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Vexas

Overview of the VEXAS Syndrome

Jack Cush, MD

A current systematic review in Rheumatology addresses the clinical features seen in the VEXAS syndrome.

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Immunomodulators in the Treatment of Autoimmune Hepatitis Autoimmune hepatitis (AIH) is a chronic, progressive inflammatory liver disease driven by autoimmune mechanisms, characterized by elevated serum aminotransferases, hypergammaglobulinemia, and interface hepatitis on https://t.co/KgzjNvrZ7v
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Is the term polymyositis obsolete?.. now being replaced by dermatomyositis, necrotizing myopathy, inclusion body myositis, antisynthetase syndrome & overlap myositis. Full read overview of inflammatory myositis & new treatments from Joint Bone & Spine https://t.co/X46sptp1Ax https://t.co/QqyMv6fkVS

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1 yr study of falls studied in 100 RA & 80 PsA pts. 33% of RA & 46% of PsA reported falls, w/ a higher frequency in PsA Pts (p=0.02). Falls associated w/ disease duration and HAQ score. As falls are assoc w/ high morbidity & mortality risk, pts should be questioned about FALLS https://t.co/tP7zmGCZcw
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Referral of 304 suspected autoinflammatory Dz (SAID) to a UK national centre for primarily adult SAID in 2022, 121 (39.5%) were diagnosed with SAID, w/ half of these having monogenic Dz. Median Dx delay was 2 to 6 yrs, worse in late-onset SAID. https://t.co/x8VOFyjuVA https://t.co/3R2HdYUlSg

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MRI-detected erosions in clinically suspect arthralgia pts do not portend future Xray erosive disease or progression. Study of 405 CSA pts; 47% had MRI erosions that incr odds of Xray erosion [OR 5.2] but 96% of MRI-detected erosion had no assoc. Xray erosion. https://t.co/hvxJRv1r0R
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Case–control study RA pts > 65yrs in US. SEER (cancer) database (2014–2019). Overall cancer risk not associated with use of JAKi (adjOR 1.04), TNFi (0.98) or other bDMARDs (0.98). But, JAKi use was assoc w/ incr risk of lung CA (OR 1.40), esp in Males (2.12) & >2 yrs JAKi. Lower https://t.co/u2psafyN1I
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Don't Stop the DMARDS!! Retrospective study of 91 JIA pts (all types; 36% oligo, 27%poly) all Rx w/ cycles of DMARD therapy. Consistently two-thirds relapsed and flared. Only one-third of JIA patients were able to remain off DMARDs. https://t.co/ifqnMKfhAe https://t.co/bEqAxzRoq6

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Biologic experienced ankylosing spondylitis patient show better retention on TNF compared to IL-17 inhibitors. 148 AS pts (F/U 31 mos), IL-17i drug survival trended better but only signif after 3yrs. More D/C w/ higher BASDAI (HR: 1.3) & ^# prior biologics (HR 1.62) https://t.co/5HXGsV4xol
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psor.elb_.jpg

Reducing Progression of Psoriasis to Psoriatic Arthritis

MedPage Today

Tumor necrosis factor (TNF) inhibitor therapy was effective in reducing the likelihood that psoriasis would progress to psoriatic arthritis (PsA), a retrospective study indicated.

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Granzyme expression is upregulated in RA, esp early RA. Blood & synovium from early arthritis & TNFi nonresponders (R4RA RCT) gene expression five granzymes, perforin, & serglycin determined by bulk RNA-sequencing data. GZM A, B, H, K, M, PRF-1, SRGN was higher in lymphoid https://t.co/v1rdFZHuuh
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Genicular nerve block (GNB) is effective intervention for Knee OA. Metanalysis of 6 RCTs & 420 KOA pts. GNB significantly reduced pain & improved function (p<0.003), w/ significant relief as early as 2wks and function by 12 weeks. https://t.co/NMtiQPICpw https://t.co/gVJ0TyuY01

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BMJ - UK population study of 1.5 million adults finds pts w/ autoimmune dz have twice the risk of affective disorders (depression, bipolar dz, anxiety) significantly higher (p<0.001) (28.8% vs 17.9% in gen. population. Signif regardless of age, sex, ethnicity, income, Fam Hx, https://t.co/dsJxkvD4Nu
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JAMA Patient Education Page on what is Interstitial Lung Disease https://t.co/BDbV6I53NH https://t.co/1OtTiJHkdt

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From 1990 to 2021, the global burden of OA from high BMI increased markedly. YLD (years lived w/ disability) rates of OA attributable to high BMI increased from 34 to 50.6 per 100,000 - higher in females, correlated w/ Socio-demographic Index levels https://t.co/RjTJFNEbYm https://t.co/tIqmn9eLQ6

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RABBIT (German biologics register) study shows overall small increase in malignancy w/ JAKi vs bDMARDs. Risks greatest in those ≥ 60 yrs, w/ Hi Dz activity, on ≥3 prior csDMARDs. 2285 JAKi vs 4259 bDMARDs: 88 vs 135 malignancies CAs (IRs 11.6 vs 8.9; adj HR 1.40). JAKi risk https://t.co/AlK2SWn6UR
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psoriatic.PIP_.JPG

Early DMARD Initiation Benefits in Psoriatic Arthritis

Jack Cush, MD

Mease et al has published the results of a cohort study showing early initiation of disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis (PsA) resulted in better outcomes compared to late initiation.

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#RA linked to 40% incr risk of serious dental Infx. National Inpatient Sample (2016-2022) retrospective study of ~15 million adult inpatient records, 10.7K (0.07%) had oral Infx Hosp. Risk factors included RA (1.9%; OR 1.4, male (1.79), Black (1.23), smoking (1.33) https://t.co/pr4Uf6ywJ7
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1,494 Ehrlangen RA pts - machine learning used baseline variables to predict remission at 6 mos. Best/most predictive results w/ AdaBoost modelingdemonstrated strongest accuracy of 85.71% (based on DAS28, Age, VAS and swollen joints. https://t.co/h9UgUKUFo4

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Japanese cohort study compared 12 pts w/ Stills Dz or intravascular lymphoma. Stills pt had significantly higher ferritin and IL-18 levels and IVL pts had significantly higher sIL-2R levels. https://t.co/Ecd6vNJTc4 https://t.co/KdEcpDeskA

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From the blog

rheumthought

CNS Lupus (NPSLE)

Jack Cush, MD
Cush RhTh CNS
29 yr. old woman with SLE and transverse myelitis. Is this NPSLE; how to diagnose?
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Therapeutic Updates

GCA: Case by Case

Sponsored by Novartis US Medical Affairs
Novartis July RX Update
Dive into 4 hypothetical case studies that reveal the diverse and often complex presentations of giant cell arteritis (GCA). Each case is guided by expert commentary from Dr Michael Putman, where he offers practical insights and clinical pearls to enhance your therapeutic strategies for this multifaceted condition.
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