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Curbside Consults (2.16.2024)
Dr. Jack Cush answers audience clinical case questions sent by email or "ask Cush anything". Cases and questions from:
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Top 5 Clinical Pearls in RA Management
RheumNow Live 2024 provided a wealth of clinical insights, particularly in the realm of rheumatoid arthritis (RA) management. Here are the top five clinical pearls from the event's opening session, "Success in Rheumatoid Arthritis."
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APIPPRA Trial: Abatacept in at-risk rheumatoid arthritis patients
Abatacept has been studied in seropositive clinically suspect arthralgia patients (at risk for rheumatoid arthritis) and shows the potential to delay or prevent the disease.
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An updated medication list for diabetes medications with Dr. O. Troum at #RWCS24 @RheumNow @RWCSmtg https://t.co/ZYr5i7PAI9
Dr. Rachel Tate uptoTate ( View Tweet)
#RWCS24 @JointMD @RWCSmtg review the TNFi differences molecularly. @RheumNow https://t.co/6JAnNwwV0n
Dr. Rachel Tate uptoTate ( View Tweet)
"In solid tumors, treat your RA patient as if they do not have a cancer, meaning do not change your therapy if the patient is responding well. Things may get dicey if hematologic malignancy." @RheumNow #RWCS24
I work w/ my onc team to ensure the patient has the needed support.
Dr. Rachel Tate uptoTate ( View Tweet)
Anticardiolipin ab are the most frequent aPL in SLE. Dr. M. Petri #RWCS24 @RWCSmtg @RheumNow https://t.co/cCxhctLTGf
Dr. Rachel Tate uptoTate ( View Tweet)
Dr. Petri reviews the 2023 ACR/APS Classification Criteria at #RWCS24 @RheumNow @RWCSmtg https://t.co/FWGsFk02Dn
Dr. Rachel Tate uptoTate ( View Tweet)
Steroids are associated with MACE events in RA. #RWCS24 @RheumNow @RWCSmtg https://t.co/U6ssALNspe
Dr. Rachel Tate uptoTate ( View Tweet)
Controversial MOSAIC results. @JointMD and @RWCSmtg discuss nuances listed below. #RWCS24 @RheumNow https://t.co/aVRJpqHuUM
Dr. Rachel Tate uptoTate ( View Tweet)
Who do you watch closely for developing RA? @RheumNow and @RWCSmtg suggest additional risk factors for ratcheting closer to RA. #RWCS24 https://t.co/lV3I5emn72
Dr. Rachel Tate uptoTate ( View Tweet)
Obese patients more likely to have a lower DMARD response compared to under/normal weighted patients. This still needs to be evaluated on a personal patient level, however, this is an important, layered discussion to have. #RWCS24 @RWCSmtg @rheumnow https://t.co/KIkVXQdcPm
Dr. Rachel Tate uptoTate ( View Tweet)
Oral IL-23 Inhibitor Effective in Psoriasis
The NEJM has published the results of the FRONTIER 1 trial demonstrating the efficacy of JNJ-77242113, an oral interleukin-23 (IL-23) receptor antagonist peptide, in patients with psoriasis (PSO).
https://t.co/9GjR6Vx3At https://t.co/tZiykNuzKS
Dr. John Cush RheumNow ( View Tweet)
Mayo study of 1643 #RA pts (Dzduration 7 yrs) found 4 clusters based on # of comorbidities (Cluster 1 [42%] few comorbidities & cluster 4 [7%] > 10). Cluster 1 w/ good prog/survival; but cluster 4 was older, less DMARDs/biologics https://t.co/qAWZoXVWlv https://t.co/g3gMsNj848
Dr. John Cush RheumNow ( View Tweet)
Retrospective cohort analysis of 330 psoriasis pts - 83 (25%) developed #PsA after mean of 36 (3.5–114) mos. PsA Predictive factors include being female (OR=3.33), nails involved (OR=5.4), severe PSO (OR=27.4), po systemic Rx prior to PsA (4.1) https://t.co/Hpn6f1EUfD https://t.co/QanJkNi5S6
Dr. John Cush RheumNow ( View Tweet)
Sex Disparities in PsA/SpA
https://t.co/3pmFyo6Ztm https://t.co/zanPiI7GT5
Dr. John Cush RheumNow ( View Tweet)
Retrospective study of non–small cell lung cancer(NSCLC) pts Rx w/ immune checkpoint inhibitor finds that those who develop immune-related AE (irAEs) (n=803) have improved overall survival (23.7 vs 9.8 mos survival; P < .001) https://t.co/yiwJZJU10W https://t.co/fwFFlf7Q6L
Dr. John Cush RheumNow ( View Tweet)
Sarcoid arthritis (SA) seen in 19% of sarcoid pts. Metanalsysis of 49 articles (8574 pts) found Ankles most frequent (80%) followed by knees & wrists. Monoarthritis was uncommon (1%). Acute , 0-2, I2 55%). Acute SA (oligo & poly) was linked to E nodosum. https://t.co/XPbS4vVX9o https://t.co/CqonQ1a3wW
Dr. John Cush RheumNow ( View Tweet)
In 551 juvenile myositis pts, 36% had myositis assoc Abs (MAA); 13% had >1 MAA. MAA+ pts had more overlap dz (18 vs 6%, p<.001) & assoc w/ Raynauds (OR 2.44), ILD (OR 3.43), chronic Dz (OR 1.72), mortality (OR 3.76). # MAAs was assoc w/ mortality (OR 1.83) https://t.co/gvHIEuiG66
Dr. John Cush RheumNow ( View Tweet)
Study of 43 SSc patients w/ gangrene shows Smoking Hx ; positive-ACA, ANCA, APL Abs & high ESR were independent risk factors for digital gangrenes in SSc. Vasculitis and macrovascular disease may contribute to the progression of digital gangrene https://t.co/YmwurwymLb https://t.co/RiOIkbIEXM
Dr. John Cush RheumNow ( View Tweet)