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ICYMI: The Nine Lives of Hydroxychloroquine (Updated)

Martin J. Bergman, MD

Hydroxychloroquine is one of many medications frequently used in rheumatology practice. Its remarkable versatility is attested by its routine use in lupus, in patients with an autoimmune coagulopathy, in patients with rheumatoid arthritis, as well as in those with a low-level inflammatory arthropathy.

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Coexistent Gout and Rheumatoid Arthritis

Jack Cush, MD

While it is often said there is a negative association between gout and rheumatoid arthritis (RA), cases of coexistent disorders are uncommonly seen. A recent VA study describes 121 patients whith both RA and gout.

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CV Risks Raised in Myopathies

Jack Cush, MD

Patients with the idiopathic inflammatory myopathies (IIMs) dermatomyositis and polymyositis are at increased risk for cardiovascular events, with risks similar to what has been documented for rheumatoid arthritis (RA), during the first 5 years after diagnosis, U.K. researchers reported.

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Premature Atherosclerosis in Autoimmune Rheumatic Diseases

Jack Cush, MD

The VITAL study is a VA registry that has shown that both systemic lupus erythematosus  (SLE) and rheumatoid arthritis (RA) patients carry higher odds of both premature and extremely premature atherosclerotic cardiovascular disease and its consequences.

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COVID's Multisystem Inflammatory Syndrome in Children

Jack Cush, MD

Two recent reports further characterize the newly described, Kawasaki-like,  syndrome affecting children with COVID-19 infections.

The NEJM describes the childhood syndrome as having Kawasaki’s disease, fever, toxic shock syndrome, acute abdominal conditions, and encephalopathy; hence the label Childhood Multisystem Inflammatory Syndrome. The disorder emerged in late April 2020, first in the U.K., and then similar cases were reported from many other countries. The CDC named this multisystem inflammatory syndrome in children (MIS-C).

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RheumNow Podcast – Lupus Mortality Declines, But… (6.26.20)

Jack Cush, MD

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

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ACR Outlines Best Practices for Kids With MIS-C

RheumNow

Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 infection has both similarities and differences with Kawasaki disease, and requires distinct clinical management, according to draft guidance from the American College of Rheumatology (ACR).

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Mortality in Lupus Declines between 2006 and 2016

Jack Cush, MD

The largest study, to date, shows that in‐hospital mortality of systemic lupus erythematosus (SLE) patients has significantly improved between 2006 and 2016, with a high mortality burden among U.S. Blacks and Hispanics with lupus.

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Rheumatology Round-Up from #EULAR2020 w/ Drs. Kavanaugh & Cush. Watch it on RheumNow https://t.co/5v9BTuLrPX or listen to the podcast on iTunes https://t.co/FHJv01AAbC or on Android Sound Cloud https://t.co/nb7iXdRMMb

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Dr. John Cush RheumNow ( View Tweet)

PRES - Posterior reversible encephalopathy syndrome. Review of US hosp records finds 3125 cases. Rheum Dz associations include ANCA+ vasculitis (OR 9.3), PsA (4.6), Scleroderma (6.6), SLE nephritis (7.5), SLE (2.4); also renal failure, pre-/eclampsia https://t.co/uLQxU3RNuD

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Dr. John Cush RheumNow ( View Tweet)

Rituximab (RTX)-associated autoimmune disease flare is rare and only seen in 7/185 pts (3.4%); all w/ type II mixed cryoglobulinemia vasculitis. Flare occurred a median 8 days post RTX, as acute kidney insuf, purpura with myocarditis or GI involvement https://t.co/pgvyddFnAd

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Dr. John Cush RheumNow ( View Tweet)

Nested case-control study of 5858 SLE patients - 51 developed cancer; most common were thyroid CA (27%), cervical (20%), & lung (14%). No risk imposed by steroids, CTX, MTX or azathioprine. But HCQ use was associated significantly lower Cancer risk in SLE https://t.co/3R0iakKbVG

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Dr. John Cush RheumNow ( View Tweet)

National Inpatient study of 61,615 systemic sclerosis pts (1998–2016) finds most common serious infections were pneumonia 45%, sepsis 32%, SSTI 19%; by 2015–2016, sepsis 1.8X more common than pneumonia. Hosp SIE mortality decr over time (10% to 8%) https://t.co/nv1KjaL3w4

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Dr. John Cush RheumNow ( View Tweet)

Increased rate of hospital #COVID-19 cases associated with some but not all chronic #inflammatory or #autoimmune conditions compared with reference population. The risks seem to depend on age, the specific disease and previous therapies. https://t.co/8j6R0oO99y https://t.co/n3cEXFx9Kk

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ARD & RMD Open ARD_BMJ ( View Tweet)
Global prevalence of juvenile idiopathic arthritis is ~ 2,069,246 < 16 year olds compared with a prevalence of ~ 206,931 < 16 year olds with juvenile SLE. JIA is 10 times more prevalent than lupus in children < 16yrs. https://t.co/2xvhg59c1J

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Dr. John Cush RheumNow ( View Tweet)

If you treat #SLE patients, Do you get a renal biopsy before starting therapy for Lupus nephritis?

Dr. John Cush RheumNow ( View Tweet)

The RheumNow Podcast is Up! Lupus Mortality Declines, But… Review of SUA and cancer; IL-12/23 and SLE; TCZ and Behcets, Pregnancy SI MRI, VTE w/ Jaks; COVID; Colchicine. Watch it here> https://t.co/2V7TbaAsOp or listen on iTunes or SoundCloud https://t.co/XMps2GTgeD

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Dr. John Cush RheumNow ( View Tweet)

Retrospective study of 2369 patients with Kawasaki disease examined different doses of aspirin showing lower ASA doses of 20–29 mg/kg/day was as effective as 30–50 mg/kg/day in preventing coronary artery aneurysms with no change in IVIG resistance https://t.co/kJgkSSpjyw

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Dr. John Cush RheumNow ( View Tweet)

J&J announced that is discontinuing its phase 3 trial of ustekinumab in #SLE. An interim analysis of the 516 pt LOTUS trial showed no new safety concerns. Study was halted for lack of efficacy. A subsequent LOTUS-C trial in China has been suspended. https://t.co/iN5trI0V71

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Dr. John Cush RheumNow ( View Tweet)

23 yoF with 1 mos digital ulcers, hair loss, sicca Sxs, dysphagia; No sclerodactyly but finger tips cyanotic w/ distal pitting scars, ischemic ulcers, periungual erythema & dilated nailfold capillaries (no hemorrhages). +tests for ANA, Ro52, Ro60 and Scl-70 Abs. How to treat?

Dr. John Cush RheumNow ( View Tweet)

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