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Hmmm Really? (7.11.2025)
Dr. Jack Cush reviews the news and journal reports from this past week - some obvious, other new thoughts and some - hmmm, reallly?
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CMS to Test Prior Authorization Model in Traditional Medicare
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Medpage Today
The Centers for Medicare & Medicaid Services (CMS) announced a new experimental model late last week to streamline some prior authorizations under the traditional Medicare program, but some politicians and experts are concerned that it could result in more delays in care.
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No Increased Malignancy Risk with Ixekizumab
A pooled analysis of 25 randomized clinical trials affirms the safety of ixekizumab (IXE) when used to treat patients with psoriasis (PsO), psoriatic arthritis (PsA), or axial spondyloarthritis (axSpA).
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Can you predict disease from serum biomarkers? Comparison of 5 controls, 36 individuals at risk, 74, RA, & 97 PsA pts finds RA w/ higher levels of sICAM-1, MMP1, MMP3, PP, c-Peptide, CRP SAA. Also CRP, SAA, GLP-1, GIP-1, Leptin, PP precede disease onset https://t.co/zqWxsbTSlC https://t.co/Kgv2ZAuzIR
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Rheums! Question or case for Jack Cush? Record it here and we may feature it on an upcoming podcast.
https://t.co/HsqM9xLNtP https://t.co/voONsOLeSK
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Study of 176 anti-MDA5-DM patients and 55 controls found anti-IFN-α Abs in 18% of MDA5-DM pts, higherin those >60 yrs. IFN-α Ab-positivity assoc w/ RP-ILD (68% vs. 41%) & pulmonary infxn (74% vs. 46%, esp fungi), Mortality (p = 0.006). https://t.co/6w6S3nozPI https://t.co/FoXEIuLBEk
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Cancer Survival Outcomes in Autoimmune Skin Disease Patients
Patients with autoimmune skin diseases (ASDs) with cancer had significantly better cancer survival outcomes than those without ASD, suggesting coexistant autoimmune or inflammatory disease does not adversely affect a https://t.co/apnX4GGAdT
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Overview of the VEXAS Syndrome
A current systematic review in Rheumatology addresses the clinical features seen in the VEXAS syndrome.
https://t.co/45qeSb14GB https://t.co/2mHEHh7BmU
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Swedish Medical Birth Register study of pregnancy in systemic sclerosis (SSc) shows increased risk of preeclampsia (RR 3.8; 1.8-7.8), preterm birth (3.3; 1.8-6.1), & caesareans (2.5; 1.8-3.5) esp w/ 1st pregnancy -- but not incr. maternal or neonatal death, nor stillbirth https://t.co/SNSK5947zO
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Reducing Progression of Psoriasis to Psoriatic Arthritis
Tumor necrosis factor (TNF) inhibitor therapy was effective in reducing the likelihood that psoriasis would progress to psoriatic arthritis (PsA), a retrospective study indicated.
https://t.co/xOtA2Hrgue https://t.co/S522IYnFgz
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Diffuse idiopathic skeletal hyperostosis (DISH)is a structural cause of dysphagia due to anterior cervical osteophytes. Retrospective study 208 dysphagia pts w/ head/neck CT. DISH was Dx in 39%; predicted by low serum albumin, COPD, & chronic pain https://t.co/zrn4dnCtLc https://t.co/svE6khmUEm
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EUSTAR Study of 893 SSc-ILD pts - 94 (10.5%) died (mean F/U 39 mos). Predictors of mortality: FVC deterioration >10% w/in 12 mos (HR 3.81) & >10% FVC decline or mRSS worsening (HR 2.82); but not changes in DLCO, mRSS or digital ulcer burden alone. https://t.co/28wSQc1dUS https://t.co/dourQ6WGDq
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Study of 74 systemic sclerosis pts shows nailfold videocapillaroscopy (capillary disorganization, late pattern changes) predicts ILD progression, worsening PFTs & mRSS in SSc over 2 yrs. KL-6 correlates w/ NVC findings & PFT decline. ILD incr from 38 to 51% in 2yrs https://t.co/h2Js6JXl2H
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Early DMARD Initiation Benefits in Psoriatic Arthritis
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 https://t.co/EdbnpBmnPe
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Despite 2024 HHS proposal to reschedule CANNABIS to Schedule III, it remains Schedule I -having "no accepted medical use" and "high abuse potential".There's lots of use (legal in 24 states, DC, decriminalized in 7 states), but no evidence, research or guidelines. https://t.co/KumpvMHdhC
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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
Links:
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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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