Recent News
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.Read Article
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
Links:
Dr. John Cush @RheumNow ( View Tweet)
Next up! Spondyloarthritis Spectrum
Tuesday, April 23, 2024 | 6:30PM ET
Nonradiographic Axial Spondyloarthritis - Eric Ruderman, MD
Enthesitis in Spondyloarthritis - Lihi Eder, MD
Future Therapy of Axial Spondyloarthritis - Lianne Gensler, MD
https://t.co/AkMjbXBJrC https://t.co/8xLTvbhlAw
Links:
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)
What a racket! Pharmacy benefit managers make billions collecting fees from payers & rebates from Pharma. 2022, these 3 (CVS Caremark, Express Scripts, OptumRx) control 79% of PBM market.Why is Congress dragging their feet here? Overview read from Reuters https://t.co/m5AnMFtEhf https://t.co/m5EwfcNMdo
Dr. John Cush @RheumNow ( View Tweet)
GPA Management in 2024
https://t.co/qTwI7oVMBI https://t.co/Tr0eVmcgNN
Dr. John Cush @RheumNow ( View Tweet)
Practice Metrics Use by Rheumatologists in RA. 54% of Rheums do "some" measure, Most used: HAQ 36%, RAPID3 27%, CDAI 18%, Vectra 13%. More than 35% do NOT measure
https://t.co/FOlyCSFF25 https://t.co/3S36tDlgcE
Dr. John Cush @RheumNow ( View Tweet)
TNFi mAbs, JAKi, –IL-17 are protective against Anterior Uveitis (AU) in AxSpA. Metanalysis of 44 RCTs shows AU IR:
- TNF mAbs: 4.1
- etanercept 5.4
- IL-17i: 2.8
- JAKi: 1.5
- placebo: 10.8 https://t.co/qN9UL16YPO https://t.co/5WOjAq9ty6
Dr. John Cush @RheumNow ( View Tweet)
ILD Onset in MDA-5 Dermatomyositis
MDA5 antibody-positive DM is a rare, aggressive and progressive subtype of DM. Its' severity is dependent on the development of progressive ILD, manifesting as either RPILD and CILD.
https://t.co/9OPddNCLKr https://t.co/7KNCLnC3BA
Dr. John Cush @RheumNow ( View Tweet)
Next up! Spondyloarthritis Spectrum
Tuesday, April 23, 2024 | 6:30PM ET
Nonradiographic Axial Spondyloarthritis - Eric Ruderman, MD
Enthesitis in Spondyloarthritis - Lihi Eder, MD
Future Therapy of Axial Spondyloarthritis - Lianne Gensler, MD
https://t.co/XvA0cPsC1E https://t.co/FZ3GfHpTFm
Links:
Dr. John Cush @RheumNow ( View Tweet)
Pregnancy in vasculitis checklist:
- goals and timeline
- disease activity in 12 mos
- is there end organ damage?
- Review Rx
- h/o clots/miscarriages, APLS?
- Check Ro/La
- Role for ASA?
- Refer to MFM
Catherine Sims #RNL2024 @RheumNow
Dr. John Cush @RheumNow ( View Tweet)
#RNL2024 @RheumNow
@philseo: I now give Tociliizumab for nearly all patients with GCA
GiACTA shows we weren't doing well enough with steroid monotherapy
GiACTA shows dosing frequency does not make a big difference in new diagnosis, but makes a difference in relapsing disease
Dr. John Cush @RheumNow ( View Tweet)
High risk medications for pregnancy:
MTX- 40% pregnancy loss, 6-10% birth defects
MMF/CYC - 40% pregnancy loss, 25% birth defects
Recommend 2 forms contraception on MMF
Change meds slowly to safe Rx and monitor disease activity at least 3 mos before pregnancy
#RNL2024 @RheumNow
Dr. John Cush @RheumNow ( View Tweet)
#RNL2024 @anisha_dua
Throwing the kitchen sink in severe GPA
CYC + RTX combo - sick population (median GFR 9, 47% on HD, 52% DAH, all received PLEX too)
- 85% survival, 69% not ESKD, low rates of relapse (13% at 36 mos)
But, prolonged B cell depletion, aggressive Rx
Dr. John Cush @RheumNow ( View Tweet)
From the blog
Over the last few decades, Japanese workers were collapsing dead at their desks or committing suicide due to the high stress stemming from their jobs; Japan coined this phenomenon, “Karoshi.” In 2021, the World Health Organization and International Labour Organization issued a warning: working 55+ hours a week is a serious health hazard and increases the risk for death from heart disease and stroke. But since the pandemic, I see many colleagues working hard at the expense of their health, family life, mental and emotional well-being. I never thought I would be burned out because I had passion for my job.
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Podcasts
Nonradiographic Axial Spondyloarthritis - Dr. Eric Ruderman
Canary In A Coal Mine (4.19.2024)
Vasculitis Faculty Panel Q&A
Tuesday Night Rheumatology- Vasculitis Mavens
Poster Hall
