Recent News
A follow-up analysis of a randomized clinical trial found that the use of calcium and vitamin D supplements among postmenopausal women was associated with decreased risk for cancer mortality, but increased risk for cardiovascular disease mortality. The analysis is published in Annals of Internal Medicine.Read Article
Best of 2024: Eating for Rheumatoid Arthritis
The majority of practicing rheumatologists at RheumNow Live 2024 were unaware of the new ACR guidelines issued in 2022 regarding dietary and lifestyle recommendations for patients with Rheumatoid Arthritis. Dr. Monica Guma reviewed these guidelines during her lecture on the impact of diet on disease activity and therapeutic response.
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Zhang @jeffsparks et al. Even more evidence that MTX does not cause ILD, and in fact prevents ILD, in RA, OR 0.48 in meta-analysis. @RheumNow #ACR24 Abstr#1384 https://t.co/w76dY29bwe https://t.co/1LBevDunjH https://t.co/Ix3UxeGUe2
Links:
Dr. John Cush @RheumNow ( View Tweet)
"If you want an argument, put two rheumatologists in a room and ask them about steroid tapers. Add a third and you'll have a fight"
-P. Merkel at UPA plenary session
#ACR24 @RheumNow
Dr. John Cush @RheumNow ( View Tweet)
Seronegative RA: sometimes there's an assumption that they'll eventually get a 'real' diagnosis
at @MayoClinic, 85% of patients diagnosed with seronegative RA kept their diagnosis at 10 years.
Usually, seroneg RA means seroneg RA!
#ACR24 @MyasoedovaElena ABST0458 @RheumNow… https://t.co/OD78mbDyNu https://t.co/vHgqX9IQOs
Dr. John Cush @RheumNow ( View Tweet)
Myths by Daniel Clauw
Small fiber neuropathy - misnomer, non-specific, not worth getting a skin biopsy
Fibromyalgia is not autoimmune - it is nociplastic pain and treated differently
#ACR24 Review Course
@RheumNow https://t.co/7SGKMTC3HY https://t.co/0718sGsass
Links:
Dr. John Cush @RheumNow ( View Tweet)
Upadacitinib in GCA. Merkel et al. SELECT-GCA study. Sustained remission week 52 Upa (+26 week steroid) 46% vs PBO (+52 week steroid) 29%. Reduced flare rates with UPA (see picture). Similar to GiACTA results. @RheumNow #ACR24 Abstr#0770 https://t.co/f7OwxAggaf… https://t.co/PUuwo0MLso https://t.co/JBzokT9icx
Dr. John Cush @RheumNow ( View Tweet)
Should you worry about giving TNFi to RA pts after a cancer diagnosis?
Medicare data with colorectal, lung, prostate Ca:
TNFi pts survival no worse (numerically better) than csDMARDs
Cancer pts deserve good RA treatment!
#ACR24 ABST0202 Suarez-Almazor @MDAndersonNews @RheumNow… https://t.co/aR75hJQ6YK https://t.co/ptDYCsOpXN
Dr. John Cush @RheumNow ( View Tweet)
ANA neg, but ENA pos
should we care about that result?
PPV 5.5% here
(similar to 6% prev @EricFMorand: https://t.co/7Lo0DgHtXT)
and how many really needed the serology? Anxiety?
Surely pos ENA w neg ANA might be more hassle than help. So what to do?⬇️
#ACR24 ABST1930 @RheumNow… https://t.co/lZ1TJxTqhs https://t.co/itx0TCFFjl
Dr. John Cush @RheumNow ( View Tweet)
Great table re:side effects of even low dose steroids in RA
Likely generalizes to other diseases ie PMR, SLE
P in prednisone stands for poison!
#ACR24 @RheumNow https://t.co/2bFy6dwl96 https://t.co/YDtjSX054I
Links:
Dr. John Cush @RheumNow ( View Tweet)
Best of 2024: SGLT2 Inhibitor Protective Effects in Lupus
Systemic lupus erythematosus (SLE) outcomes were assessed based on whether they received sodium-glucose co-transporter 2 inhibitors (SGLT2i), in the setting of comorbid type 2 diabetes (T2D).
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Best of 2024: Good Clinical Practice Recommendations on Glucocorticoid Withdrawal and Adrenal Insufficiency
Glucocorticoids are widely prescribed as anti-inflammatory and immunosuppressive agents. This results in at least 1% of the population using chronic glucocorticoid therapy being at risk for glucocorticoid-induced adrenal insufficiency. This risk is dependent on the dose, duration and potency of the glucocorticoid, route of administration, and individual susceptibility.
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TAPIR study of continuing vs stopping steroids in ANCA vasculitis in remission. Relapse at month 6 in 16% vs 4%. OR 4.22, but low rate in either group. If treated Rituximab, no difference! Merkel et al. @RheumNow #ACR24 Abstr#0774 #ACRbest https://t.co/F9DOBLrjVq https://t.co/BtphAuEopA
Dr. John Cush @RheumNow ( View Tweet)
54K Peptic Ulcers Annually (12.13.2024)
https://t.co/18FiQx1YQA https://t.co/32UZi9XafS
Dr. John Cush @RheumNow ( View Tweet)
Improvements in Pain and Fatigue in Bimekizumab
Dr. Philip Mease discusses abstract 2368, presented at the 2024 ACR Convergence meeting in Washington, DC.
https://t.co/ON09z9yTuJ https://t.co/650TUdHwYm
Dr. John Cush @RheumNow ( View Tweet)
Vaccine Responses:The DMARD Counts
Dr. David Liew reviews abstracts 0247, 0248, 1988, 1009, reporting from Melbourne, Australia for the 2024 ACR Convergence meeting.
https://t.co/0qDGRkT64B https://t.co/dO9EvhD1NE
Dr. John Cush @RheumNow ( View Tweet)
Best of 2024: Efficacy of Biologics in Patients with Chronic Kidney Disease
A retrospective cohort study of biological disease-modifying antirheumatic drugs (bDMARDs) persistence in rheumatoid arthritis patients with chronic kidney disease, shows the 3 year survival to be under 50% but that all studied biologics were nearly equivalents with regard to safety and efficacy.
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Best of 2024: 13 Risk Factors for RA-associated Interstitial Lung Disease
Interstitial lung disease (ILD) is the most widespread and fatal pulmonary complication of rheumatoid arthritis (RA). A recent metanalysis shows the pooled prevalence of RA-ILD was approximately 18.7%.
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How do you manage skin in Sscl?
-RNA pol III + high risk for skin progression.
-Limited+ low risk + stable Sscl no need for immunesuppresors.
-Look for EF in pts with generalized morphea.
-Ttnt of skin depending on other organ involvements.
-If no Raynaud’s/hands spared think of… https://t.co/DZzhShKzS8 https://t.co/J9Qg1Lk2Wl
Dr. John Cush @RheumNow ( View Tweet)
#ACR24 Year in Review:
💡GLP1i significantly decreased knee OA pain over time (or was it the wt loss itself?🤨)
💡CD19 CAR T-Cell therapy has potential to treat/cure many autoimmune diseases (are risks and $ worth the benefit?)
💡 High risk of CV events within 30 days of gout… https://t.co/g3egOpCYNr https://t.co/KMiOEP7pSg
Dr. John Cush @RheumNow ( View Tweet)
Sarcoidosis is biopsy supported not proven”
-Dx is clinical with broad ddx.
-Assess organ involvement in all pts.
-Whole body PET can help assess disease activity (not in CNS disease)
-MR brain with pituitary cuts helpful in CNS sarcoid.
#ACR24 @ACRheum @RheumNow… https://t.co/Ka1cHtFOqj
Dr. John Cush @RheumNow ( View Tweet)
From the blog
How would you manage a patient with Overlap (anti-synthetase) syndrome, ILD, polyarthritis and myositis?
Podcasts
Bah Humbug Vitamin D (12.20.2024)-
54K Peptic Ulcers Annually (12.13.2024)
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Don’t Buy Guitars (12.6.2024)
ACR24 IL-17 Topic Panel Advancing Care with IL-17 Pathway Insights
Poster Hall
