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On this week's podcast, Dr. Jack Cush reviews the news: Steroids are easy to start and hard to stop; hold the MTX but not the biologic or JAK, weighing in on avacopan, and age-old messages for old-age patients.
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Close to 90% of patients with rheumatoid arthritis (RA) well controlled on targeted therapies were able to take 50% dosage reductions without experiencing worsened disease activity in a randomized trial, South Korean researchers said.
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Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.
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That promised land of substantive weight loss comes within it the illusion of better disease control and, for inflammatory arthritis patients, the possibility of reducing the burden of regular medicines - often driven by the patient, with or without telling you. It is a dream worth aspiring to and, as we’ve discussed this month, one which is increasingly achievable, albeit still for a small minority of patients. So for those who do reach that ultimate goal, what next?
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The American Journal of Clinical Nutrition has published the results of the SUN Project study, showing that long-term adherence to a Mediterranean diet (MedDiet) was associated with a substantially lower risk of incident rheumatoid arthritis (RA), but not psoriasis.
Dr. John Cush
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T-cell engager blinatumomab (CD3xCD19 TCE) was used for Deep B-cell depletion in 15 resistant RA pts (MDR-RA). @wk 12 9/15 CDAI LDA, 3/15 CDAI remission. Synovial B cells were depleted (4 of 5 biopsies) but not in lymph nodes. Later, 14/15 flared. No ICANs, 3/15 w/ CRS (gr 1) https://t.co/ddLb7lIHka
Dr. John Cush
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Upadacitinib is now approved in European Union to treat active polyarticular juvenile idiopathic arthritis (pJIA) ages > 2yrs for those not responding to 1+ DMARDs. In the USA, UPA is approved for pJIA & juvenile PsA https://t.co/Vhx717rw5T https://t.co/hObov1Umgb
Dr. John Cush
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Remission — believe it or not. What’s happening in rheumatology this week? Dr. Jack Cush breaks down the latest news and journal reports on RheumNow:
10-year T2T data: 82% in remission
Residual steroids don’t preserve remission
Biologics linked to lower PsA risk
GLP-1s + knee OA https://t.co/2Zf9g1Wehg
Dr. John Cush
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The GLP-1 Opportunity Cost in Rheumatology
There is no doubt it is an incredibly exciting time to be tackling obesity-related diseases, like many rheumatic diseases appear to be, to some extent.
https://t.co/49EscdPOTG https://t.co/c0kSgOXZy7
Dr. John Cush
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The weight is off, the DMARDs are off - now what?
Sometimes it’s only when we have effective solutions that we have to think about what to do next. And when that happens, remember why we do things in the first place. In an era when weight loss is happening on scale, now we need https://t.co/MTjU5YRS5q
Dr. John Cush
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ARthritis & CAncer (ARCA) is Spanish retro study of 728 #RA pts w/ Hx of CA & Rx w/ biologics. W/ F/U of 11 022 yrs, new/recurrent CA was not incr (7.3/1000PYs) & = Pts Rx w/ csDMARDs (HRs 0.94; 0.73,1.21) & not incr w/ TNFi (0.94), IL-6i (1.03), CD20i (0.81), JAKi (0.6), ABA https://t.co/UUWlsaYV0Z
Dr. John Cush
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Mediterranean Diet Lowers Incident Rheumatoid Arthritis Risk
The American Journal of Clinical Nutrition has published the results of the SUN Project study, showing that long-term adherence to a Mediterranean diet (MedDiet) was associated with a substantially lower risk of https://t.co/9GhEwXuCEI
Dr. John Cush
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Lifestyle and Incretin Therapy Advice for Rheumatologists
As GLP-1/GIP receptor agonists become standard co-management tools for obese patients with RA, PsA, axSpA, and gout, this JAMA Insights perspective by Kushner, et al. reframes lifestyle counseling as an adjunct to https://t.co/9dfmKLuJF7
Dr. John Cush
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Systematic review of 21 papers (23K RA pts) finds 12% w/ difficult-to-treat RA. Risk factors -- smoking (OR 1·16), obesity (1·38), FM (2·20) & depression (1·74). No assoc w/ current smoking or anxiety. https://t.co/BHxyEbSg8Y
Dr. John Cush
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Upadacitinib is now approved in European Union to treat active polyarticular juvenile idiopathic arthritis (pJIA) ages > 2yrs for those not responding to 1+ DMARDs. In the USA, UPA is approved for pJIA & juvenile PsA https://t.co/Vhx717rw5T https://t.co/OBMdjsegIq
Dr. John Cush
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Long-term F/U of T2T Artic trial. 230 DMARD naive pts, 84% ACPA+ 179 (82%) in 10 yr F/U & 82% were in DAS < 1.6 remission 10 yrs later w/ only 17% w/ Xray progression. ~50% on csDMARDs, 30% on bDMARDs. Early aggressive works! https://t.co/ASRrIZqfS5 https://t.co/SykEI4QjPa
Dr. John Cush
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Residual steroids doesnt preserve remission. Japan FRANK #RA registry 411/3,863 were in Boolean remission - 130 on GC vs 231 non-GC (1/3 on b/tsDMARDs). Roughly 1/3 flared to LDA @12 mos. Outcomes same for GC vs non-GC Rx pts. https://t.co/xPctEjFCLT https://t.co/YIHFaQkzeO
Dr. John Cush
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Obesity and Psoriatic Disease
Obesity is a clinically important comorbidity in psoriasis (PsO) and psoriatic arthritis (PsA). Excess adiposity contributes to systemic inflammation and cardiometabolic risk and may adversely affect disease severity and response to some systemic https://t.co/WVIqfq8vEj
Dr. John Cush
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Systematic review 14 studies assessed Lung ultrasound (LUS) (vs HRCT) to detect RA-ILD (using threshold of ≥ 5 B-lines) found sensitivity was 86.8% (95% CI 80.1–91.4), specificity 75.4% (95% CI 62.3–85.1), and AUC 0.890 https://t.co/GlNpsPBwtS https://t.co/I4mITEqBI6
Dr. John Cush
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Lifestyle and Incretin Therapy Advice for Rheumatologists
As GLP-1/GIP receptor agonists become standard co-management tools for obese patients with RA, PsA, axSpA, and gout, this JAMA Insights perspective reframes lifestyle counseling as an adjunct to pharmacotherapy - a https://t.co/ltPdGEgQ60
