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An Epidural Letdown (4.4.2025)

Jack Cush, MD

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

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Vamorolone: a New Steroid on the Horizon?

Jack Cush, MD

Vamorolone is a potentially new alternative to traditional glucocorticoids for use in inflammatory diseases.

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Steroids, Prophylaxis and Pneumocystis Pneumonia

Jack Cush, MD

A case-control study has shown that glucocorticoids and tapering glucocorticoids are risk factors for the development of Pneumocystis jirovecii pneumonia (PJP).

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GCA,woman

Upadacitinib for Giant-Cell Arteritis - A Phase 3 Trial

Jack Cush, MD

The NEJM has published a randomized controlled trial in giant-cell arteritis (GCA) patients, demonstrating significant efficacy and safety of upadacitinib (UPA), given as 15 mg daily, as compared to placebo. 
 

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Stillsnow, Stills, podcast

1st Line Biologics vs csDMARDs in Adult Still's Disease

Jack Cush, MD

A German multicentre, retrospective study assessed the first-line efficacy of biologics and conventional synthetic DMARD therapy in patients with adult-onset Still's disease and found biologic agents were significantly better with sustained, event-free remissions and fewer complications.

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Peripheral Nerve Blocks for Hip Fractures

Jack Cush, MD

JAMA reviews the use of peripheral nerve block with hip fractures as an effective pain management strategy that can be performed by credentialed clinicians outside of the operating room.

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Targeting Obesity in Rheumatic Disease Patients

Jack Cush, MD

Sattar et al. has published an informative overview of the effect of obesity on rheumatic and musculoskeletal diseases (RMDs). They estimate that nearly 70% of RMD patients are overweight or obese.

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Prgnancy,outcome

Disease activity during Pregnancy in Rheumatoid arthritis and Spondyloarthritis

Jack Cush, MD

A prospective French study of rheumatoid arthritis (RA) or spondyloarthritis (SpA) patients showed that most maintained stable disease activity during pregnancy, but over one-third flared and required major changes in treatment.

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Adrenal Dysfunction after Steroids in PMR and GCA Patients

Jack Cush, MD

JAMA has published a study of PMR and GCA patients who stopped glucocorticoid (GC) therapy and noted a low (1.2%) risk of GC-induced adrenal insufficiency after planned cessation.

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PAFLAR Guidelines for Polyarticular Juvenile Idiopathic Arthritis

Jack Cush, MD

The Pediatric African League against Rheumatism (PAFLAR) initiative has published its guidelines for the diagnosis and treatment of polyarticular juvenile idiopathic arthritis (pJIA).

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Steroids, Prophylaxis and Pneumocystis Pneumonia A case-control study has shown that glucocorticoids and tapering glucocorticoids are risk factors for the development of Pneumocystis jirovecii pneumonia (PJP). The authors provide guidance on the optimal timing for prophylaxis https://t.co/0nKVEKOEex
Dr. John Cush RheumNow ( View Tweet)
Matched cohort study of 83,811 #RA pts showed RA had a 12% increased risk of avoidable hospitalizations (CHF, pulmonary edema; (IRR 1.12). Predictors of ACSC hosp. were age, Steroids, ambulatory comorbid Dxs. ambulatory care access & ^ primary care may reduce this risk. https://t.co/AxQVoXoxxx
Dr. John Cush RheumNow ( View Tweet)
An estimated 118,000 people throughout the world have EGPA. Steroids & immunosuppressants have been the mainstay; but for managing EGPA. Mepolizumab (2015) & Benralizumab (2024) are FDA approved for EGPA. The latter (Fasenra) approval based on the MANDARA trial https://t.co/84W4sOig9d
Dr. John Cush RheumNow ( View Tweet)
Vamorolone, a promising alternative to traditional glucocorticoids for inflammatory diseases. ◦ #Vamorolone is a dissociated steroid compound with reduced side effects. ◦ Unlike conventional #glucocorticoids, vamorolone lacks the hydroxyl or ketone groups and is resistant to https://t.co/yvDWqcbXbn

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Alberto Giraldo alb_giraldo ( View Tweet)
Diagnosing PMR is easy before Pred initiation; but after steroids NO SO. Before Pred, PMR Dx from non-PMR (median probabilities 7.8 vs 2.8) w/ 86% sensitivity/83% specificity. After Pred Dx probability of PMR dropped to 1.0 w/ sensitivity 3.5%; not much better w/ Pred D/C https://t.co/q4TceeFByc
Dr. John Cush RheumNow ( View Tweet)
Diagnosing PMR is easy before Pred initiation; but after steroids NO SO. Before Pred, PMR Dx from non-PMR (median probabilities 7.8 vs 2.8) w/ 86% sensitivity/83% specificity. After Pred Dx probability of PMR dropped to 1.0 w/ sensitivity 3.5%; not much better w/ Pred D/C https://t.co/RRIYY6xleN
Dr. John Cush RheumNow ( View Tweet)
Adrenal Dysfunction after Steroids in PMR and GCA Patients JAMA has published a study of PMR and GCA patients who stopped glucocorticoid (GC) therapy and noted a low (1.2%) risk of GC-induced adrenal insufficiency after planned cessation. https://t.co/zQSa8ex9na https://t.co/gkKxHFPuNe

Links:

Dr. John Cush RheumNow ( View Tweet)
Adrenal Dysfunction after Steroids in PMR and GCA Patients JAMA has published a study of PMR and GCA patients who stopped glucocorticoid (GC) therapy and noted a low (1.2%) risk of GC-induced adrenal insufficiency after planned cessation. https://t.co/ZTaIQxs0ex https://t.co/LA5qji8Zj5

Links:

Dr. John Cush RheumNow ( View Tweet)
Glucocorticoid Toxicity Index Dr. John Stone has led the effort to develop the GTI - glucocorticoid toxicity index. In this review article he acknowledges the need and benefit of steroids, but details a novel means to identify and limit the untoward effects of glucorticoids https://t.co/foTaoYrfDn
Dr. John Cush RheumNow ( View Tweet)
Glucocorticoid Toxicity Index Dr. John Stone has led the effort to develop the GTI - glucocorticoid toxicity index. In this review article he acknowledges the need and benefit of steroids, but details a novel means to identify and limit the untoward effects of glucorticoids… https://t.co/xR8D4Jpjfv https://t.co/LyfHrbneTO
Dr. John Cush RheumNow ( View Tweet)
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