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TNR Grand Rounds - Moving Forward with Telemedicine

d Jack Cush, MD

Dr. Alvin Wells gives a primer on Telerheumatology and Telemedicine in the era of COVID-19. This 1 hour Grand Rounds Presentation includes a 30 minute lecture, followed by stimulating 30 minutes of Q&A with a rheumatology attendee audience.

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COVID-19 and the Slippery Road of Cytokine Storms

d RheumNow

Early reports on the COVID-19 pandemic allude to a cytokine storm or hyper-inflammation, especially in patients who succumbed to the illness.

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Lower Risk of Diabetes with Abatacept

d RheumNow

 Patients with rheumatoid arthritis (RA) treated with abatacept (Orencia) had a lower risk of developing diabetes mellitus compared with those receiving certain tumor necrosis factor (TNF) inhibitors, a large cohort study suggested.

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A Role for Netosis in COVID-19 Infection?

d Jack Cush, MD

Journal of Experimental Medicine has published a paper from a consortium of researchers at Cold Spring Harbor Laboratory, the Feinstein Institutes for Medical Research, and the Research Institute of the McGill University Health Centre (RI-MUHC) on the potential of neutrophil extracellula

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2 Canadian studies BioTrac & OBRI, w/ RA 1376 pts found 14-18%, D/C TNFI for nonresponse. Primary NR 66-87% failed to achieve LDA by DAS28-ESR, or 66-91% by CDAI. 19-61% Primary NR D/C w/in 6 mos; 61-87% of 2nd NR discontinued >12 mos https://t.co/xegAogSAQx https://t.co/IyiAStXQLs

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Dr. John Cush RheumNow ( View Tweet)
Metanalysis of 1st line TNFi survival: 12 mos 24 mos 36 mos ETN 71% 63% 59% IFX 69% 57% 49% ADA 70% 59% 51% Does ETN have better survival? https://t.co/T4QVbI5lf7 https://t.co/mqsaADb7Uu

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Dr. John Cush RheumNow ( View Tweet)
The greatest risk of treatment-related damage and fatal infections when treating GPA is in the first 3 mos when higher doses of corticosteroids. A study of elderly Rx w/ RTX or CYC for GPA/MPA resulted in less organ damage and hospitalizations. https://t.co/Nt3AcH9zg9

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Dr. John Cush RheumNow ( View Tweet)

WHO scientific brief on NSAID use with COVID-19 - notes no direct evidence of harm in COVID-19, SARS, or MERS is available. Indirectly studies show no evidence of severe AE, health utilization, survival, or QOL with COVID-19 owing to NSAID https://t.co/KCOyvfPRxk

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Dr. John Cush RheumNow ( View Tweet)

Great lecture Alvin! Moving Forward with Telemedicine - Watch it on RheumNow or here https://t.co/pOwRCboSYe https://t.co/yU585fsDp0

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Dr. John Cush RheumNow ( View Tweet)

MGMA survey of practices finds that 48% of practices have experienced furloughs and 22% layoffs. There has been a 55% decrease in revenue and a 60% decrease in patient volume since the beginning of the pandemic https://t.co/20AUe9Qlro

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Dr. John Cush RheumNow ( View Tweet)

Study from the National Inpatient Database shows that #RA pts have increased risk of hospitalizations for acute myocardial infarction. But compared to nonRA STEMI+ MI, RA- MI had a lower in-hospital mortality and cardiac arrests. https://t.co/lFHkqSgXbp

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Dr. John Cush RheumNow ( View Tweet)

An immunogenicity study w/ live ZOSTAVAX given ~2-wks before tofacitinib showed after mean 27 mos - 5 of 100 TOFA rx pts developed H. Zoster (at 218, 280, 748, 741, 544 days post-vaccination). OOOPs; not very protective. Use Shingrix! https://t.co/hEIJTCjJ3t

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Dr. John Cush RheumNow ( View Tweet)

GI experts COVID guidelines, state “Despite the potential for increased exposure to SARS-CoV-2, the limited available data and expert opinion suggest that patients with IBD do not appear to have a baseline increased risk of COVID-19infection" https://t.co/kGfIMJoZGI

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Dr. John Cush RheumNow ( View Tweet)

Last weeks TNR Grand Rounds on "Evaluating the Febrile Rheumatic Patient" is now available as a podcast for listening on iTunes or SoundCloud Part 1 https://t.co/R5OGoB42Zi and Part 2 https://t.co/CP3HOd982A

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Dr. John Cush RheumNow ( View Tweet)

Riociguat a guanylate cyclase stimulator w/ antiprolif & anti-inflamm effects studied in a DBRPCT in diffuse Systemic sclerosis; There was more improvement in mRSS (-2.09 vs -0.77), Raynauds (41% vs 26%) & FVC (2.7 vs 7.6) - but these were not significant https://t.co/7aEzdDxpVY

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Dr. John Cush RheumNow ( View Tweet)

NYU & Montreal Heart Instit. teaming on the COLCORONA study of Colchicine in early phase COVID-19 infx. TBD in 6,000 patients with mild forms of the disease. Dr. M Pillinger says colchicine, early on, may inhibit damaging inflammatory responses https://t.co/UTW2g6QU2r

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Dr. John Cush RheumNow ( View Tweet)

1st paper on the Global Rheumatology Alliance @rheum_covid registry published in Lancet Rheumatology. @ April 1st 110 COVID-19 Rheum pts enrolled from Europe, N&S America, Asia, Africa, Oceania; now up to 487 with 9894 in the patient survey. https://t.co/RI2AKsyf5T

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Dr. John Cush RheumNow ( View Tweet)

@LupusCanada has enhanced our survey to better understand the current situation and evolution of HcQ availability in Canada. Please share this survey with anyone impacted by this issue https://t.co/0ImHloC0JZ #LetsTalkLupus #LupusCanada #lupus

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Lupus Canada LupusCanada ( View Tweet)

Scary as hell ! The COVID-19 death rate in the USA doubles at least every 3 days..... https://t.co/u0UTLMf3NH

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Dr. John Cush RheumNow ( View Tweet)

Neurologic side effects of TNFi are rare; Sweden/Denmark population study shows TNFi in AS/PsA, but not in RA, associated with increased risk of neuroinflammatory events (0.59 to 0.87 /1000PY) with TNFi and 0.19-0.40/1000PY in unexposed https://t.co/FeRtKSspXj

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Dr. John Cush RheumNow ( View Tweet)

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