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Good Clinical Practice Recommendations on Glucocorticoid Withdrawal and Adrenal Insufficiency
Glucocorticoids are widely prescribed as anti-inflammatory and immunosuppressive agents. This results in at least 1% of the population using chronic glucocorticoid therapy being at risk for glucocorticoid-induced adrenal insufficiency. This risk is dependent on the dose, duration and potency of the glucocorticoid, route of administration, and individual susceptibility.
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Sustained Hydroxychloroquine and Cardiovascular Outcomes
A national cohort study shows that continuous use of hydroxychloroquine (HCQ) protects agains cardiovascular (CV) events in patients with systemic lupus erythematosus (SLE).
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Running with Data (8.30.2024)
Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com - including tips on steroids, MAS, and myositis testing.
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Consumption of Alcohol and the Risk of Gout
Alcohol is a risk factor for gout and flares. While the inciting potential differs among alcohol types, are these differences sex specific?
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Retrospective observational study of 96 stable #SLE pts compared maintenance on HCQ vs belimumab. There were no significant differences in Flare rate (18% HCQ vs 8.3% BLM; p=0.47), damage index increase, SLEDAI, Pred dose or adverse events https://t.co/sVPMugSHn3 https://t.co/6bdel6Kvs9
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Consumption of Alcohol and the Risk of Gout
Alcohol is a risk factor for gout and flares. While the inciting potential differs among alcohol types, are these differences sex specific?
https://t.co/CzE9ZSEN9f https://t.co/e4WBSBlNEo
Dr. John Cush RheumNow ( View Tweet)
Scleroderma skin findings in pts w/ skin of colour (SOC) - Raynauds was common but SOC pts had fewer hallmark Sxs: telangiectasias, calcinosis, digital swelling (complicating Dx). SOC had more severe pulmonary Dz & increased mortality, Atypical skin findings… https://t.co/8XkelxqvYE https://t.co/JOw8OSNjzw
Dr. John Cush RheumNow ( View Tweet)
It takes >3-4 weeks of steroids (@ any dose >5 mg pred/d) to pose risk of adrenal insufficiency – Hence, Endocrine Society Guideline says short-term glucocorticoid therapy of <3-4 wks, irrespective of dose, DOES NOT require GC tapering https://t.co/o7tz1Am9pe https://t.co/CndfCYRApj
Dr. John Cush RheumNow ( View Tweet)
Birth Control Use in Lupus
Published guidelines on lupus mgmt urge that female patients plan and prepare carefully for pregnancy, and use contraceptives when it's not intended -- but these reco’s are rarely followed, a registry study suggested.
https://t.co/81mQbp5Sib https://t.co/NJmwxvtR44
Dr. John Cush RheumNow ( View Tweet)
ANA's over time may be more dynamic than previously accepted. SLE & ANA+associated Dz tend to have higher titers, esp. higher in early disease, but decrease over time https://t.co/caUazl9U6S https://t.co/jBglFBJ886
Dr. John Cush RheumNow ( View Tweet)
Renal Impairment in Rheumatoid Arthritis
Patients with highly active rheumatoid arthritis (RA) experienced faster declines in kidney function than those whose disease was under better control, analysis of a large registry indicated.
https://t.co/WaUDtJCitG https://t.co/RmPPLsihAG
Dr. John Cush RheumNow ( View Tweet)
ACR Backs FDA Rule Change on Interchangeable Biosimilars
The ACR submitted comments to the FDA supporting their proposal to update the approval process for biosimilars’ interchangeability status.
https://t.co/YD11qZJxIr https://t.co/tVij0ebwz4
Dr. John Cush RheumNow ( View Tweet)
ANCA-associated vasculitis analysis of 6 European registries, 3868 pts (2434 GPA, 1434 MPA), age ~57 yrs. Identified 5 clusters: 3 w/ renal dz a) variable ANCA, Hi CRP & Cr; b) MPO+; c) PR3+ & 2 extrarenal 1) PR3+ multisystem; 2) ENT w/ low CRP. Clusters better predicted outcomes… https://t.co/XZcSZ6lGjH https://t.co/yEg64YGTrA
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Myositis (IIM) pts w/ ILD have higher mortality. Study of IIM (n 190) vs myositis-mimics (414) shows ILD risk incr by myositis-specific antibody (MSA) 6 fold; Ro-52 8 fold; or 20 fold with dual positivity (MSA + Ro-52 antibodies) https://t.co/oLFflVjzOb https://t.co/uzqpfBP28M
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Retrospective study of 58 pts w/ #SLE concurrent with PJP infx, showed that 39% died, with many of these having diabetes and invasive ventilation. A 4 fold incr Mortality seen risk factorsHyperglycemia/DM, decreased C3, & thrombocytopenia https://t.co/CqPpRXG8mN https://t.co/GyKbiU8GWY
Dr. John Cush RheumNow ( View Tweet)
Diagnosing Seronegative Sjogren's Disease
Sjögren disease (SjD) is highly prevalent, but diagnosis may be challenged if anti-SSA antibodies or a labial salivary gland biopsy are negative. A recent cohort analysis suggests a novel autoantibody profile has predictive value SSA… https://t.co/v1Es7vVim2 https://t.co/RKxa2Iyeq0
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IV Methylprednisolone in Giant Cell Arteritis
A retrospective study in giant cell arteritis (GCA) patients suggests there is no added value using higher dose, intravenous methylprednisolone (IVMP) in early GCA.
https://t.co/5udYabU5z5 https://t.co/5FHhBnAX2j
Dr. John Cush RheumNow ( View Tweet)
Pooled data from BE MOBILE 1 & 2 RCTs shows Bimekizumab (dual-IL-17A/F inhib) may protect against uveitis in axSpA pts. N=349 pts - 0.6% BKZ vs 4.6% placebo developed uveitis (1.8 vs 15.4/100 PYs); even in pts w/ Hx of uveitis (6.2 vs 70/100 PYs; p=0.004) https://t.co/f8Uk0rEg86 https://t.co/mY1ikcGCNP
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Karolinska genotyping study of 329 JIA pts (oligo 161, Seroneg Poly 87, Seropos poly 12, Stills 24, ERA 22, PsA 19). HLA-DRB1*08 linked to JIA total; The HLA-DRB1*11 to Oligo; ANA+ JIA linked to HLA-DRB1-DQA1-DQB1, HLA-DRB1*11, & HLA-DPB1*02 https://t.co/1yNawNTEys https://t.co/dmmlH0CvRi
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Antibiotics May Increase Inflammatory Arthritis Risk
A Danish registry study has shown that amongst those patients who develop inflammatory arthritis (IA), antibiotics use was more frequent when compared to the background population (BP)
https://t.co/5CEewNqirM https://t.co/FSOFp4N6ks
Dr. John Cush RheumNow ( View Tweet)