Recent News
Read ArticleDr. Jack Cush reviews this past week’s news and journal articles from RheumNow.com.
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.
https://t.co/SCsuYuXgw4 https://t.co/bHB9ggf20H
Dr. John Cush @RheumNow ( View Tweet)
1/3 of lupus nephritis patient classified as ""complete responders"" continued to accrue progressive renal damage despite resolution of proteinuria over 1 year.
Dr. @andreafava reviews GFR trajectories after renal bx at #RNL2024 @RheumNow https://t.co/mqwhfIFQsL
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Dr. John Cush @RheumNow ( View Tweet)
#RNL2024
@DrDavidKarp
Incomplete lupus is heterogeneous term
""Stage 2"" pre-classification stage as ILE/UCTD
Stage 1: non-specific antibodies, dysregulation
2: incomplete features
3: classified, multi-system disease
4: irreversible tissue damage https://t.co/lmorwojG49
Links:
Dr. John Cush @RheumNow ( View Tweet)
Urine proteomics in lupus nephritis
IL-16 and CD163 are urinary biomarkers most correlated w/ histologic activity
Myeloid & degranulation sign ass w histo activity -> PR3+cells abundant in LN
@andreafava #RNL2024 @RheumNow https://t.co/YpoMiupOlQ
Links:
Dr. John Cush @RheumNow ( View Tweet)
Venous thromboembolic event Risk study in 1854 SLE pts vs controls (12,107) from 1985–2015 in W Australia. VTE affected 12.8% SLE pts; 6 fold higher than controls (RR 6.6). Risk factors: aPL(aHR 4.24), serositis (2.7), nephritis (1.75), low Plts (1.65) https://t.co/KNInhNkjmQ https://t.co/jT3cTemxMD
Dr. John Cush @RheumNow ( View Tweet)
Our final TNR for the month of April will take place on 4/30 at 6:30pm ET.
Mastering SLE
Rethinking Pre-Clinical Disease in Lupus - David Karp, MD
Biology and Rx of Lupus Flares - Michelle Kahlenberg, MD
Current/Future Biomarkers in SLE - Andrea Fava, MD
https://t.co/IoRDAaAJbo https://t.co/C7HpKvehXX
Links:
Dr. John Cush @RheumNow ( View Tweet)
Predicting Infection in Lupus Nephritis
Machine learning (ML) models were applied to 3 cohorts of lupus nephritis (LN) patients and established algorithms to predict co-infection in LN.
This study analyzed 111 non-infected LN patients, 72 infected LN patients, and 206 healthy controls (HCs), looking at patient demographics, infection outcomes, medication, and laboratory indexes (including cell counts and lymphocyte subsets).
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Prospective look at 25 280 older adults (mean 74yrs) w/ incident fracture, shows impact of multimorbidity by Charlson Comorbid Index (CCI). If CCI =2-3, Incr risk of subseq Fx (16-25%) & death (HR ~2); If CCI=4+, Fx Risk ^33-48%, death HR~4. https://t.co/6wnhFNiSXH https://t.co/Xy2y0ANDRd
Dr. John Cush @RheumNow ( View Tweet)
Prevalence of MSK presentations in practice = 21.1%, based on UK practice cohort. Most common: pain in LS spine (18%) & knee (17%). Re-presentations of existing Dx made up 74% all MSK consultations. Steroid injx given to 1/3 of knee consults https://t.co/nTioq1lCEB https://t.co/ecm8Kxz2cu
Dr. John Cush @RheumNow ( View Tweet)
JAMA review of ILD; that affects 650,000 in USA, leading to 25,000-30,000 deaths/YR. Types reviewed. Key Symptoms: dyspnea and cough, w/ chest CT being diagnostic tool. Antifibrotic & immunomodulatory may slow disease progression. https://t.co/xegChTUysM https://t.co/6GMJCqjoBx
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Dr. John Cush @RheumNow ( View Tweet)
Is Colchicine Rx a problem? Retrospective study of UK Clinical Practice registry, 13945 gout initiated allopurinol with colchicine (64yrs; 78% male). 26% on 1+ meds interacting w/ colchicine. Diarrhea & MI more freq w/ comorbidities & more severe CKD https://t.co/Y2boo9gcg2 https://t.co/aqUGMooXto
Dr. John Cush @RheumNow ( View Tweet)
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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Self Acupressure in Knee Osteoarthritis
A clinical trial has shown that self-administered acupressure (SAA) is effective in relieving knee osteoarthritis (KOA) patients.
https://t.co/jwP25u7J0b https://t.co/PH3aOoJaDu
Dr. John Cush @RheumNow ( View Tweet)
ICYMI: How do you manage enthesitis?
https://t.co/8cuKz1Ddpb https://t.co/3KMKQCVDSN
Dr. John Cush @RheumNow ( View Tweet)
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)
From the blog
One of the first words I was taught by my parents was “chào”. In Vietnamese, you say chào and bow when you greet someone or when you leave as a sign of respect.
In my first blog about self-discovery, I detailed the burnout and why I left clinical practice. In this second blog of the trilogy, I wanted to share encounters with patients as I told them goodbye. While I received great advice when I started practice, no one ever talks about how hard it is to leave.
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Podcasts
Rheum Chapter Notes (4.26.2024)
Spondyloarthritis Faculty Panel Q&A
Tuesday Night Rheumatology- Spondyloarthritis Spectrum
Nonradiographic Axial Spondyloarthritis - Dr. Eric Ruderman
Poster Hall
