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Predicting CKD Outcomes in Lupus Nephritis

An observational cohort study suggests that proteinuria levels in lupus nephritis (LN) patients did not predict their histologic class. A multicentre observational study of patients with biopsy-proven LN; either proliferative (PLN) or membranous (MLN) lupus nephritis were compared regarding clinical and laboratory presentation and long-term outcomes. The primary outcome was progression to chronic kidney disease (CKD).

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ICYMI: Five Takeaways in PsA/SpA at RNL 2024

Continuing with the theme of clinical pearls, the PsA and SpA speakers also provided a wealth of information. Here are my five key takeaways and clinical pearls. 

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50 active RA pts RCT Rx w. either low dose IL-2(n=26), IL-2+TCZ (9) or control (15). All improved clinically by DAS28-ESR, but IL-2 Rx pts had signif proliferation of Tregs, w. decr inTh1, Th2, & Th17 cells. TREG #s correlated w/ ESR drop (r=0.54) https://t.co/1tF63FuXzx https://t.co/M5TWsa6zI4
Dr. John Cush @RheumNow (  View Tweet)
Single center retrospective 173 pts w/ CTD-ILD - 34% Sjogren’s, 30 RA, 25 systemic sclerosis, 6 UCTD, 3% idiopathic inflam myositis, 1,2% MCTD, 0.6% SLE. NSIP most common (60%) inSS & SSc; UIP more common in RA. 6 died, mostly infection https://t.co/IL2tnVDtoQ https://t.co/Ada49Qv5XL
Dr. John Cush @RheumNow (  View Tweet)
'Drug Rediscovery for Rare Immune Mediated Inflammatory Diseases’ - a 6 center consortium will study if JAKi (filgotinib) is effective and safe in 3 rare disorders -- Behcets, inflammatory myositis & IgG4 related disease. https://t.co/2gKCKEl7Ml https://t.co/yTrvFzFUgf
Dr. John Cush @RheumNow (  View Tweet)
SGLT2 Inhibitors Lowers Gout Risks in Type 2 Diabetes A population-based cohort has demonstrated tha SGLT2i use in gout patients is superior to sulfonylurea therapy in lowering the risk of incident gout and recurrent flares among patients withT2D. https://t.co/QZ7bt39zEW https://t.co/Wlo9SF0hPF
Dr. John Cush @RheumNow (  View Tweet)
STEP 9 - a, multinational phase 3 RCT studied semaglutide vs PBO in 407 Knee OA (Gr2-3) pts w/ pain >4/10 & BMI >30 (mean 40.3; mean WOMAC 71). At wk 68 SEM > PBO lowering WOMAN pain (-42 v -27; p<.001). Wt loss: 13.7% v 3.2%, respectively. https://t.co/101qML0wQM https://t.co/tG3hk5Wy5E
Dr. John Cush @RheumNow (  View Tweet)
Articular Findings Sarcoidosis: - Acute arthritis: Lg Jt Oligoarthritis; Loffgrens syndrome (hilar LN, arthritis, E. nodosum) - Acute > Chronic arthritis - Chronic arthritis: tenosynovitis, oligo- &polyarthritis, dactylitis, erosions or Jaccouds arthritis https://t.co/zDLJqsjnbj https://t.co/lo6UIlhka3
Dr. John Cush @RheumNow (  View Tweet)
178 Knee OA pts undergoing Arthroscopic Surgery do not have a higher risk of Total Knee Arthroplasty (33.7% vs 41.9% controls (HR 0.85), nor was there a significant delay or hastening TKA. https://t.co/vKN1Nsjr1n https://t.co/0mb5dJWf6u
Dr. John Cush @RheumNow (  View Tweet)
New Oregon law rebrands Physician Assistants to a new title of “physician associates" (goes into effect 6/6/2024). The title change only applies to PAs and not NPs. The AMA has come out against such change in title, thinking it may confuse patients. https://t.co/oWxNwpIW7U https://t.co/GJC8u0XrRj
Dr. John Cush @RheumNow (  View Tweet)
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)

Self Acupressure in Knee Osteoarthritis

A clinical trial has shown that self-administered acupressure (SAA) is effective in relieving knee osteoarthritis (KOA) patients.

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ICYMI: How do you manage enthesitis?

Enthesitis can be a challenge for clinicians to identify, evaluate, and manage in patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). It affects 27-35% of PsA patients and 36% of axSpA patients. Dr. Lihi Eder discussed the evaluation and treatment of enthesitis at RheumNow Live on January 28, 2024.

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Hyperpigmentation from Hydroxychloroquine. From 316 HCQ pts, 26% got hyperpigmentation; delayed onset of 12 mos (6–30mos) after median cum. dose of 108 g. Seen on face (602%), Legs (36%) & hands (20%). Daily sun exposure decrease in the incidence (P=0.02) https://t.co/365qcuIpWE https://t.co/cHO16kDtK3
Dr. John Cush @RheumNow (  View Tweet)
Chikungunya arthritis Metanalysis & good full-read review - 8 studies showing chronic arthritis (CCA) in minority of infected;, polyarticular, looks like RA, few seropositive, few w/ erosions on imaging. CCA may be progressive w/ irreversible damage https://t.co/Da7bKtM6oC https://t.co/OGBbIiGAc5
Dr. John Cush @RheumNow (  View Tweet)
CPPD in seronegative RA? Among 364 RA patients - 73% seropositive & 26% seronegative (n=96). Amongst latter, 18 pt (18.9%) met CPPD-disease criteria. CPPD+ pts were more likely to be older & have Hx of acute episodic arthritis https://t.co/XO0J6Adaa0 https://t.co/3ouUCPshoh
Dr. John Cush @RheumNow (  View Tweet)
Dawn of CAR-T cell therapy in autoimmune diseases - A review article from the Chinese Medical Journal https://t.co/Qbort9Rsmh https://t.co/wWwTXkZiXj
Dr. John Cush @RheumNow (  View Tweet)
BSR Guideline on Management of Sjogren’s Syndrome Sjögren disease (SD) is the most common of all autoimmune disease, yet little is know of its etiology and there are insufficent interventions for those affected with mucosal or systemic manifestations. https://t.co/M5fQ8lyZBS https://t.co/30XpP3r4FV
Dr. John Cush @RheumNow (  View Tweet)
AbbVie announced preliminary positive results from phase 3 SELECT-GCA study showing remission in 46% of #GCA pts Rx w/ upadacitinib for 52wks (vs 29% PBO); RCT included a 26-wk steroid taper regimen https://t.co/DIstJ4hazo https://t.co/VXc7rj0REJ
Dr. John Cush @RheumNow (  View Tweet)
Renal Dz in 44 AOSD (Stills)pts-mean age 38; 28 w/ renal onset after Dx. 36 renal Bx showed amyloidosis (25%), collapsing glomerulopathy (11%), thrombotic microangiopathy (11%), IgA nephropathy (9%), minimal change (7%). Renal assoc w/ 6 deaths; 4 ESRD https://t.co/tQykmjNIIb https://t.co/n0xgi6uF6D
Dr. John Cush @RheumNow (  View Tweet)