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UK study shows PreClin RA, Establ #RA 1) have increased bowel permeability; 2) gut permeability worsens w/ activity; 3) gut-permeability markers not affected by treatment; 4) in a RA Mouse model-blocking gut permeability ameliorates arthritis https://t.co/HZNl56cQnn

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Dr. John Cush RheumNow ( View Tweet)

FDA, warning, side effect

FDA: New Cardiac and Cancer Warnings for All JAK Inhibitors

d Jack Cush, MD

Today, Sept.1st, the FDA announced its decision regarding tofacitinib's safety concerns from the Oral Surveillance study - handing down warnings for not only Pfizer's JAK inhibitor, but also for other marketed JAK inhibitors from AbbVie and Eli Lilly & Co.

These safety concerns arise from the Oral Surveillance study - a large, post-marketing, safety trial of tofacitinib versus adalimumab in high risk patients. New warnings about the risks of cardiac events, death and cancer will appear as a revision to the "boxed warnings" in the product label (package insert) for all JAK inhibitors - tofacitinib, baricitinib and upadacitinib. 

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colitis.jpg

TNF Inhibitor Induced IgA Vasculitis in IBD

d Jack Cush, MD

A new descriptive series shows an uncommon association between IgA vasculitis (IgAV) and inflammatory bowel diseases (IBD), with most cases interestingly arising after  or during anti-TNF-α therapy.

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Gut microbiome strongly influences irAE's in advanced melanoma pts taking checkpoint blockade targeting CTLA-4 and PD-1. Signatures for Bacteroides intestinalis & Intestinibacter bartlettii more grade 3+ irAE by inducing IL-1B https://t.co/rEHknJ3TSC

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Dr. John Cush RheumNow ( View Tweet)

Study from the UK BSRBR for #AS & 2043 pts showed 44% w/ at least 1 comorbidity. Each comorbidity was associated w/ 0.40 unit increase in BASDAI and 0.53 in spinal pain. More Dz activity w/ Depression, CHF and peptic ulcer, not CRP/ESR https://t.co/0vAnbjHicw

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Dr. John Cush RheumNow ( View Tweet)

Literature review examined safety of IL-17 inhibitors in 106 controlled RCTs, 40,053 pts. Inflammatory bowel disease was reported in 0.4% of IL-17i Rx patients. (same in 61 uncontrolled RCTs -0.36%). Other AE: diarrhea (2.5%), N/V(0.7%) https://t.co/2wSZQqB1Zs

Links:

Dr. John Cush RheumNow ( View Tweet)

RA, hands, MCP, deformity

Combo Methotrexate and Leflunomide Safety in RA

d Jack Cush, MD

Methotrexate and leflunomide (LEF) are the most widely prescribed DMARDs worldwide; yet biologic DMARDs are the newest and best selling agents for rheumatoid arthritis worldwide.

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ICYMI: New-Onset IBD & IL-17 Inhibitors: What’s the Risk? https://t.co/zXDQotDiWV Patients w/ inflammatory/autoimmune diseases who initiated treatment w/ IL-17 inhibitors didnt have a higher risk for development of IBD, but only based on the severity of their underlying disease https://t.co/w3IpQkzmn7

Links:

Dr. John Cush RheumNow ( View Tweet)
colitis.jpg

New-Onset IBD and IL-17 Inhibitors: What Is the Risk?

d MedPage Today

Patients with inflammatory/autoimmune diseases who initiated treatment with interleukin (IL)-17 inhibitors did not have a higher risk for the development of inflammatory bowel disease (IBD), but only after taking into account the severity of their underlying disease, French investigators reported

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Serious problem! Pulmonologists believe that MTX causes and/or worsens ILD. MTX causes hypersensitivity pneumonitis, not ILD. RA, lupus DM, PSS cause ILD and they may need MTX to manage their disease. Do your own research, look at this paper to start. https://t.co/vUyCxJP2Mh

Links:

Dr. John Cush RheumNow ( View Tweet)

RheumNow Podcast square

RheumNow Podcast – As Good As I Ever Was (7.2.2021)

d Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.

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Retrospective study of 258 IBD patients, 17% had MRI sacroiliitis (73% w/ bone marrow edema. Sacroiliitis was significantly associated w/ Female gender, back pain, and later age of CD diagnosis. >two-thirds of these pts never seen a rheumatologist. https://t.co/HYhAU6aRIf

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Dr. John Cush RheumNow ( View Tweet)

Analysis of Ph 3 data Tofacitinib in Ulcerative Colitis shows no increase in Cancer; rates equal to that seen w/ Tofa in RA, PsA & other biologics in UC. In 1124 pts (2576 PtYrs) there were 20 cancers, excluding NMSC (IR, 0.75; 0.46–1.16) https://t.co/xiTIKYAtyY

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Dr. John Cush RheumNow ( View Tweet)

Combination disease modifying antirheumatic drug (DMARD) therapy may not be only for rheumatoid arthritis; combining disease modifying agents may be the path to better renal response. Read more. https://t.co/0d1bxBlUS0 https://t.co/OZzJKwNJ4i

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Dr. John Cush RheumNow ( View Tweet)
Video: Combination DMARD for Lupus Nephritis: Dr. Kathryn Dao ( @KDAO2011 ) #EULAR2021 https://t.co/RGVZ6jukYy https://t.co/PTjSOfM7YQ

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Dr. John Cush RheumNow ( View Tweet)
#EULAR2021 POS0237: Gut dysbiosis linked to worse disease status in axSpA. ⭐️Dysbiosis in 33% of AxSpA vs 17% of controls wo rheumatic disease ⭐️Gut dysbiosis associated with worsening disease activity @RheumNow https://t.co/rRl4Zbs7xc
Eric Dein ejdein1 ( View Tweet)
Gut dysbiosis linked to worse disease status in AxSpA ⭐️higher dysbiosis associated w/ worse EvalGlobal, ASDAS-CRP, BASDAI, BASFI, VAS pain ⭐️comparing dysbiosis vs. non-dysbiosis group - significant difference in BASDAI, BASFI, EvalGlobal Abs#POS0237 #EULAR2021 @RheumNow

Robert B Chao, MD doctorRBC ( View Tweet)

OP0010 at #EULAR2021. FLORA trial: Fecal microbiota transplant as add-on Rx to MTX. Small trial showing time-to-event curves show inferiority to sham but good safety. Fascinating concept exploring gut-joint interaction. @RheumNow. https://t.co/BIOmA5z6vK
Eric Dein ejdein1 ( View Tweet)
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RheumNow Podcast – Heart, Lung & Liver (5.28.2021)

d Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.

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Virtual DDW meeting this wk reports claims data comparing IBD to IBD with RA - IBD alone vs IBD w/ RA dx w/ more depression (21% vs 84%), anxiety (20% vs 47%). IBD w/ RA had more depression (OR 7.2); anxiety (OR, 1.25;) or both (OR, 2.3) https://t.co/B78xcJw584

Links:

Dr. John Cush RheumNow ( View Tweet)

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