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ICYMI: Co-management of Psoriatic Disease
It is a common clinical scenario to see someone with both severe psoriatic arthritis and skin psoriasis. In an ideal world this would involve a combined clinic with our local friendly dermatologist. For many of us, however, this is not practical for many reasons. The excellent Saturday morning session on choosing systemic therapies in psoriatic disease at RheumNow Live 2024 from dermatologist extraordinaire Dr. April Armstrong was therefore hugely insightful.
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Seasonal Pathogens and Henoch-Schönlein Purpura
Epidemiologic studies of Henoch-Schönlein purpura (HSP) have suggested seasonal variation in occurrence rates (higher from September-April, lower in June-August), suggesting a role for infectious triggers.
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#RNL2024 @RheumNow
@AlexisOgdie
Many therapies for SpA - but ONLY TNFi, IL17i, and JAKi for AxSpA
Check out https://t.co/3918uYvdFj to help guide treatment decisions: Prior therapies? enthesitis? concomitant IBD/uveitis? comorbidities? Pt preferences? https://t.co/6ugueBPMTy
Dr. John Cush RheumNow ( View Tweet)
TAPIR study shows that GPA patients treated with rituximab can be safely weaned off low dose prednisone. But. 20% risk of relapse in those treated with non-RTX regimens @VasculitisBCN24 #vasculitis https://t.co/jDy0lOQQIP
Catherine Hill CatherineL_Hill ( View Tweet)
Human touch. A systematic review that underscores the physical and mental health benefits. The essence of medicine that will not be provided by #AI
https://t.co/OvCDJYAsoS @NatureHumBehav @j_packheiser @helenahhartmann
@FredericMichon @GazzolaValeria @sbl_nin https://t.co/YuAiKtq87p https://t.co/Sxj1LfO5ZG
Links:
Eric Topol EricTopol ( View Tweet)
Expert Review
Rheumatoid Arthritis: The Continuum of Disease and Strategies for Prediction, Early Intervention, and Prevention
📰 https://t.co/JfkO8WpELc
#rheumatoidarthritis #prediction #prevention https://t.co/3xqHalhjCV
Links:
The Journal of Rheumatology jrheum ( View Tweet)
2018 ACR/National Psoarasis Foundation Guidelines for Treatment of PsA
- Created helpful definitions of Severe PsA and Severe PsO
#RNL2024 @RheumNow @AlexisOgdie https://t.co/mYOWNEevfW
Links:
Dr. John Cush RheumNow ( View Tweet)
#RNL2024 @RheumNow
@_AprilArmstrong
Choosing a biologic in Psoriasis
TNF - great in PsA, pregnancy. Avoid in demyelinating, hep B
IL-17 - robust skin, PsA (axial too). Avoid in IBD
IL-23 - robust skin, PsA evidence, fewer injections https://t.co/42kUaIZxKs
Links:
Dr. John Cush RheumNow ( View Tweet)
vedolizumab-induced enthesitis
@lihi_eder #RNL2024 @RheumNow
11/90 (12.2%) of pts on VDZ for IBD w/ develop new-onset enthesitis
Is this true drug rxn or previously masked by prior meds (TNF)?
Usually unilateral +/- oligo, dactylitis
Most respond to NSAID or injxn, 27% change Rx
Dr. John Cush RheumNow ( View Tweet)
Staph. aureus bacteremia (SAB) is assoc w/ poor outcomes & Osteoarticular infection. Danish study of 18 274 SAB pt (367 w RA). 90d SAB risk in RA was 23% vs 12.5% in non-RA (HR 1.93). Higher w/ Jt implants (29%) & TNFi use (42%). 90d Mortality was 35% https://t.co/hjaPnTbE0E https://t.co/7t7omiUVYf
Dr. John Cush RheumNow ( View Tweet)
Polycyclic Aromatic Hydrocarbons Increase Lupus Risk
A case-controlled study shows environmental exposure to polycyclic aromatic hydrocarbons (PAH) may increase the risk of developing systemic lupus erythematosus (SLE).
https://t.co/04MPWwQlUr https://t.co/iTf6EmKLId
Dr. John Cush RheumNow ( View Tweet)
We're back on 4/9 with another Tuesday Night Rheumatology! We'll be focusing on PsA Hot Topics. Register to attend today!
https://t.co/Ay0uxyfYDk https://t.co/QxZSI9EzTg
Links:
Dr. John Cush RheumNow ( View Tweet)
10 SLE pts w/ ITP and thrombocytopenia were Rx w/ belimumab IV (age 34.3 ± 14 yrs). Overall response rate of thrombocytopenia was 90%, w/ improvement in platelets, lymphocyte count, Hgb, dsDNA, C3, C4 and SLEDAI https://t.co/5U7mHoY0fg https://t.co/oOqUJqUNgl
Dr. John Cush RheumNow ( View Tweet)
13 Risk Factors for RA-associated Interstitial Lung Disease (ILD)
ILD is the most widespread and fatal pulmonary complication of rheumatoid arthritis (RA). A recent metanalysis shows the pooled prevalence of RA-ILD was approximately 18.7%.
https://t.co/x1YFv0ZlL9 https://t.co/XGeilz2tus
Dr. John Cush RheumNow ( View Tweet)
Pearl: Three "S" Rule (Smoking, Seropositivity, Sex/Male): if present the risk of RA-UIP (ILD) goes up nearly 13 fold (ACR23 Abstract 1269) https://t.co/2YFosInpGs https://t.co/rOVN79JJRz
Dr. John Cush RheumNow ( View Tweet)
Pearl: 40% of acute gout attacks will have a normal serum uric acid (that will elevated during intercritical phase) - Draw the lab during and after the attack. https://t.co/CynZOal9jc
Dr. John Cush RheumNow ( View Tweet)
Neuropsychiatric (NP) Sxs compared in SLE (n 609), controls (463) & IA patients (489).
Hallucinations and severe headache were most directly attributable to NP-SLE. https://t.co/JWbyHmpWcq https://t.co/gBubdEjq63
Dr. John Cush RheumNow ( View Tweet)
337 PMR pts studied by FDG PET, followed 6 mos - 9% (31) had subclinical vasculitis (GCA)
- 21 had isolated LG vessel
- 3 isolated cranial vasculitis
- 7 both cranial & LG vessel vasculitis.
Steroid use higher w/ subclinical vasculitis, but not relapse https://t.co/uwXf4ucVnQ https://t.co/AOacTnQZaS
Dr. John Cush RheumNow ( View Tweet)
How do you communicate risk/benefit to patients? @RADoctor's recent publication highlighted by Dr. H. Gabalawy at #RNL2024
-Increase awareness
-Include numbers for context
- Make it easy for patients to understand those numbers
-Use absolute risks
- Avoid 1 in X format
Dr. John Cush RheumNow ( View Tweet)
Aging in RA: "(RA is due to a poorly functioning immune system which increases a patients risk of CVD, infection, and cancer. The aging immune system additionally affects this process.
Dr. John Cush RheumNow ( View Tweet)