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Are Non-TNF Biologics Superior to TNF inhibitors?

d Jack Cush, MD

Current ACR and EULAR guidelines list TNF-inhibitors (TNFi) abatacept, rituximab, and tocilizumab as being equally effective after methotrexate or as second line therapies when treating rheumatoid arthritis.

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EULAR Recommendations on Large Vessel Vasculitis

d Jack Cush, MD

Th European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) was originally published in 2009. Since then there have been new randomised clinical trials and cohort analyses leading to an update the original recommendations.

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Sjogren's Syndrome at Risk for Psychiatric Disorders

d Jack Cush, MD

A population-based claims study from Taiwan shows significantly increased incidences of depressive disorder, anxiety disorder, and sleep disorder in patients with primary Sjögren’s syndrome (pSS). 

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RheumNow Podcast – More Than a Spot of Tea (8.2.19)

d Jack Cush, MD

Dr. Jack Cush reviews the journal articles and news reports from the past week on RheumNow.com:
MMP-7 and Myositis-ILD; Post-surgical gout attacks; CV events and testosterone; and a Boxed warning for tofacitinib.

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NHANES 30 yr study of 58,731 shows prevalence of of chr hepatitis B & alcoholic liver dz stable; chronic hepatitis C decreased twofold; but non-alcoholic fatty liver dz (NAFLD) has increased from 20% to 32%; with a parallel increase in obesity & NIDDM https://t.co/6vxFLUBhEd

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Dr. John Cush RheumNow ( View Tweet)

Metanalysis of 9 studies shows that use of IVIG in ANCA-Associated vasculitis is assoc. w/ significant and rapid improvement in BVAS (SMD –1.7), ANCA (SMD –0.72) and CRP (SMD –0.92) within 2-24 weeks. https://t.co/aw3VjBWCcf

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Dr. John Cush RheumNow ( View Tweet)

FDA has approved Turalio (pexidartinib) for the treatment of adults with the rare disorder, tenosynovial giant cell tumor (TGCT) associated with severe morbidity or functional limitations and not responsive to improvement with surgery. https://t.co/eMTmFSW97A

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Dr. John Cush RheumNow ( View Tweet)

War on RA - Parts 1 & 2 - Listen to the podcasts on iTunes or SoundCloud here: Part 1 - Walk on the Moon https://t.co/IZ1cjiwbnZ and Part 2 - All about You https://t.co/u5j8TAZvYC

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Dr. John Cush RheumNow ( View Tweet)

The RheumNow Podcast is up – More on osteoporosis, myositis, lipids and gout, testosterone, abatacept in PSS & Boxed Warning for tofacitinib. Watch it here>> https://t.co/I1lBS1lUmY or listen to the Podcast on iTunes or SoundCloud here>> https://t.co/uYyPV7pxcN

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Dr. John Cush RheumNow ( View Tweet)

Claims analysis of 88,463 #RA pts (2006-2015) finds no greater risk of cardiovascular events w/ Tocilizumab (11.8/1000 PY) compared to TNF inhibitors (15/1000PY) or abatacept; suggesting no net increase in CVD w/ occ hyperlipidemia seen w/ TCZ https://t.co/6L8aKlLGta

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Dr. John Cush RheumNow ( View Tweet)

Claims analysis of f 45,208 TNFi +MTX initiators and 1,387 triple DMARD (MSH) initiators showed no significant difference in the risk of serious infections (2.46 TNFi+MTX vs 2.03 triple DMARD/100PY) (HR 1.23; 0.87‐1.74) https://t.co/pe52p8Xtrv

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Dr. John Cush RheumNow ( View Tweet)

Oral candidiasis (OC) is a significant predictor of severe infections during immunosuppressive Rx in ANCA-associated vasculitis. 71 pt cohort study; Predictors of severe infx: low albumin, pulse methylprednisolone (adj HR = 5.44), & OC (adjHR  5.31) https://t.co/BSZzWxDU4k

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Dr. John Cush RheumNow ( View Tweet)

Can a Nice Doctor Make Treatments More Effective? - The New York Times https://t.co/Aj5vUBofHJ

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Daniel H Solomon DanielHSolomon ( View Tweet)

Doctors - Who do you go “above & beyond” for?

Dr. John Cush RheumNow ( View Tweet)

My advice to Patients on Joint Replacement Surgey: 1) talk to others who had the surgery; 2) consult orthopedics LONG before its urgent; 3) PRE-hab (getting strong before surgery); 4) Get a physical therapist who will work you to normal (3-5X/wk for 4-8 wks)

Dr. John Cush RheumNow ( View Tweet)

Measures used to limit costs & utilization of expensive biologics: 1) Generics 1st requirement; 2) Pre-authorization; 3) limited (6-9 mos) approval w/ proof of benefit; 4) 30 day supply; 5) preferred tiered drugs; & 6) utilize less expensive providers https://t.co/2HRrJn87AY

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Dr. John Cush RheumNow ( View Tweet)

2nd Edition of my "The War on RA" - being fought daily by rheumatologists - Change, Innovation and Discovery will be driven by Rheumatologists. Rheums must lead the fight to win the immense challenge of #RA today. We need you! https://t.co/7vOzRvvuVi

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Dr. John Cush RheumNow ( View Tweet)

MMP-7 levels studied in myositis pts w/ anti-synthetase syndr (ARS) and fourd to be higher in ARS Ab+ & MDA5 Ab+ PM/DM-ILD patients, and were associated with a worse prognosis. MMP-7 levels associated w/ worse survival (OR 18.0). https://t.co/lGlc5S00sR

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Dr. John Cush RheumNow ( View Tweet)

IL-18 may be a biomarker for Systemic JIA (Stills), higher w/ active dz and hx of MAS. Study of 40 sJIA pts finds elevated IL-18 levels inactive and active dz & with history of MAS. IL-18 was correlated w/ ferritin (R=0.74), CXCL9 (R=0.56), S100 (R=0.47) https://t.co/c0KjAyiEjq

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Dr. John Cush RheumNow ( View Tweet)

70 #gout pts studied & 44.3% developed post-surgical flares. Risk factors included Presurgical sUA ≥ 9 mg/dL (OR 3.77) & sUA changes before and after surgery (OR 1.62); but \allopurinol reduced risk (OR 0.15). Mean time to flare=3.7 days. Knee > MTP1 https://t.co/U6rl5c8Cf3

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Dr. John Cush RheumNow ( View Tweet)

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