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New EULAR/ACR Classification Criteria for SLE

d Jack Cush, MD

The European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) have jointly developed new classification criteria for systemic lupus erythematosus (SLE); prompted by the need for criteria that were both highly sensitive and specific. The net result is improved sensitivity and specificity, but the use of positive ANA requirement along with a longer list of weighted criteria ensures its utility in SLE research (including early or latent SLE), but not clinical practice.

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War on RA - Part 3: Useless Drugs

d Jack Cush, MD

We have options that are endless – we have 28 biologics in rheumatology; 19 approved for RA in the last 20 years, but 15 of these are me-too copies or biosimilars. We currently have 2 JAK inhibitors and may have 3 or 4 by year end. But what we really need is the right drug, at the right time, in the right patient – but how will we know.

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Are Non-TNF Biologics Superior to TNF inhibitors?

d Jack Cush, MD

Current ACR and EULAR guidelines list TNF-inhibitors (TNFi) abatacept, rituximab, and tocilizumab as being equally effective after methotrexate or as second line therapies when treating rheumatoid arthritis.

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EULAR Recommendations on Large Vessel Vasculitis

d Jack Cush, MD

Th European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) was originally published in 2009. Since then there have been new randomised clinical trials and cohort analyses leading to an update the original recommendations.

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Prospective study of 83 gout patients; 77 on urate lowering Rx, 6 discontinued Rx. The D/C group had no change in MSU deposits or SUA levels, In the ULT group MSU burden significantly decreased (MSU volume: p=0.007) and sUA dropped from 7.2 to 5,8 mg/dl. https://t.co/YfXjTKz1va

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PLoS reports that a study of 10,059 men from Israel were followed serially showing that higher variability in serum Uric Acid levels over 5 years was clearly predictive of 18-year Coronary heart disease and all-cause mortality. https://t.co/bDqI32aVXt

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NHANES 30 yr study of 58,731 shows prevalence of of chr hepatitis B & alcoholic liver dz stable; chronic hepatitis C decreased twofold; but non-alcoholic fatty liver dz (NAFLD) has increased from 20% to 32%; with a parallel increase in obesity & NIDDM https://t.co/6vxFLUBhEd

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Metanalysis of 9 studies shows that use of IVIG in ANCA-Associated vasculitis is assoc. w/ significant and rapid improvement in BVAS (SMD –1.7), ANCA (SMD –0.72) and CRP (SMD –0.92) within 2-24 weeks. https://t.co/aw3VjBWCcf

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FDA has approved Turalio (pexidartinib) for the treatment of adults with the rare disorder, tenosynovial giant cell tumor (TGCT) associated with severe morbidity or functional limitations and not responsive to improvement with surgery. https://t.co/eMTmFSW97A

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War on RA - Parts 1 & 2 - Listen to the podcasts on iTunes or SoundCloud here: Part 1 - Walk on the Moon https://t.co/IZ1cjiwbnZ and Part 2 - All about You https://t.co/u5j8TAZvYC

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The RheumNow Podcast is up – More on osteoporosis, myositis, lipids and gout, testosterone, abatacept in PSS & Boxed Warning for tofacitinib. Watch it here>> https://t.co/I1lBS1lUmY or listen to the Podcast on iTunes or SoundCloud here>> https://t.co/uYyPV7pxcN

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Claims analysis of 88,463 #RA pts (2006-2015) finds no greater risk of cardiovascular events w/ Tocilizumab (11.8/1000 PY) compared to TNF inhibitors (15/1000PY) or abatacept; suggesting no net increase in CVD w/ occ hyperlipidemia seen w/ TCZ https://t.co/6L8aKlLGta

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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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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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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)

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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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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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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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