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RheumNow Podcast – Delays in Diagnosis (3.8.19)

d Jack Cush, MD

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

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Multiple Delays in Referral of New RA Patients

d Jack Cush, MD

A UK study of early onset arthritis or new rheumatoid arthritis patients shows multiple sources of delayed referral to the first rheumatology consultation.

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Congenital Heart Block: Dangers Ahead

d RheumNow

Children of autoantibody-positive mothers who were born with congenital heart block were at high risk for developing later cardiovascular and autoimmune disorders, as were their siblings, Swedish researchers reported.

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Biologic Agents have Equal Efficacy in Enthesitis and Dactylitis

d Jack Cush, MD

A systematic review has shown that TNF inhibitors (TNFi) are equaled in efficacy by other biologic agents (ustekinumab, secukinumab, and ixekizumab) in psoriatic arthritis (PsA) patients with in dactylitis and enthesitis.

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Lower Mortality Results from Lower Activity in Lupus

d Jack Cush, MD

Data from the longitudinal Tromsø Lupus Cohort study has shown that lupus patients who achieve a Lupus Low Disease Activity State (LLDAS‐50) were shown to have significantly less severe damage, and a reduction in mortality.

This was a population‐based study of SLE patients in the northern‐most counties of Norway.

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Full Read Review Inclusion Body myositis: IBM) is slowly progressive & commonly misdiagnosed as arthritis or polymyositis. IBM is assoc w/ CV complications and other autoimmune dz. Look for unique features such as finger flexor and knee extensor weakness. https://t.co/WteGovZBFL

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Dr. John Cush RheumNow ( View Tweet)

Free online access to RheumNow Live - 16 hrs of Innovative lectures and Q&A Panels beginning friday afternoon 3/22, ending Sunday 3/24. Register for FREE at https://t.co/wIgS5rq4UE or come to https://t.co/4UQlqwujiR

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PODCast of the last weeks QD Clinics can be found on iTUnes and here >> https://t.co/6SJHvbA2ho

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Dr. John Cush RheumNow ( View Tweet)

A 10-year study of more than half a million Danish children found no evidence that vaccines increased the risk of autism. The study comes at a time when anti-vaccine suspicion is on the rise again. https://t.co/ZhZaW1kUQl

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NYT Health NYTHealth ( View Tweet)

Complacency - not knowing whether you’re in a groove or rut - Lisa Bodell

Dr. John Cush RheumNow ( View Tweet)

“Innovation is the pirate ship that sails into the yacht club”. - Lisa Bodell

Dr. John Cush RheumNow ( View Tweet)

Shoulder replacement surgery - low risk of revision in older women (2.7%), highest (23%) in men 55-59 yrs; Revision highest in the 1st 5 yrs. SAE risk <90d was <4.8%; highest in men >85 yrs (21%). Pulm embolism risk Rel Risk = 61fold in women 50-64. https://t.co/NVSzfgZvwS

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Systematic review of Paternal DMARD exposure prior to pregnancy shows no firm evidence of harm with TNFi, ABA, RTX, azathioprine, cyclosporine, HCQ, leflunomide, MTX or mycophenolate mofetil. Data from 84 papers, 611 male exposures, 5986 pregnancies https://t.co/yfIYoMqaRs

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Study of 6529 Afib pts on warfarin, 37.5% were also on aspirin. Adding aspirin to warfarin yielded significantly more bleeding (26 vs 20%), major bleeding (5.7 vs 3.3%), ER visits (13.3 vs 9.8%) but similar thrombosis rates (2.3 vs 2.7%) at 1 yr. https://t.co/m5XDBEN6jh

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Dr. John Cush RheumNow ( View Tweet)

Claims analysis from Natl Taiwan Health Database, compared 262 JIA pts w/ controls & showed JIA pts have 30 fold higher risk of an adult autoimmune dz- Hazard Ratio=129.5 for RA; aHR-10.1 SLE, 49.62 AS & 8.2 PsA. Highest risk (46x) for JIA onset 11-15 yrs https://t.co/oL3stNLYvc

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Dr. John Cush RheumNow ( View Tweet)

Risk of pancreatitis with azathioprine in adults estimated to be 3-7%, but unknown in kids. 3374 pairs of pediatric IBD pts compared pts on AZA vs not. AZA use was associated with a 5.82 events/100PY risk of pancreatitis (AZA 49·1 vs NOT 8·4 events/100PY) https://t.co/arap2ShTPN

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Dr. John Cush RheumNow ( View Tweet)

Rule of thumb on VTE risks: Normal population 0-.4/100PYs; RA patients are increased at 0.3-0.7/100 PY. If a new RA drug were to cause VTE (venous thromboembolic events; DVT/PE) it would have to have a rate consistently higher than 0.5 and probably higher than 0.7/100PY

Dr. John Cush RheumNow ( View Tweet)

The PARA study shows among 249 pregnancies (2002-2008), breastfeading was less in RA - at 4-6, 12 & 26 wks postpartum 43%, 26% and 9% of the RA breastfed (vs 63%, 46% & 41% in controls). Many patients D/C breastfeeding so they could start medication. https://t.co/ONf1jgFJYL

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Dr. John Cush RheumNow ( View Tweet)

A study of 2,369 patients with fibromyalgia showed the mean time from initial complaint to diagnosis was 6.42 years. Comorbidity, younger patient, and older physician age were associated with longer time to diagnosis. https://t.co/mHGIR7C4PW

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Dr. John Cush RheumNow ( View Tweet)

QD Clinic - Five Leflunomide Pearls | from RheumNow https://t.co/A4dwd0eTQ9

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Dr. John Cush RheumNow ( View Tweet)

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