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Pediatric Rheum

Pharmacologic Efficacy in Still's Disease

A systematic review of the effectiveness and safety of pharmacological treatments for adult-onset Still’s disease (AOSD) supports the use of either IL-1 or IL-6 inhibitors.

A metanalysis was performed using databases, trial

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Cutoffs for Systemic Juvenile Arthritis Disease Activity Score

An international cohort of children with systemic Juvenile idiopathic arthritis (Still's disease) validated the systemic Juvenile Arthritis Disease Activity Score 10 (sJADAS10), a disease activity measure distinguish patients with inactive disease, minimal disease activity, moderate disease

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Featured BSR Abstracts (5.2.2024)

Dr. Jack Cush muses on the news, journal reports, FDA announcements and the 2024 BSR abstracts just released.

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Methotrexate Does Not Increase ILD Risk in Dermatomyositis

A cohort analysis of dermatomyositis (DM) patients starting immunomodulators finds that methotrexate use was not associated with an increased risk of interstitial lung disease (ILD).

ILD affects ~23% of DM patients and the oft used MTX is has a low risk of pneumonitis and pulmonary

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Rheum Chapter Notes (4.26.2024)

Dr. Jack Cush reviews this past week’s news and journal articles from RheumNow.com.

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Pediatric IMID pts have 4 fold mortality. Danish population study of 11,581 pIMID (vs 99K controls), 1.37 million PYs F/U. Dx age 12.6 yrs; 152 pIMID deaths (vs 316) aHR=3.8. +6.9 deaths/100K PYs. Most for GI Dz/CA & lymphoproliferative dz https://t.co/JpGzusLXMH https://t.co/OMtB1z0RmG
Dr. John Cush @RheumNow( View Tweet )

Canary in a Coal Mine (4.19.2024)

Dr. Jack Cush reviews regulatory reports, news and novel journal articles - this week focusing on Sjogren's, ILD, Gout and Uveitis.

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Mental health in 1150 adolescents & young adults w/ juvenile idiopathic arthritis (age 15.6 yrs; Dz duration 7.2 yrs, 43% oligo-, 26% polyarthritis): 30% reported suicidal thoughts, 19% mod-severe depressive/anxious Sxs (moreso in Females OR 2.33) https://t.co/THW1IMqZpa https://t.co/IU2Kr3efYj
Dr. John Cush @RheumNow( View Tweet )

Seasonal Pathogens and Henoch-Schönlein Purpura

Epidemiologic studies of Henoch-Schönlein purpura (HSP) have suggested seasonal variation in occurrence rates (higher from September-April, lower in June-August), suggesting a role for infectious triggers. The importance of infection was recently shown with nonpharmaceutical interventions (

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Higher Rates of Childlessness in Rheumatic Diseases

A large Finnish population study shows that several rheumatic diseases may impair reproduction and pregnancy outcomes, with significantly higher rates of childlessness or fewer children overall for women.

A nationwide cohort study of 5 339 804 Finnish citizens, born 1964–1984,

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MMWR: Vaccination and Multisystem Inflammatory Syndrome in Children MIS-C is a rare but serious condition typically occurring 2–6 weeks after SARS-CoV-2 infection and characterized by fever and multiorgan involvement. https://t.co/PN2MPQxqSR https://t.co/eIzB4pjner
Dr. John Cush @RheumNow( View Tweet )
JAK inhibitors maybe an option in refractory Juvenile Dermatomyositis. Metanalysis of 26 reports (195 pts) JDM Rx w/ JAKi (median 5 rys); most Rx w/ tofacitinib (57%), ruxolitinib(27%), baricitinib (15%), w/ Improvement in 90%, 69%, 93%, respectively. https://t.co/tfISYVtwUN https://t.co/zv88Vdy6c0
Dr. John Cush @RheumNow( View Tweet )

Ides of March (3.15.2024)

Dr. Jack Cush has advice for Caesar and the superstitious, and covers pregnancy, platelets, dialysis and vaccinations in Lupus.





  1. Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory

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MMWR: Vaccination and Multisystem Inflammatory Syndrome in Children

CDC

Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition typically occurring 2–6 weeks after SARS-CoV-2 infection and characterized by fever and multiorgan involvement.  The current MMWR report shows that MIS-C case numbers have decreased by 98% since 2021.

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Sniffles & Arthritis (3.1.2024)

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Are these associations with infection, biomarkers and weather real or imaginary? Linked or luck? Causal or casual?  You decide....





  1. No clear link between weather & MSK symptoms

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Sinusitis Linked to 40% Heightened Risk of Rheumatic Disease

EurekAlert!

The common inflammatory condition sinusitis is linked to a 40% heightened risk of a subsequent diagnosis of rheumatic disease, particularly in the 5 to 10 years preceding the start of symptoms, finds research published in the open access journal RMD Open.

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In 551 juvenile myositis pts, 36% had myositis assoc Abs (MAA); 13% had >1 MAA. MAA+ pts had more overlap dz (18 vs 6%, p<.001) & assoc w/ Raynauds (OR 2.44), ILD (OR 3.43), chronic Dz (OR 1.72), mortality (OR 3.76). # MAAs was assoc w/ mortality (OR 1.83) https://t.co/BXhasmel3Z
Dr. John Cush @RheumNow( View Tweet )
Adult vs Juvenile DM by @susanshenoi at #RWCS24 @RWCSmtg @RheumNow Adults tend to have myalgia, arthralgia, raynauds vs kids with skin ulcerations and vasculopathy https://t.co/1DW2kJsLfa
Dr. Rachel Tate @uptoTate( View Tweet )
Dr. @susanshenoi reviews IIM in juveniles vs adults. Some highlights: *IBM only in adults *PM more common in adults See picture for additional pearls #RWCS24 @RWCSmtg @RheumNow https://t.co/onUEwkKXBN
Dr. Rachel Tate @uptoTate( View Tweet )

VITAL Info on Autoimmune Disease (2.9.2024)

Dr. Jack Cush reviews the journal reports from the past week on RheumNow.com. Highlights are summarized by three songs: "Stairway to Heaven", "You're No Good", and "How Long (has this been going on)".





  1. Many #RA pts remain on Steroids despite b/tsDMARD use! Study 228 #RA pts

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Best Treatments for COVID-Related MIS-C

The RECOVERY trial focused on pediatric MIS-C patients treated with immunomodulators and anti-cytokine therapy demonstrated the benefits of first-line therapy with intravenous methylprednisolone or second-line tocilizumab in children refractory to initial treatment. Neither IV

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Tic-Borne Disorders Causing Chronic Arthritis?

Findings from a population based cross-sectional study suggests that while up to 20% of patients have antibodies to tick-borne exposures, only a minority reported musculoskeletal symptoms. 



Lyme disease is one of many tick-borne diseases (TBDs) that may include spotted fever

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SLE: A Mutated Gene and TLR7 Overexpression

EurekAlert!

A group of researchers lead by Min Ae Lee-Kirsch from the Department of Pediatrics, Medical Faculty, TUD Dresden University of Technology (Germany), studied four patients from two families who developed symptoms of SLE in the first years of life. As familial occurrence of SLE in young

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2023 Rheumatology Year in Review

Dr. Jack Cush reviews highlights, advances and hot topics in rheumatology from 2023 and the RheumNow website.  



2023 was a year of growth and new horizons while returning to operational and practice standards (in care and education) established before the pandemic.  

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StillsNow Podcast December 2023 - ACR23 Highlights

Dr. Jack Cush reviews selected AOSD & systemic JIA abstracts from the ACR 2023 Annual meeting held in San Diego, November 12th thru 16th.





  1. Abstract 0761. EULAR / PreS Recommendations for the Diagnosis and Management of Systemic Juvenile Idiopathic Arthritis (sJIA) and

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