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The Great Unknowns (8.5.2022)

Jack Cush, MD

Dr. Jack Cush reviews the news, FDA approvals, journal articles from the past week on RheumNow; plus viewer questions. This week great hopes for vitamin D, the great unknows of CSA and the great big mess that is the gout.

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ACR guidance

ACR Updated Guideline on Vaccinations for Rheumatic Patients

Jack Cush, MD

The ACR has posted a new ACR Clinical Practice Guideline Summary providing recommendations on the use of vaccinations for children and adults with rheumatic and musculoskeletal diseases (RMDs).

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DLE discoid lupus

Plasmacytoid Dendritic Cell Inhibitor in Cutaneous Lupus

Jack Cush, MD

Litifilimab, a humanized monoclonal antibody against BDCA2, targets the BDCA2 receptor on plasmacytoid dendritic cells. When administered to patients with cutaneous lupus erythematosus (CLE) was shown reducing disease activity in CLE patients.

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Lungs ILD

Approach to ILD in Myositis Syndromes

Jack Cush, MD

Mehta et al have published a full read review of managing interstitial lung disease (ILD) in patients with inflammatory myopathies, a heterogeneous group of syndromes connected by ILD and and increased morbidity and mortality risk.

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Fever,temp,man,HA,thermometer

Rheumatic Causes for Fever of Unknown Origin

Jack Cush, MD

Fever of unknown origin (FUO) represents a diagnostic challenge to many physicians and while cancer and infectious causes need to be excluded, rheumatic disorders are amongst the most common causes of FUO.

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IPF.JPG

Nintedinib’s Durable Efficacy in Systemic Sclerosis

MedPage Today

Patients with interstitial lung disease (ILD) related to systemic sclerosis continued to see less progression when treated with nintedanib (Ofev) in the pivotal 100-week SENSCIS trial, researchers said.

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mitochondrial,DNA

Mitochondria as Master Regulators of Inflammation

Jack Cush, MD

Mitochondrial constituents and metabolic products may give rise to immune activation; this is especially true for mitochondrial DNA, which can function as damage-associated molecular patterns (DAMPs) leading to inflammasome activation.

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Early, Aggressive and Seropositive (7.22.2022)

Jack Cush, MD

Dr. Jack Cush covers the news and journal reports from the past week on RheumNow.com. This week we have Insights NAFLD, overdose deaths, septic arthritis, refractory stills, & when MTX doesn’t work.

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Do not take antacids or PPI with mycophenolate. Magnesium & aluminium hydroxide antacids (Maalox) will lower MMF Cmax 33% & AUC 17% if given simultaneously. PPI also lowers AUC by ~33% https://t.co/IoWISgL3SY https://t.co/JV1Yv5Pg9d https://t.co/b8UoQ4zMUV https://t.co/VwNgVQ5End

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Dr. John Cush RheumNow ( View Tweet)
Plasmacytoid Dendritic Cell Inhibitor in Cutaneous Lupus Litifilimab, a humanized monoclonal antibody against BDCA2, targets the BDCA2 receptor on plasmacytoid dendritic cells. https://t.co/nmadPUhlyH https://t.co/4UbNPMtxIh

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Dr. John Cush RheumNow ( View Tweet)
Belimumab (Benlysta) has been FDA approved for use in pediatric patients with active lupus nephritis who are receiving standard lupus therapy. The approval in kids is for the IV formulation only; SC belimumab is for SLE and LN in adults https://t.co/TKyNDwIUQH https://t.co/6VaMOMfwYi

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Japanese SLE registry looked at infection risk with Prednisolone (PSL). Among 509 SLE pts (47 yrs); 77% used immunosuppressants & 52 had hospitalized infxns. Signif higher SIE w/ PSL 5.0–7.5 mg (aHR 6.8) & PSL 7.6-15 mg (aHR 7.6) vs 0-2.5 mg/d https://t.co/xZ5Yx4X1uw https://t.co/FSfsTENeUx

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Study of 245 active SLE pts followed x 2 yrs shows low disease activity (LLDAS) achieved in 63%. By multivariate analysis, negative predictors of LLDAS were nephritis, heme involvement & low C3/C4. Early LLDAS predicted future LLDAS-50 https://t.co/IQaDFRtrZy https://t.co/G6MdBOMftX

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Dr. John Cush RheumNow ( View Tweet)
Belimumab (Benlysta) has been FDA approved for use in pediatric patients with active lupus nephritis who are receiving standard lupus therapy. The approval in kids is for the IV formulation only; SC belimumab is for SLE and LN in adults https://t.co/LCUFDpZM6j https://t.co/R2kA2DbxKy

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Dr. John Cush RheumNow ( View Tweet)
Have you checked out our new sister-site, Still's Now? A new site for Still's disease, autoinflammatory & febrile disorders. https://t.co/oWEugnOB6k https://t.co/5jwiP2Xqrz

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11.5% of Crohns pts have TNFi use contraindications (either MS, CHF, neoplasia, infx risk, TNFi AE, comorbidities, SLE. Alternatively GI survey respondents use ustekinumab (76%), vedolizumab (249%), or tofacitinib (0.5%) https://t.co/6ApUz93iS0 https://t.co/PTmnsTd2Wh

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213 #SLE pts were screened for Cryoglobulinemia (2013 -2017); CG is frequent in SLE (66%), but mostly asymptomatic. Mean levels 40mg/L (0-228). Cryo Vasculitis in 15% w/ purpura, ulcers, digit ischemia, arthritis, GN (5%) or CNS (19%) https://t.co/jRVXCj4MlV https://t.co/gamOOwkJ5R

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Leflunomide versus azathioprine in lupus nephritis? Study of 215 bx proven LN given either LEF or AZA - Renal flares were equal (15.7% v 17.8%), as was time to flare (16 mo vs AZA 14 mo); 24-hr proteinuria, creatinine, C3 and C4 improved similarly. https://t.co/2TWmweS2wy https://t.co/0YzlU4vfXP

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Rheums: Got a Rheumatology question or case for Jack Cush? Record it here and we'll feature it on an upcoming podcast. Tell us your name and where you practice rheumatology. https://t.co/QUTIbK3r89 https://t.co/FZcTLREida

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Rheumatologist Survey: What do you rely on MOST in diagnosing Still’s disease? Sxs? Labs? Both? Criteria? Fever? Vote here: https://t.co/oANKpKqJA5 https://t.co/LIjRSBHNBi

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