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An Ounce of Prevention (2.4.2022)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.  He discusses the GI side effects of IL-17 inhibitors, downstream revenues from rheumatology care and dietary prevention of gout. 

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Best of 2021: Jack of All Subspecialties

Jack Cush, MD

It's great to be a rheumatologist, but boy, it's getting harder and harder. You have to be a jack of all trades. You have to be good at cardiovascular disease, osteoporosis, vaccination, inflammatory bowel disease - it just never ends. This and more, as Dr. Cush summarizes more than a dozen journal articles, news reports and questions + cases.

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Cancer,cells

Certain Cancers Increased with Autoimmune Diseases

Jack Cush, MD

Rheumatologists are well aware that inflammation and immune dysregulation are prime contributors to cancer risk, but do oncologists carry the same impressions? A large study from JAMA Oncology shows that patients with immune-mediated diseases (IMD) have an overall increased risk of cancer, especially in organ-specific immune-mediated diseases. 

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Methotrexate and hepatic fibrosis: we must be doing something right

David Liew, FRACP

Methotrexate may be a rheumatologist’s best friend, but a key part of counselling any patient about its use has always been the risk of hepatotoxicity.

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Cush ACR learning computer online

Day 2 Report from ACR21

Jack Cush, MD

This report highlights the VITAL trial; the ORAL Surveillance Study; and the Microbiome study of monozygotic psoriasis patients.

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liver.jpg

Methotrexate and hepatic fibrosis: we must be doing something right

David Liew, FRACP

Methotrexate may be a rheumatologist’s best friend, but a key part of counselling any patient about its use has always been the risk of hepatotoxicity.

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Systematic review of GI Safety of IL-17 inhibitors included 106 RCTs and 40,053 patients. Inflammatory bowel disease occurred in 0.4%; Most freq Sxs - diarrhea (2.5%), nausea or vomiting (0.7%), and gastroenteritis (0.2%). https://t.co/tv3QXHU1Hg

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Dr. John Cush RheumNow ( View Tweet)

ICYMI: Filgotinib (Jyseleca) was approved by European Commission approved for EU use in adults with moderately to severely active Ulcerative colitis (not responding to conventional therapy or a biologic). Rec based on Phase 2b/3 SELECTION trial. https://t.co/9VbCJse6Tr

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Dr. John Cush RheumNow ( View Tweet)

#ACR21 Thieves! TM11. Belly pain in patient with RA nodules: ⭐️ A: rheumatoid nodulosis of pancreas and duodenum. Great case! @Rheumnow https://t.co/PuO4tka3FJ
Eric Dein ericdeinmd ( View Tweet)
#ACR21 #Abstr1492 Could gut microbiome contribute to Anti-Ro+/autoimmunity in #lupus? Analyses of 125 stool samples from mother of children with neonatal lupus and/or heart block revealed its potential role in genetic-environment interaction @RheumNow https://t.co/FnJtZJSCRj https://t.co/ttRdP9NIrG

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Loved this session on: Preclinical Rheumatoid Arthritis- Can we stop RA? As a patient advocate living with RA, my providers have always ran tests on my microbiome. The findings have correlated with my disease flares, and was a big trigger overall. #ACR21 @ACRheum Thank you! https://t.co/6hm6hr85JS
Effie Koliopoulos RisingAboveRa ( View Tweet)
Love-hate relationship with #methotrexate. Side effects are common ex nausea/GI in 1/3 and alopecia in women. ?if you ask do you get more AES. Tough to treat especially SEs are early. ?Coach pt to help w persistence abst1444# @RheumNow #ACR21 https://t.co/NDQDVz8lk2
Janet Pope Janetbirdope ( View Tweet)
Low incidence of GI-related serious AE in pooled 1 year data from VOY1&2 and DISC1&2 trials of Guselkumab for PsA/PsO treatment ⭐️no new onset IBD or exacerbation of IBD ⭐️no uveitis, infections, TB Abs#1342 #ACR21 @RheumNow https://t.co/x3OmLgInV0

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Robert B Chao, MD doctorRBC ( View Tweet)

In one institution, 25% of Crohn's patients had abnormal SI findings on MRE/MRI. Majority without back pain, were female with intestinal complications. Abs#1306 #ACR21 @RheumNow https://t.co/z8Yvc98s67

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Robert B Chao, MD doctorRBC ( View Tweet)

⭐️Imaging of the SIJ in psoriatic axSpA is similar to axSpA associated with iritis or colitis! Abst#0902 (https://t.co/f55Vfi1LSS) #ACR21 @RheumNow https://t.co/UCXrwPiyhh

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Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
In pts w/o RF, liver bx prev suggestd if lifetime cumulative MTX dose was 1-1.5g, then 3.5-4g. All pts in centre offered Fibroscan liver stifness associations: - age, BMI - not cumulative MTX dose maybe survival bias, but what we're doing now is fine! #ACR21 ABST0786 @RheumNow https://t.co/I6IhS3jhmC
David Liew drdavidliew ( View Tweet)
Interesting study with Dr. Julia Manasson on gut and skin microbiome in monozygotic twins discordant for psoriatic disease. (red = Psoriatic). Gut ruminococcus bromii virtually absent in psoriatic pts. Eager to see further studies! #ACR21 Abst#0944 @RheumNow https://t.co/zrZPBAjh5p
Pedro Castillo _Castillo_Pedro ( View Tweet)
Monozygotic twin study in PsO patients showed a gut and skin microbiome difference compared to their "normal" twin ⭐️Ruminococcus decreased/absent in gut flora of PsO ⭐️microbiome differences even in healthy PsO skin Abs#944 #ACR21 @RheumNow #ACRBest https://t.co/VlfVh5Kt3Y https://t.co/W0eSqi77lx

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Robert B Chao, MD doctorRBC ( View Tweet)
MTX and liver: FibroScan scores compatible with liver fibrosis are significantly correlated w/ several parameters -BMI -waist circumference -male gender -age but NOT MTX cumulative dose in a cohort of 500+ patients. #Abst0786 @RheumNow #ACR21 https://t.co/RkSpVqN4qF https://t.co/9TENaR0WZ3

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Aurelie Najm AurelieRheumo ( View Tweet)
AxSpA pts share a gut microbiome signature with Crohn's disease and anterior uveitis pts ⬇️Blautia ⬆️Veillonella and Lactobacillus ⭐️SpA pts uniquely enriched in Collinsella Abs#0062 #ACR21 @RheumNow #ACRBest https://t.co/sdlHxNbhr8 https://t.co/r8eG9c9vwa

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Robert B Chao, MD doctorRBC ( View Tweet)
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