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Recommendations – Good & Bad (5.27.2022)

Jack Cush, MD

Dr. Jack Cush reviews the news, regulatory updates and journal reports from the past week on RheumNow.com. This week gout worries, mortality risks, measuring anti-drug antibodies and a better way in lupus?

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coronavirus,COVID,Mask,red

Increasing Corticosteroid Use in Non-Hospitalized COVID-19

Jack Cush, MD

JAMA reports that despite NIH recommendations (that corticosteroids only be used in hospitalized COVID-19 patients), nonhospitalized COVID infected patients were oftent prescribed systemic corticosteroids.

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Long,covid

Long COVID Manifestations

MMWR

The acute consequences of a SARS-CoV-2 infection may be bothersome or devastating, but the long-term consequences may lead to so-called "long COVID" syndrome.  Long COVID appears to affect up to 20% of those who survive COVID-19 infection. 

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The Inflammation Reflex (5.20.2022)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. This week, neuroimmunology leading to therapy, the cold shoulder approach and Regulatory updates from the FDA.

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Methotrexate Monitoring (5.13.2022)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Bad news for digitial ulcers in Systemic sclerosis, Readmissions in Lupus and Thrombocytopenia in APL patients.

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$30 Billion and Counting (4.29.2022)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports and takes viewer questions this week.

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Pre-exposure Prophylaxis for COVID-19 (4.22.22)

Jack Cush, MD

Dr. Jack Cush discusses the news and recent journal reports from last weeks RheumNow.com, and answers viewer questions from #ACA - Ask Cush Anything.

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vaccine,mRNA,Covid,vial

COVID-19 Vaccination Uptake and Perceptions in Rheumatic Patients

Jack Cush, MD

Putman et al has reported vaccine survey results from the COVID-19 Global Rheumatology Alliance (C19-GRA) in Lancet Rheumatology showing the uptake and vaccine hesitancy among people with rheumatic diseases (RMD).

Survey data from 7005 vaccinated and unvaccinated, adult RMD respondents from 102 countries was analyzed.

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COVID,vaccinate,injection,green

Evusheld as Protective Therapy in High Risk COVID-19 Patients

Jack Cush, MD

A single dose of the monoclonal-antibody AZD7442 (combination of tixagevimab and cilgavimab) has been shown to be safe and effective as prophylaxis against COVID-19 infection in high risk individuals who tested positive for COVID-19. 

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NSAID use is not associated with increased COVID-19 severity, all-cause mortality, invasive ventilation, AKI, or ECMO in COVID-19 inpatients. 38-center retrospective cohort propensity matched of EHR data from the National COVID Cohort Collaborative. https://t.co/u6Id4WnLPT

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Dr. John Cush RheumNow ( View Tweet)

Israel study of 171 kids w/ MIS-C (med age 8 (5-12): Dx#s - 59 during Alpha , 79 Delta , & 33 Omicron waves. All Rx w/ IVIG + steroids. 6-15% prev recv COVID VAX, none ICU admitted. Worse Dz & higher incidence during alpha wave (54.5/100K) https://t.co/wAby8uKIH4 https://t.co/zc19zeUKpq

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Dr. John Cush RheumNow ( View Tweet)
SARS-CoV-2-infected alveoli (specifically N protein-coding plasmid alone) induces IL-6 production. Also, COVID-19 Sera also induced IL-6, moreso in those w/ severe disease. anti-N Ab promotes IL-6 production & may lead to cytokine storm https://t.co/jfPNwZM0g8 https://t.co/FwIs11i2qc

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Dr. John Cush RheumNow ( View Tweet)
FDA has approved baricitinib (Olumiant) for the Treatment of Certain Hospitalized Patients with COVID-19 who require supplemental O2, mechanical ventilation, ECMO. Rec dose: 4-mg once daily for 14 days or until hospital discharge https://t.co/RiEp01tc0v https://t.co/f3RvUAzdRp

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Dr. John Cush RheumNow ( View Tweet)
Study of 198 RMD pts, vaccinated 91% JAKi and 80% MTX mono pts were Ab+ for spike protein. Adjusting MTX or JAKi did not significantly alter the immunogenicity (S1 spike Abs). DMARD adjustments w/ COVID-19 VAX may not be needed. https://t.co/ebw172M5I4 https://t.co/vjXqTbuD5t

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Dr. John Cush RheumNow ( View Tweet)
Canadian study of 6012 Pregnancies w/ +COVID-19 PCR test shows Preg pts increased risk of hospitalization (RR 2.65) & ICU adm (RR 5.46) vs gen population and higher risk of preterm birth vs preg women without COVID (RR 1.63) https://t.co/6UAaa0Jf8j https://t.co/aLQbxZArmq

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Dr. John Cush RheumNow ( View Tweet)
FDA update on Paxlovid - for use pts need to have: - COVID test + - Mild-mod dz @ risk for severe COVID - High risk comorbidity - potential interaction w/ statins, OCPs, HIV meds - Dose adjust (nirmatrelvir) w/ CKD - Dose 3 tabs bid x 5d - Watch LFTs https://t.co/oSqwlKijXq https://t.co/3Yx1C23QSz

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Dr. John Cush RheumNow ( View Tweet)
RUXCOVID phase 3 RCT ruxolitinib (5mg bid x 14d) + plus standard care in 432 hospitalized COVID-19 showed no benefit over placebo in day 29 primary outcomes (death, respiratory failure (invasive ventilation), or ICU care. https://t.co/eyAit2uOLi https://t.co/R9rA1A4dm5

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Dr. John Cush RheumNow ( View Tweet)
"Belt & Suspenders" strategy - both COVID-19 vaccination & PrEP (Evusheld) needed to prevent SARS-CoV-2 in moderately to severely immunocompromised pts (transplant, cancer, immunodeficiency) and active poorly controlled autoimmune Dz https://t.co/RmflniD7rD https://t.co/K7pmQtqcOb

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Dr. John Cush RheumNow ( View Tweet)
FDA approved 1st drug for kids with COVID-19. Veklury (remdesivir) get an expanded indication in Peds >28days old & wt > 3 kg who has SARS-CoV-2 & are Hospitalized, or Not hospitalized & at high risk for severe COVID-19 or death https://t.co/7Hn4CwKjxv

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Dr. John Cush RheumNow ( View Tweet)

COVID-19 Vaccination Uptake and Perceptions in Rheumatic Patients Putman et al has reported vaccine survey results from the C19-GRA in Lancet Rheumatology showing the uptake and vaccine hesitancy among people with rheumatic diseases (RMD). https://t.co/fIHAhpvVho https://t.co/6tFbQd0vJQ

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Dr. John Cush RheumNow ( View Tweet)
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