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JAK or TNF Inhibitor as First Drug for Rheumatoid Arthritis?
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Medpage Today
A Janus kinase (JAK) inhibitor outperformed tumor necrosis factor (TNF) blockers for substantially reducing rheumatoid arthritis (RA) symptoms in patients for whom conventional anti-rheumatic drugs had failed, a pragmatic head-to-head trial found.
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2023 EULAR classification criteria for hand osteoarthritis
A EULAR consensus group has established classification criteria for overall hand osteoarthritis (OA) and its subtypes (interphalangeal OA and thumb base OA).
The criteria require two mandatory criteria to be met:
ACR Calls on CMS for Enhanced Transparency & Reporting
The American College of Rheumatology has submitted its response to the Centers for Medicare & Medicaid Services (CMS) request for information and feedback from stakeholders on how best to enhance Medicare Advantage data capabilities and increase public transparency.
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202 adults w/ idiopathic inflammatory myositis (IIM) studied. Multiple myositis-specific Abs seen in 22% (2/3 w/ tRNA synthetase Abs (ARS+) & half MDA5+). Multiple MSA pts had better survival (HR 0.11), less RP-ILD, fever, rash; more muscle & dysphagia https://t.co/6PCMZJkuNn https://t.co/ElkJzPODaU
Dr. John Cush RheumNow ( View Tweet)
Role of Diet in Gout Risk
Diet has long been influential in gout care and risks. A large cohort study has shown that plant-based diets may reduce the risk of developing gout.
https://t.co/cqP7G4KeWi https://t.co/zxiOeACb5u
Dr. John Cush RheumNow ( View Tweet)
Ankylosing spondylitis Tx w/ Tofa- How quick do they respond? Post hoc analysis 269 pts:
- 4 wks for Pain >30%
- 4 wks for ASDAS improved ≥ 1.1 points
- 8-24 wks for ≥ 50% improved pain, enthesitis, AM stiffness, BASDAI & fatigue
https://t.co/HfhOWHHfvt https://t.co/9QOYNvLaBS
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Systemic sclerosis sine scleroderma in children is more aggressive than in adults. 18 juvenile vs 38 adults - ssJSSc more female (39% vs 89%), more digital pitting scars/ulcers (35 vs 10.5%), Pulm (50 vs 24) & CV (50 vs 3%); w/ more deaths https://t.co/l4f5bH1IX1 https://t.co/viQcD3tN9V
Dr. John Cush RheumNow ( View Tweet)
Australian study of informal caregivers (not iworking) of arthritis pts shows excess cose of $388 million (in 2015), expected to increase to $576.9 million by 2030. Informal caregivers less likely to work, due to the demands & duties of their caregiving https://t.co/Gw1eIBN6WW https://t.co/h1TY0BtaSE
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Disjointed incomplete arthritis care! 82 arthritis pts w/ new complaints surveyed; 29% went to the ED (1/3 repeat visit) for arthritis flare. Only 26% referred to a rheumatologist of which 38% were unable to do so in the time frame suggested. https://t.co/f3RbhdKL8u https://t.co/C1iRsQoiAJ
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Canadian study of 44,438 older adults (age 76) w/ gout found only 52% reached serum uric acid (SUA) target w/in 12-mos, improving from 45% (2010) to 61% (2019). ULT adherence was 55%, also improved annually. Only 3.5% Rx by Rheumatologist! https://t.co/vAc8myxiRm https://t.co/gcMz379iPH
Dr. John Cush RheumNow ( View Tweet)
Review of 31 FDA Rheum drug approvals betw 1995-2021 showed patient-reported outcomes seldom reported or published. Despite meeting MCID (57%) & significance (85%), 1/3 PROs not reported & 10% remained unpublished (4yrs later) https://t.co/pvGhTxlP03 https://t.co/t3VEHw7FJv
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FDA has approved upadacitinib (Rinvoq), for use in pediatric patients (age >2 years) w/ active polyarticular juvenile idiopathic arthritis (pJIA) & psoriatic arthritis (PsA), after inadequate resp/intolerance to TNFi. Also available as oral solution. https://t.co/lGvIHb8wfZ https://t.co/8BiTnTNJzO
Dr. John Cush RheumNow ( View Tweet)
Review of the Scleroderma spectrum disorders (full-read) https://t.co/xaIxf8q0Tj https://t.co/kxFiQTqKqV
Dr. John Cush RheumNow ( View Tweet)
Boxed Warnings in Derm:
- Topical Calcineurin inhib (atopic dermatitis): rare risk of cancer
- IL-17 Inhibitors (PSO, PsA): exacerbation of IBD (38 RCTs: only 12/16,690 new IBD case
- Psoriasis and suicidality: suicide risk same w/ or without treatments https://t.co/HsjO78NtjP https://t.co/v9Pys8RwcH
Dr. John Cush RheumNow ( View Tweet)
Cohort study of 25 315 women followed 25 years shows adherence to the Mediterranean diet associated with a 23% reduced all-cause mortality - explained by lipids, inflammation markers and BMI; more than cholesterol or glycemic measures https://t.co/kgj18lG12G https://t.co/NN2FlPSngW
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TriNetX US claims study of 7580 RA pts Rx w/ tofacitinib or adalimumab found Tofa signif. more likely to cause dyslipidemia (HR 1.250), but no difference betw TOFA & ADA in MACE (HR 0.995; 0.76–1.3) or all-cause mortality (HR 1.4; 0.89–2.2) https://t.co/83CGng2R9e https://t.co/QfD4ePuTER
Dr. John Cush RheumNow ( View Tweet)
ACR’s Run at Goliath (PCPs) (5.31.2024)
The ACR (and Cush) address their new website designed to educate PCPs and APPs - what do you think?
https://t.co/DQOkhowU0b https://t.co/MK9aVe7Yaf
Dr. John Cush RheumNow ( View Tweet)
We are covering #EULAR24! We'll be sharing recaps, videos, and more.
https://t.co/7ehREq5gnl https://t.co/ao2LzcFxrt
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Full read review on Psoriasis Flares; risks:
- mechanical stress
- infections
-dysbiosis
-drugs (Lithium, B-blockers, HCQ, tetracyclines, ACEi, IFN)
- environment(smoking, obesity)
-lifestyle
- stress
- hormonal/metabolic https://t.co/dpnVS05Pm7 https://t.co/l3rdxaBSgV
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NEJM Images - Polyarteritis Nodosa. 62 yoM with myalgias, wt loss, numbness, negative ANCA & HBV. Abdominal angiography shows multiple aneurysms. https://t.co/Axaobo01wD https://t.co/y2XYg6kVjB
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Dr. John Cush RheumNow ( View Tweet)