation was negative for metastatic disease and the serum creatinine (SCr) level was 1.55 mg/dL, correlating with an estimated glomerular filtration rate (eGFR) of 46 mL/min/1.73m2.
ConclusionOccurrence of VTE in a total of 50,865 RA patients initiating treatment with tofacitinib or a TNF inhibitor was infrequent (
CONCLUSIONSFindings from this study suggest that RA patients experience a higher incidence of medical complications, specifically DVT/PE. Preoperative lower-extremity ultrasounds, inferior vena cava (IVC) filter placement, and/or early initiation of DVT prophylaxis in RA patients may be indicated. Perioperative complications, morbidity, and long-term outcomes are otherwise similar to non-RA patients. PMID: 30835702 [PubMed - as supplied by publisher]
ConclusionsIn RA clinical trials, no association was found between baricitinib treatment and MACE, ATE, or CHF. For DVT/PE, 6 events were reported for baricitinib 4 ‐mg but not placebo; during longer‐term evaluation, IRs were similar between doses, consistent over time, and similar to published rates in RA.This article is protected by copyright. All rights reserved.
ConclusionIn conclusion, occurrence of VTE in a total of 50,865 RA patients initiating tofacitinib or a TNF inhibitor was infrequent (
Rheumatoid arthritis is a complex disease state with multiple associated comorbidities. Perioperative evaluation of the rheumatoid patient from a multidisciplinary approach is necessary to achieve favorable outcomes. A complete history and physical, laboratory, cervical, cardiovascular, pulmonary, and medication assessment before surgery should be performed. Educating the patient on potential complications, such as wound dehiscence, infection, and venous thromboembolism, as well as general postoperative expectations, is essential when evaluating the rheumatoid patient for surgery.
CONCLUSION: In this integrated analysis of patients with moderate to severe active RA with exposure up to 5.5 years, baricitinib has an acceptable safety profile in the context of demonstrated efficacy. Trial registration numbers: NCT01185353, NCT00902486, NCT01469013, NCT01710358, NCT01721044, NCT01721057, NCT01711359, and NCT01885078 at clinicaltrials.gov. PMID: 30219772 [PubMed - as supplied by publisher]
Conclusion: Oral TXA shows comparable efficacy to that of the intravenous forms after total knee and hip arthroplasty. Due to the limited quality of evidence currently available, higher quality RCTs is necessary.
BY ANDRZEJ KIELTYKA, PA; PARDEEP THANDI, MD; &ANUMEHA SINGH, MDA 56-year-old man presented to the emergency department with shortness of breath for one month and pleural effusions on an outpatient chest x-ray. He had been taking adalimumab, methotrexate, and steroids for arthritis and Sjogren's syndrome.A right pleural effusion in a patient with nephrotic syndrome.His monoclonal gammopathy of undetermined significance (MGUS) was monitored annually, but no medical intervention beyond surveillance was required. He had excessive thirst but normal urine output. He noted face and hand swelling in the morning that gave wa...
AbstractTwo different Janus kinase (JAK) inhibitors —baricitinib and tofacitinib—are effective and licensed in active rheumatoid arthritis (RA). There have been recent concerns about potential thromboembolic risks with these drugs. Concerns about baricitinib focus on clinical trial findings. Using all publically available data, we estimate thromb oembolic risks are approximately five events per 1000 patient years with 4 mg baricitinib daily. Concerns about tofacitinib have been raised by analyses of the Federal Drug Administration Adverse Event Reporting System (FAERs). These show some evidence of increase...