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RheumNow Podcast – Antibiotics Increase RA Risk (8.16.19)

d Jack Cush, MD

Dr. Jack Cush reports the news and important journal articles from the past week on RheumNow.com.

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Updated CDC Recommendation for Serologic Diagnosis of Lyme Disease

d Jack Cush, MD

Serologic testing is the principal means of laboratory diagnosis of Lyme disease. Current recommendations include using a sensitive enzyme immunoassay (EIA) or immunofluorescence assay, followed by a western immunoblot assay for specimens yielding positive or equivocal results.

On July 29, 2019, the Food and Drug Administration cleared several Lyme disease serologic assays with new indications for use, allowing for an EIA rather than western immunoblot assay as the second test in a Lyme disease testing algorithm. Thus, serologic assays that utilize a second EIA in place of western immunoblot assay are acceptable alternatives for the serologic diagnosis of Lyme disease.

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Rise in Fatty Liver Disease Linked to Obesity and Diabetes

d Jack Cush, MD

Gut has published population results from NHANES population study showing that the prevalence of fatty liver disease is rising in the US and is driven by obesity and diabetes.

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Trends in Inflammatory Arthritis Care in Germany

d Jack Cush, MD

The German National Database (NDB) has reviewed their experience in the care and quality of life of inflammatory rheumatic disease patients snce 1993, showing improved use of metrics, improved outcomes and a changing profile of biologic and anti-rheumatic drug use.  

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With Autoimmunity, Checkpoint Inhibitors Can Be Used

d RheumNow

Among patients with pre-existing autoimmune diseases who developed cancer and were treated with immune checkpoint inhibitors (ICI), flares of the underlying disease and other immune-related adverse events were common, a retrospective study conducted in France showed.

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Bisphosphonate Use Associated with Reduced Mortality

d Jack Cush, MD

The Journal of Bone and Mineral Research (JBMR) has published a report showing that a reduction in the rate of bone loss by nitrogen bisphosphonates was associated with a 40% lower mortality risk.

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War on RA – Part 4: Desperado – Time to Open the Gate

d Jack Cush, MD

Do you know what the best-selling album of all time is? Could it be Bing Crosby? U2? Fleetwood Mac? AC/DC? I know, it’s Michael Jackson’s “Thriller” right?

Actually it’s the Eagles Greatest Hits – it surpassed Jackson’s Thriller in August 2019 as the best-selling with a total of 36 million copies sold since it was released in 1976. Wait! Are we not Rheumatologists? Aren’t we supposed to be discussing rheumatoid arthritis?

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CORRECTION: FDA approves Abbvies new JAK1 inhibitor - upadacitinib (named RINVOQ)

Dr. John Cush RheumNow ( View Tweet)

FDA approves Abbvies new JAK1 inhibitor - upadacitinib (named Rinvok) Package insert - indicated for use in mod. to severely active RA not resp to MTX (do not combine w/ other JAKS, biologics). 15 mg qd. Warning for VTE, DVT. https://t.co/9KODynuWKC https://t.co/zRpeiaiTNS

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Chance over metrics? If your metrics are not predictive, then you have failed metrics and the opportunity to refine, Change or rethink. Should you randomly chose a drug from equivalent drugs or use data to make a better choice? https://t.co/a7GibSmOWv

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UT Southwestern Super Hepatologist Dr Will Lee lecturing on drug induced liver injury (DILI) shows DILI is not increase with NASH/NAFLD https://t.co/1Kt7hFhUx1
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Nurses' Health Study II shows high gluten intake is not assoc w/ a greater risk of Psoriasis (HR 1.15;0.98-1.36), Psoriatic arthritis (HR 1.12;0.78-1.62) or Atopic dermatitis (HR 0.91; 0.66-1.25); 85,185 Pso, 85,324 PsA & 63,443 atopic dermatitis patients. https://t.co/P1eWGZZqKl

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Kaiser study from N California shows increasing trend in cannabis use w/ #pregnancy. Sample of 367 403 pregnancies in 276 991 women between 2009-18, cannibis use rose from 1.95% to 3.38% - ?increasing acceptance & decreasing perceptions of harms? https://t.co/VdOPrCsZQ1

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Ah yes...lifestyle is certainly a BIG issue in RA, especially when there's a poor outcome. Besides life in the fast lane - other bad advice for RA - Take It Easy, Take It to the Limit & Tequila Sunrise. Good Advice? Take it easy! https://t.co/uKkRveDYzp

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Cross sectional analysis of ~3000 and meta-analysis (14 studies) finds #gout has a higher risk of hypothyroidism, esp in female gout pts (OR=2.44;1.15-5.17); Metaanalysis ^risk hypothyroidism in gout (OR=1.51) and hyperuricemic pts (OR=1.34) https://t.co/1w3xfHqryJ

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Lilly announces the results of its phase 4 trial comparing Taltz (IL-17) to Tremfya (IL-23) in mod-severe plaque psoriasis. Taltz had superior skin clearance (PASI 100) at week 12, better PASI 75 at week 2 and PASI 90 at weeks 4 and 8. https://t.co/GzfZoepUrK

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"WAR on RA - Part 4: Desperado" is featured on RheumNow. Why the Eagles and Glenn Fry's death should inspire us to better, greater, more and other superlatives in RA. https://t.co/dgShcQpWHP

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Dr. John Cush RheumNow ( View Tweet)

In GCA/Temporal arteritis, when do you start a DMARD/Biologic?

Dr. John Cush RheumNow ( View Tweet)

Osteoarthritis Iniative study of 3053 #OA pts shows worsening in health related quality of life is most rapid with Female gender, higher BMI, smoking, knee pain, and lower income at baseline. Rapid progressors had higher risk of TKR (HR 6.2;CI 3.6–10.7) https://t.co/73OlM7ymH6

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Case-control study using the UK Clinical Practice Research database examined 22677 RA pts. 1995–2017) exposed to antibiotics vs ~90K controls shows the risk of RA is 60% higher if Abx exposed (OR 1.60; 95% CI 1.51–1.68) - microbiome changes? https://t.co/ysfEXnRU3c

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Dr. John Cush RheumNow ( View Tweet)

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