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Sjogren's Syndrome at Risk for Psychiatric Disorders

d Jack Cush, MD

A population-based claims study from Taiwan shows significantly increased incidences of depressive disorder, anxiety disorder, and sleep disorder in patients with primary Sjögren’s syndrome (pSS). 

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RheumNow Podcast – More Than a Spot of Tea (8.2.19)

d Jack Cush, MD

Dr. Jack Cush reviews the journal articles and news reports from the past week on RheumNow.com:
MMP-7 and Myositis-ILD; Post-surgical gout attacks; CV events and testosterone; and a Boxed warning for tofacitinib.

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Biologic Therapy Improves Psoriasis and Reduces CV Inflammation

d Jack Cush, MD

Psoriasis confers a significant risk of comorbidity, but is psoriasis associated with increased coronary inflammation and is this risk attenuated by biologic therapy?

JAMA Cardiology has published a cohort study of 134 consecutive patients with moderate to severe psoriasis, showing that biologic therapy was associated with a significant decrease in coronary inflammation as assessed by perivascular fat attenuation index, a marker of coronary inflammation associated with cardiovascular outcomes. Patients not receiving biologic therapy had no change in perivascular fat attenuation index at 1 year.

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TNF Inhibitor and Biologic Induced Psoriasis

d Jack Cush, MD

Analysis of RA patients in the German biologics register, RABBIT, shows an increased risk of psoriasis with TNF inhibitor (TNFi) compared to csDMARDs and other non-TNFi biologics. 

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Top Rheumatology Centers Led by Johns Hopkins

d Jack Cush, MD

Medscape has reported the results of the US News & World Report's annual ranking of the best adult rheumatology hospitals nationwide has again honored Johns Hopkins Hospital, with runner up status going to the Cleveland Clinic, Hospital for Special Surgery, NewYork-Presbyterian Unive

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Claims analysis of f 45,208 TNFi +MTX initiators and 1,387 triple DMARD (MSH) initiators showed no significant difference in the risk of serious infections (2.46 TNFi+MTX vs 2.03 triple DMARD/100PY) (HR 1.23; 0.87‐1.74) https://t.co/pe52p8Xtrv

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Dr. John Cush RheumNow ( View Tweet)

Oral candidiasis (OC) is a significant predictor of severe infections during immunosuppressive Rx in ANCA-associated vasculitis. 71 pt cohort study; Predictors of severe infx: low albumin, pulse methylprednisolone (adj HR = 5.44), & OC (adjHR  5.31) https://t.co/BSZzWxDU4k

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Dr. John Cush RheumNow ( View Tweet)

Can a Nice Doctor Make Treatments More Effective? - The New York Times https://t.co/Aj5vUBofHJ

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Daniel H Solomon DanielHSolomon ( View Tweet)

Doctors - Who do you go “above & beyond” for?

Dr. John Cush RheumNow ( View Tweet)

My advice to Patients on Joint Replacement Surgey: 1) talk to others who had the surgery; 2) consult orthopedics LONG before its urgent; 3) PRE-hab (getting strong before surgery); 4) Get a physical therapist who will work you to normal (3-5X/wk for 4-8 wks)

Dr. John Cush RheumNow ( View Tweet)

Measures used to limit costs & utilization of expensive biologics: 1) Generics 1st requirement; 2) Pre-authorization; 3) limited (6-9 mos) approval w/ proof of benefit; 4) 30 day supply; 5) preferred tiered drugs; & 6) utilize less expensive providers https://t.co/2HRrJn87AY

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Dr. John Cush RheumNow ( View Tweet)

2nd Edition of my "The War on RA" - being fought daily by rheumatologists - Change, Innovation and Discovery will be driven by Rheumatologists. Rheums must lead the fight to win the immense challenge of #RA today. We need you! https://t.co/7vOzRvvuVi

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Dr. John Cush RheumNow ( View Tweet)

MMP-7 levels studied in myositis pts w/ anti-synthetase syndr (ARS) and fourd to be higher in ARS Ab+ & MDA5 Ab+ PM/DM-ILD patients, and were associated with a worse prognosis. MMP-7 levels associated w/ worse survival (OR 18.0). https://t.co/lGlc5S00sR

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Dr. John Cush RheumNow ( View Tweet)

IL-18 may be a biomarker for Systemic JIA (Stills), higher w/ active dz and hx of MAS. Study of 40 sJIA pts finds elevated IL-18 levels inactive and active dz & with history of MAS. IL-18 was correlated w/ ferritin (R=0.74), CXCL9 (R=0.56), S100 (R=0.47) https://t.co/c0KjAyiEjq

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Dr. John Cush RheumNow ( View Tweet)

70 #gout pts studied & 44.3% developed post-surgical flares. Risk factors included Presurgical sUA ≥ 9 mg/dL (OR 3.77) & sUA changes before and after surgery (OR 1.62); but \allopurinol reduced risk (OR 0.15). Mean time to flare=3.7 days. Knee > MTP1 https://t.co/U6rl5c8Cf3

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Dr. John Cush RheumNow ( View Tweet)

Candian study of 376 pregnancies (284 F) with #SLE and drug use: only 24.2% on antimalarials, 8.2% azathioprine, 19.7% steroids & 4.8% on NSAIDs during pregnancy. 1st trimester discontinuations seen in 16.7% of HCQ & 29.2% AZA https://t.co/YoRUXU9RJB

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Dr. John Cush RheumNow ( View Tweet)

Phase IIb/III trial of multidoses of fasinumab (NGF mAb) in 421 pts w/ mod‐severe hip or knee #OA (WOMAC pain ~6+) showed signif reductions in pain (LMS -1.1 to -1.4) vs PBO (-.79) & >30% improved pain by @wk16 (63–74 vs 47%); arthropathy 7% FAS vs 1%PBO https://t.co/UtkqDE5lGf

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Dr. John Cush RheumNow ( View Tweet)

RA patients with an inadequate response to adalimumab, in the presence of sufficient/high ADA drug levels, benefit 33% less from switching to another TNF inhibitor, etanercept. Data 449 RA patients in the Reade Rheumatology Registry https://t.co/uBzF8D9KpA

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Dr. John Cush RheumNow ( View Tweet)

A prospective 10-year study of 1,024 older women shows that severe abdominal aortic calcification (AAC) scores were associated with ncreased fracture risk (HR 1.48 [1.15-1.91], p=0.002; not fully indicated by predictors of bone structure. https://t.co/NVbo9eHcYF

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Dr. John Cush RheumNow ( View Tweet)

Observational study of 124 gouty patients with high cholesterol & triglycerides treated with ULT (febuxostat, allopurinol, benzbromarone) showed that ULT significantly lowered SUA and lipid levels too. https://t.co/JSdh3TRTX3

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Dr. John Cush RheumNow ( View Tweet)

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