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Channeling Bias and Cancer Risk with Biologic or Targeted Synthetic DMARDs

d Jack Cush, MD

A retrospective US administrative claims cohort study of RA patients on tumor necrosis factor inhibitors (TNFis), non-TNFi biologics, or Janus kinase inhibitors (JAKis) found a statistically significantly higher risk of incident cancer in patients receiving rituximab, abatacept, or JAKis (compared with TNFis).

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Earlier ACL reconstruction and a lower risk of knee osteoarthritis

d EurekAlert!

A preclinical study by HSS investigators found that earlier anterior cruciate ligament (ACL) reconstruction led to lower immune cell activity, less inflammation and fewer joint changes associated with knee osteoarthritis compared to delayed surgery.

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Glucocorticoid Toxicity Index

d Jack Cush, MD

Dr. John Stone has led the effort to develop the GTI - glucocorticoid toxicity index. In this review article he acknowledges the need and benefit of steroids, but details a novel means to identify and limit the untoward effects of glucorticoids (GC).

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2024 Rheumatology Year in Review

d Jack Cush, MD

2024 was a year of surprising new growth in technology, with the expansion of new therapeutic options for many patients and clinicians.  While these many advances offer new hope, they are countered by disappointments and gapping unmet needs in rheumatology. Below is my top 10 list (in no particular order) of 2024 developments and desires that may change rheumatologic practices.

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Cardiovascular and Fracture Risk with Denosumab Versus Bisphosphonates in Dialysis Patients

d Jack Cush, MD

Annals of Internal Medicine has published a  Japanese administrative claims database study showing that, compared with oral bisphosphonates (BIS), denosumab (DEN) lowered fracture risk by 45%, but increased the risk for major adverse cardia

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Still's Dz Afro-Caribbean study of 58 pts (57% AOSD). Sex differed betw kids F 36% vs F71% in adults. Kids had signif more typical skin rashes (100 vs 29%), coronary artery dilation (16 vs 0%), & MAS (52 vs 9%). Adults signif more polyarthalgia (91 vs 32%) & lung dz (51 vs 4%).… https://t.co/AYKNazgio5 https://t.co/1yQgeMiwku
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Sobi announced it has submitted to FDA a supplemental (sBLA) for Gamifant (emapalumab-Izsg) for use in adult & kids w/ hemophagocytic lymphohistiocytosis (HLH)/macrophage activation syndrome (MAS) in Still’s disease with an inadequate response glucocorticoids, or with recurrent… https://t.co/PLpcD5jzxH https://t.co/0LUe9bXaYS
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Can you distinguish which PsA? Persistent inflammatory (PIPsA) vs non-inflammatory PsA (NIPsA)? NIPsA has normal ESR/CRP, w/ obesity, biomechanical pain, OA, fibromyalgia, secondary post-inflam damage or central pain mechanisms. https://t.co/9SRmpNfXCF https://t.co/wsH6poUO1m

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New insights into Moyamyoa a complex cerebrovascular disorder affecting children/young adults w/ carotid or CV vessel narrowing; leading to CVA, Sz, HA, TIA, Cognitive Sx. Genetic mutations add to succeptibility (RNF213, ACTA2, DIAPH1, HLA). DIfficult to Dx vs Atherosclerosis.… https://t.co/LqFcU0xO3J https://t.co/CileSRAZgU
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With GLP-1 agonists, is there a risk of aspiration during gen. anesthesia. Most advise against elective surgery/anesthesia unless the GLP-1 is held for 1-2 weeks. Based on MOA of delayed gastric emptying - 7/8 studies show Incr residual gastric contents in GLP-1, but none… https://t.co/U690OmeqJm https://t.co/Q6kyv9fyVJ
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Study of sarcopenia in 138 young adults with inflammatory arthritis (IA) found sarcopenia in ~47% of IA- Signif different between JIA, SpA, & RA. W/ multivariable analysis, predictors of sarcopenia included BMI (OR 0.84), BMD (OR 0.01), vit D (OR 0.96) & HAQ (OR 14.5)… https://t.co/JHKwF8icj1 https://t.co/ph3pVIYuXx
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Congratulations to Dr. Joseph Merola (Rheumatologists & Chair of Dermatology at UT Southwestern) on his appointment to the Board of Directors for the American Academy of Dermatology (AAD) https://t.co/TxjuZWeXoJ https://t.co/Mo7PwLWD5f

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A Veterans study of 27,540 #RA pts shows the risk of multiple myeloma (MM) did not differ b/tsDMARD & csDMARD users. 30% took b/tsDMARD during follow-up (192,000 PYs). MM incidence rate: b/tsDMARD-naïve 0.37/1000PYs vs csDMARDs 0.42/1000PYs (HR 1.32; 0.78, 2.26)… https://t.co/Xp4v4eIQnd https://t.co/5MVdz5UQSb
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Long-Term Use of NSAIDs Linked to Lower Dementia Risk https://t.co/nlo2BodhLG https://t.co/TiE34zyvts

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Are Combination Biologics Safe? Real-life data from a French observational study suggests the overall risk of severe adverse events (SAE) with combotherapy does not seem to be increased (vs monotherapy), but certain combinations warrant caution. https://t.co/IEIi6kQI4b https://t.co/KVSbqeMbyA

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A Case of IgA Vasculitis Presenting as Duodenal Perforation Presentation by Dr. Audrey Liu, at the Rheumatology Winter Clinical Symposia - Feb 2025 https://t.co/kZWgy1S0Wh https://t.co/9mJAzVRVpl

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Hydroxychloro-King (3.7.2025) Dr. Jack Cush reviews the news, journal reports and regulatory actions from the past week on RheumNow. https://t.co/83ZAyrrgg3 https://t.co/63cIdP559y

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Late Breaking abstract from 2025 Amer. Acad. Dermatology (AAD) on the Phase 3 ICONIC-LEAD study showed J&J's oral IL-23 inhibitor (icotrokinra) was superior to deucravacitinib in skin clearance (65% vs 8%) & PASI90 (50% v 4%) at Wk 15 in 684 moderate-to-severe plaque PsO pts… https://t.co/GYK604kJ9u https://t.co/Ao1BpL1Qxt
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The European Commission (EC) has approved Celltrion’s Avtozma (CT-P47), a biosimilar referencing Roche’s RoActemra (tocilizumab). https://t.co/ukMDwtgUhw https://t.co/htDVWKbu3n

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Congratulations to Dr. Mehmet Hocaoglu (University of Pittsburgh) on being awarded a 2024 Rheumatoid Arthritis Research Program grant to investigate the unique and shared risk factors between patients with preclinical rheumatoid arthritis and patients with RA.… https://t.co/eF4yb3Hxsj https://t.co/MLNWKFiCiU
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