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urticaria

Urticarial Vasculitis Overview

Jack Cush, MD

Urticarial vasculitis is rare and the causes often go undiagnosed. A Medscape recent overview highlights key features in the diagnosis and management of this rare disorder.

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steroid prednisone lab

Good Clinical Practice Recommendations on Glucocorticoid Withdrawal and Adrenal Insufficiency

Jack Cush, MD

Glucocorticoids are widely prescribed as anti-inflammatory and immunosuppressive agents. This results in at least 1% of the population using chronic glucocorticoid therapy being at risk for glucocorticoid-induced adrenal insufficiency. This risk is dependent on the dose, duration and potency of the glucocorticoid, route of administration, and individual susceptibility.

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Running with Data (8.30.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com - including tips on steroids, MAS, and myositis testing.

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All in the Family (8.23.2024)

Jack Cush, MD

Dr. Jack Cush picks highlight reports from the past week on RheumNow.com, with reports on the challenge of lupus nephritis, perplexing skin issues, you don't know JAK (about Tyk) and the value of a good family history.

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Pulse Steroids with Tocilizumab in Giant Cell Arteritis

Jack Cush, MD

A pilot study assessed pulse methoprednisolone with weekly subcutaneous tocilizumab (TCZ) in patients with large vessel-GCA (LV-GCA) and showed that a sizeable minority will relapse after the TCZ is discontinued. 

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CARRA Consensus Treatment for Refractory Juvenile Dermatomyositis

Jack Cush, MD

CARRA has developed consensus treatment plans for the use of biologic disease-modifying antirheumatic drugs (bDMARDs) in patients with refractory, moderately severe juvenile dermatomyositis. Juvenile dermatomyositis is the most common form of idiopathic, inflammatory myositis in childhood, with an estimated incidence of 3.2 per million children per year in the United States.

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alveolar hemorrhage acute

PEXIVAS: Diffuse Alveolar Hemorrhage in ANCA-Associated Vasculitis Patients

Jack Cush, MD

A secondary analysis of the PEXIVAS study showed antineutrophil cytoplasmic antibody–associated vasculitis (AAV) patients complicated by diffuse alveolar hemorrhage (DAH) may have improved with plasma exchange and glucocorticoids, the results did not achieve significance. 

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GCA,woman

JAK Inhibitors in Giant Cell Arteritis

Jack Cush, MD

Trials are underway evaluating the potential benefits of JAK inhibitors (JAKi) in giant cell arteritis (GCA) patients who are refractory to standards of care.

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EULAR24,Roundup

EULAR 2024 Rheumatology Roundup (6.21.2024)

Jack Cush, MD

Drs. Artie Kavanaugh and Jack Cush discuss highlights from the EULAR 2024 meeting in Vienna

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Retrospective observational study of 96 stable #SLE pts compared maintenance on HCQ vs belimumab. There were no significant differences in Flare rate (18% HCQ vs 8.3% BLM; p=0.47), damage index increase, SLEDAI, Pred dose or adverse events https://t.co/sVPMugSHn3 https://t.co/6bdel6Kvs9

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Dr. John Cush RheumNow ( View Tweet)
It takes >3-4 weeks of steroids (@ any dose >5 mg pred/d) to pose risk of adrenal insufficiency – Hence, Endocrine Society Guideline says short-term glucocorticoid therapy of <3-4 wks, irrespective of dose, DOES NOT require GC tapering https://t.co/o7tz1Am9pe https://t.co/CndfCYRApj

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Dr. John Cush RheumNow ( View Tweet)
MDs: How long must you be on Pred 40 mg/d before you must slowly wean pred (vs stopping abruptly)?

Dr. John Cush RheumNow ( View Tweet)

Check out a NEW review on the dichotomy of #glucocorticosteroids treatment in #rheumaticdiseases by @maurizio_cutolo and team 👉https://t.co/6c08ucQlDN 👨‍🎓Glucocorticosteroids - a double-edged sword https://t.co/VdKlPzFpOb

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@ReumatologiaJ ReumatologiaJ ( View Tweet)
RISE registry study shows Prednisone Rx before rheum consult ends up with more long-term Pred. 1,733 RA pts; 715 on GC (41% 0.5-2 mos before rheum care). mean GC use =157 d. GC before rheum care associated with longer GC use https://t.co/UpeK4hwIN0 https://t.co/F8cuoX0ACq

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Dr. John Cush RheumNow ( View Tweet)
Metanalysis of 50 RCTs (3,231 pts w/ lupus nephritis (LN) related starting pred dose to rates of complete response (CR), serious infections, & death. PO pred 25 mg/D assoc w/ 20%, 3.2% & 0.2%, respectively. Pred 60 mg/day incr rates to 35%, 12% & 2.7% https://t.co/6FH9BWsmaz https://t.co/0cQPAIuvRw

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Dr. John Cush RheumNow ( View Tweet)
TRUST: 10 Yr Japanese study of tacrolimus in 1355 SLE nephritis pts; half on TAC x 10yrs. TAC use assoc w/ signif reduction corticosteroid use (~16 mg/d @4wks to 7.2 mg/d @ 1Yr(P < 0.001). 9.7% w/ serious AEs. https://t.co/PsfCVZF4tk https://t.co/l3HkTRc4oC

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Dr. John Cush RheumNow ( View Tweet)
Literature review - Glucocorticoid use in elderly to be problematic. GC use may be assoc w/ remission, but GC increases AE rates, & there is difficulty w/ GC discontinuation. Goal: D/C GC early, but some may require for up to yrs to control Dz activity https://t.co/6liN0mubIv https://t.co/PiGKGSYrof

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Dr. John Cush RheumNow ( View Tweet)
192 RA pts on MTX: GI Sxs studied w/ MISS (MTX intolerance severity score). GI intolerance seen in 56%, Nausea & pain post-MTX most common. More in afro-descendants, w/ FM, Steroids, or JAKi. MISS results unrelated to Route, Gi Dz, age, MTX dose https://t.co/EROmZQo1Zs https://t.co/SOMzzXXj0b

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Dr. John Cush RheumNow ( View Tweet)
RT @yuz6yusof #EULAR2024 OP0180 Can we safely taper GC in #lupus patients who are in remission? Single study in Italy showed in pts with SLEDAI=0 + pred =&lt;5mg/d + stable IS/HCQ, GC discontinuation after proper tapering appeared safe and was associated with a low risk of flare

Dr. John Cush RheumNow ( View Tweet)

RT @drminidey OP0165- incidence &amp; risk factors of D2T RA in an early RA cohort Factors assoc with D2T RA: 🩸 Seropositivity 🦴 Erosions 📈 Disease activity 📊 D2T pts have higher steroid doses &amp; more commonly develop iatrogenic-related #comorbidities, e.g. osteoporosis

Dr. John Cush RheumNow ( View Tweet)

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