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Insights on Postinfectious ME/CFS

d Jack Cush, MD

The medical community is challenged by myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS - its origins, pathogenesis outcomes and treatment.  JAMA has reviewed a recent Nature paper wherein an NIH led team of multidisciplinary experts performed an inpatient study of postinfe

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Ides of March (3.15.2024)

d Jack Cush, MD

Dr. Jack Cush has advice for Caesar and the superstitious, and covers pregnancy, platelets, dialysis and vaccinations in Lupus.

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MISC,CDC

MMWR: Vaccination and Multisystem Inflammatory Syndrome in Children

d CDC

Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition typically occurring 2–6 weeks after SARS-CoV-2 infection and characterized by fever and multiorgan involvement.  The current MMWR report shows that MIS-C case numbers have decreased by 98% since 2021.

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US Trends in RA DMARD Use 2017-2021 A trend analysis of disease-modifying anti-rheumatic drugs (DMARDs) shows that only half of rheumatoid arthritis (RA) patients are taking DMARDs, and that the COVID-19 pandemic substantially affected DMARD use. https://t.co/vQmVyAjIaL https://t.co/tSJ4H5XtnU

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MMWR: Vaccination and Multisystem Inflammatory Syndrome in Children MIS-C is a rare but serious condition typically occurring 2–6 weeks after SARS-CoV-2 infection and characterized by fever and multiorgan involvement. https://t.co/PN2MPQxqSR https://t.co/eIzB4pjner

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In RA, NO selective response with Seropositivity. Study of 28 eligible RCTs shows pts Rx w/ cs- or bDMARD that seropositivity did not predict better bDMARD response (ACR20 RRR ~1). Comparable resp in RF+ & RF- w/ TNFi or non-TNFi bDMARDs. https://t.co/AUWPgkzayt https://t.co/om9AYhNsQ9

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9 Facts about Leflunomide Medscape has published an informative review of leflunomide, drawn from Dr. Eric Ruderman’s recent lecture on the subject at the February RWCS meeting in Maui. https://t.co/X9lyrOs3D7 https://t.co/TGh2LnGdJ8

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Retro study 109 oligoarticular JIA pts (~8 yrs) Rx w/ intraarticular steroids w/ 4.3 yrs F/U: 38% needed no Rx, 15.5% needed more IAS; 46% systemic Rx(MTX; 8 mos) &22% biologics(2.2 yrs later). @FUV 89% were inactive. Persistence predicted by ANA+ & B27+ https://t.co/5YLkYyA84l https://t.co/wClhEiKOIw

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Japanese study of 672 autoimmune pts on TNFi & tocilizumab - 1.6% (n=9) developed non-tuberculous Mycobacteria (NTM) infx post biologics. 2 disseminated NTM, 2 died. NTM pts had higher mortality [(22% vs 2.6%) & took more steroid (17 vs 3 mg, P=0.004).https://t.co/fGGafrTeiL https://t.co/DkmiC2hVEA

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JAMA Review of DMARD Use in Rheumatoid Arthritis JAMA has reviewed the "2022 EULAR Recommendations for the Management of Rheumatoid Arthritis With Synthetic and Biological Disease-Modifying Antirheumatic Drugs". https://t.co/fpAigPpKzv https://t.co/GkbqW2BxpA

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JAK-pot: 46913 Rx courses on JAKi, TNFi, other MOA. Rx D/Cs for AEs: - TNFi = JAKi (HR 1.0) - Other MOA > JAKi (HR 1.11) - TNFi < tofacitinib (0.81) - TNFi > baricitinib (1.15) - TNFi < JAKi; if >65yrs w/ CV risk (0.79) https://t.co/jCtLG3SNvP https://t.co/FN5U5Z1M9M

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Effective Treatments for Still's Disease A systematic review of pharmacological treatments for adult-onset Still disease (AOSD) supports the efficacy of tocilizumab (TCZ), anakinra (ANK), and canakinumab (CNK). https://t.co/r7RGD5WlvO https://t.co/Jfq7zPR0ci

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JAK inhibitors maybe an option in refractory Juvenile Dermatomyositis. Metanalysis of 26 reports (195 pts) JDM Rx w/ JAKi (median 5 rys); most Rx w/ tofacitinib (57%), ruxolitinib(27%), baricitinib (15%), w/ Improvement in 90%, 69%, 93%, respectively. https://t.co/tfISYVtwUN https://t.co/zv88Vdy6c0

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Again, a High Mortality with Depression and RA Last week we reported on a Korean study showing a 66% elevated mortality risk in RA patients with depression. This week, a new report shows depression in RA increases the mortality risk by more than 5 fold. https://t.co/C7Z7djny4S https://t.co/J9B6DUqcIC

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Study 1189 males athletes sanctioned for doping with Androgenic anabolic steroids compared to 59 450 controls. Anabolic steroids signifi. increased the mortality risk (HR 2.81) from both unnatural (accidents) & natural causes (CVD, etc) https://t.co/XJr1oUw1gM https://t.co/YIQhdCXd2y

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9 Facts about Leflunomide Medscape has published an informative review of leflunomide, drawn from Dr. Eric Ruderman’s recent lecture on the subject at the February RWCS meeting in Maui. https://t.co/M0wtGTYkdO https://t.co/dvYqz4WEH2

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HS-Related Autoinflammatory Syndromes HS is an autoinflammatory skin disorder of the terminal hair follicle, manifesting with painful nodules, abscesses, draining tunnels, and hypertrophic scarring, typically occurring in apocrine gland bearing skin. https://t.co/02Svwj99Bm https://t.co/9oy1UngII7

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SLE & remission on hemodyalysis (HD)? Cohort of 137 pts starting HD & the # off SLE Rx increased w/ time: 67% (HD start), 76.0% (1st Yr), 83% at 3 yrs (less w/ younger). Lupes flares most in 1st yr of HD; @12 mos 52% minor and 12% had severe flares. https://t.co/8N7CJWkIUY https://t.co/48eOclzrJH

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Japanese study of 672 autoimmune pts on TNFi & tocilizumab - 1.6% (n=9) developed non-tuberculous Mycobacteria (NTM) infx post biologics. 2 disseminated NTM, 2 died. NTM pts had higher mortality [(22% vs 2.6%) & took more steroid (17 vs 3 mg, P=0.004).https://t.co/cLqt3FSzBk https://t.co/eD84WPZyuq

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Long-term safety of Ixekizumab (IXE) - 26 RCTs (22k PYs) in PSO, PsA, AS & nr-axSpA - nasopharyngitis most common AE; AEs did not incr over time - D/C from AE 3-5/100Pys - ISRs: 5.9-11.6/100PYs - Candida 1.2-2/100PYs - IBD: 0.1 PsO - 0.8/100PY for axSpA https://t.co/nOoCE3VOxD https://t.co/F4gP1yR1Je

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