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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Burnout or Retire (4.12.2024)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. Is it time to worry about burnout and those who are leaving healthcare?
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ILD Onset in MDA-5 Dermatomyositis
Anti–melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM) is a rare, aggressive and progressive subtype of DM. Its' severity is dependent on the development of progressive interstitial lung disease (ILD), manifesting as either rapidly progressive ILD (RPILD
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GEM: Dysphagia in myositis pts is from skeletal muscle involvement, causing upper pharyngeal dysphagia, but may also manifest as dysphonia, nasal regurgitation, or aspiration (w/ risk of pneumonia). https://t.co/MOyfdCJywC
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.
Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory
Review article on inclusion body myositis, a progressive, debilitating myopathy w/ onset > 50 yrs. IBM typically has asmmetric, painless, weakness & atrophy of finger flexors or quadriceps w/ dysphagia. Most are wheelchair bound w/in 13-15 years https://t.co/LoWtmDqimu https://t.co/N3OUU7QMc1
Dr. John Cush @RheumNow( View Tweet )
Depression and RA (3.8.2024)
Dr. Jack Cush reviews the news, journal reports and regulatory approvals from the past week.
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85 pts w/ Myositis by MRI. Abnl MRI patterns correlated w/:
- Honeycomb & foggy w TIF1γ or Mi2+, MSA-neg DM/PM, SRP+, HMGCR+
- Honeycomb w Cancer (OR 6.8), Gottrons(OR 8)
- Foggy w weakness (OR 11.2)
- Dense dot w dysphagia (OR 6.3) & CA https://t.co/kZGuNLFglg https://t.co/lK93U5iY7q
Dr. John Cush @RheumNow( View Tweet )
Immunosuppression Increasing (2.23.2024)
Dr. Jack Cush reviews the news and journal reports from the past 2 weeks on RheumNow.com; but begins with a discussion of what constitutes "immunosuppression" and how it applies to our patients.
2021 NHIS Survey data suggests the prevalence of immunosuppression in the USA
CD19 CAR T-Cell Therapy in Autoimmune Disease
The NEJM has published the results of CD19 B cell depletion (by CAR-T cell therapy) in autoimmune disease patients, demonstrating it to be feasible, safe, and efficacious.
The rationale to CD19 CAR-T cell transfer is to reset aberrant autoimmunity via deep depletion of B cells with
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Favorable Survival w/ MDA-5 Ab+. 154 pts w/ MDA5+DM; 40 died (26%) Rx induction (mostly resp. failure). 114 survived, w/ 5-yr survival of 97% & relapse-free survival 77%. Survival improved w/ JAKi use (P=.03). 8% achieved complete drug-free remission. https://t.co/QkqM9IztEG https://t.co/yBCH85CpUN
Dr. John Cush @RheumNow( View Tweet )
Autoimmune disease and pregnancy
EurekAlert!
For many aspiring mothers with autoimmune disease, pregnancy can be daunting and full of unknowns. In some cases, those suffering from specific autoimmune conditions have chosen to forego pregnancy altogether due to concerns about their disease treatments and adverse pregnancy outcomes
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SeXXist Reason for More Women with Autoimmune Disease
EurekAlert!
Somewhere between 24 and 50 million Americans have an autoimmune disease, a condition in which the immune system attacks our own tissues. As many as 4 out of 5 of those people are women.
Rheumatoid arthritis, multiple sclerosis and scleroderma are examples of autoimmune disorders
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Cancer and Myositis #RNL2024 @RheumNow
@DrLisaCS on Cancer screening:
Risk stratify: dermatomyositis, NXP2, TIFy, <40yo, refractory, dysphagia, cutaneous necrosis at higher risk
Enhanced risk stratification for those at risks, versus "basic screening" for lower risks https://t.co/3yy9Fx1pk8
Eric Dein @ericdeinmd( View Tweet )
Dr Christopher-Stine @DrLisaCS Factors which should influence (some very strongly) your cancer screening approach in myositis @RheumNow #RNL2024 https://t.co/BoyJLrVDwo
Richard Conway @RichardPAConway( View Tweet )
anti-Sp4 Ab may be protective against cancer in myositis pts who are TIF1-g positive - Dr. L Christopher-Stine #RNL2024 @rheumnow https://t.co/n7Ikn3llGH
TheDaoIndex @KDAO2011( View Tweet )
Continue to love this myositis diagram. Seems to be getting ever more complicated though! @DrLisaCS @RheumNow #RNL2024 https://t.co/eXz6144y3y
Richard Conway @RichardPAConway( View Tweet )
Cancer and Myositis #RNL2024 @RheumNow
@DrLisaCS
Dermatomyositis risks - TIF1y is highest risk, followed by NXP2
Protective features: childhood onset, ILD, arthralgias
Cancer and myositis often present w/in 1 yr before or after
Cancer is major cause of death
Eric Dein @ericdeinmd( View Tweet )
Increased CV Comorbidity in Dermatomyositis
A cohort study suggest that patients with dermatomyositis (DM) are at an increased risk for multiple comorbidities, including chronic kidney and cardiovascular disease,
https://t.co/bYvd5AhqSl https://t.co/4y4kjYhTm3
Dr. John Cush @RheumNow( View Tweet )
Methotrexate Nodulosis (1.19.2024)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. How good (or not) are rheumatologists and what to do about MTX nodulosis?
Network meta-analyses of 153 trials & 8713 patients w/ chronic pain from TMJ disorders; Most effective (
Increased CV Comorbidity in Dermatomyositis
A cohort study suggest that patients with dermatomyositis (DM) are at an increased risk for multiple comorbidities, including chronic kidney and cardiovascular disease,
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Drug-Induced Dermatomyositis
A JAMA Dermatology systematic review of drug-induced dermatomyositis (DM) found the most commonly implicated agents include hydroxyurea, immune checkpoint inhibitors, statins and lipid-lowering agents, penicillamine, and tumor necrosis factor inhibitors.
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JAMA: cutaneous hallmarks of dermatomyositis. Printable Patient education overview. https://t.co/S7MaAz6fX2 https://t.co/5ETcQRz8Fd
Links:
Dr. John Cush @RheumNow( View Tweet )
Programmed-cell-death 1 (PD-1) expression on T-cells is assoc w/ activation & exhaustion. The exhausted phenotype of PD-1+CD8+ T cells add to the pathogenesis of active idiopathic inflammatory myositis. https://t.co/xOYfEs16ou https://t.co/MzEPpUc7Eb
Dr. John Cush @RheumNow( View Tweet )
RheumNow Podcast – Bill of Rights (12.15.2023)
Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Two major reports on fatigue and fibromyalgia misfired, and "ankylosing spondylitis" is sent to the Rheumatology dead word cemetery.
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Winning is everything – in football and in medicine. Rheumatologists have achieved many successes but still struggle to win against a handful of rheumatic foes. This retrospective examines past wins and losses and helps us to look ahead to a new season.
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