The edition · Rheumatology
Treating weight alongside psoriatic arthritis, and tramadol against stronger opioids in osteoarthritis
Adding tirzepatide to ixekizumab raised ACR50 response in psoriatic arthritis with obesity; in a million people with osteoarthritis, tramadol was linked to fewer deaths and fractures than hydrocodone or oxycodone.
The edition in brief
A US claims cohort of over a million adults aged 50 or more with osteoarthritis found tramadol associated with lower mortality and fewer fractures than hydrocodone or oxycodone, and similar risks to codeine, though residual confounding is likely. A multicentre lupus nephritis cohort found that extra-renal activity after renal response was almost universal, and that combined serological and clinical activity was associated with renal flares and damage. A meta-analysis of 12 trials found platelet-rich plasma had no consistent effect on knee osteoarthritis structure. The practice-changer is the phase 3b TOGETHER-PsA trial in 271 adults with psoriatic arthritis and overweight or obesity: ixekizumab plus tirzepatide gave higher ACR50 at 36 weeks (33.5% vs 20.4%) than ixekizumab alone, with better function and fatigue and no new safety signal.
Tramadol in osteoarthritis linked to fewer deaths and fractures than stronger opioids
If an opioid is needed in osteoarthritis, consider tramadol or codeine before stronger opioids, after non-opioid options.
After renal response in lupus nephritis, serological plus clinical activity predicts trouble
After renal response in lupus nephritis, watch most closely for positive anti-dsDNA with clinical extra-renal activity, which predicted renal flares.
Platelet-rich plasma did not consistently change knee osteoarthritis structure
Do not present platelet-rich plasma as a cartilage-protecting treatment for knee osteoarthritis; the structural evidence is inconsistent.
Hydroxychloroquine in lupus: keep it going, and screen the retina
Continue hydroxychloroquine in lupus at no more than 5 mg/kg a day, with baseline and then annual retinal screening after five years.
Adding tirzepatide to ixekizumab improved psoriatic arthritis in people with obesity
Consider adding weight-loss treatment such as tirzepatide for patients with psoriatic arthritis and obesity, since it improved joint response with ixekizumab.
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