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New Sleep Medicine Guidelines for Obstructive Sleep Apnea

d Jack Cush, MD

The American Academy of Sleep Medicine (AASM) has established new guidelines for the evaluation and treatment of sleep-disordered breathing in adults, specifically guiding the use of positive airway pressure (PAP) in the treatment of obstructive sleep apnea (OSA) in adults. 

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2018 Swedish Guidelines for Giant Cell Arteritis Treatment

d Jack Cush, MD

The Swedish Society of Rheumatology has developed evidence-based guidelines for the management of giant cell arteritis (GCA) with a focus on the appropriate use of corticosteroids and tocilizumab. 

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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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QD Clinic - Biologic Class Switching | RheumNow - Can you switch biologics within the same class? Heck yeah! https://t.co/ybHEF6Cbp5

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CORRONA Registry - Chronic opioid use doubled 2002-2015, rising from 7.4% to 16.9%. Strongest predictors included severe pain (HR 2.53), antidepressant use (HR 1.79), high Dz activity (HR 1.55) & high disability (HR 1.45). https://t.co/vPBqvWIy19

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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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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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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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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

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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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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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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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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

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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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