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Oral Dysbiosis May Antedate Rheumatoid Arthritis

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d Jack Cush, MD

Oct 06, 2020

A study of oral microbiome in anti-cyclic citrullinated peptide (anti-CCP) positive at-risk individuals without synovitis (CCP+at risk) shows dysbiotic subgingival microbiomes and increased abundance of P. gingivalis compared with controls.

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"Prednisone >30 mg/day for > 4 weeks, patients should be on PJP prophylaxis." Image shows when to start/stop PJP prophylaxis Dr. Kevin Winthrop on Risks/Prevention of OI @UTSWRheum Grand Rounds @rheumnow https://t.co/nXuWYRxbgy

k dao KDAO2011 ( View Tweet)

Oct 05, 2020

Utilization study of 1031 tofacitinib vs 17,803 biologic DMARD Rx-patients shows 14% higher discontinuations w/ TOFA (HR 1.14), but pts who switched to tofacitinib from a bDMARD had longer persistence than pts switched to another bDMARD (HR 0.90) https://t.co/5cqloTTbjb

Links:

https://bit.ly/3nkAANg

Dr. John Cush RheumNow ( View Tweet)

Oct 05, 2020

Hellenic reigstry of 385 RA pts on DMARDs finds that, compared to remission or LDAS - those in persistent moderated disease activity had 50-80% more serious adverse events. https://t.co/3JA3VaMxeO

Links:

https://bit.ly/3jAyXcc

Dr. John Cush RheumNow ( View Tweet)

Oct 05, 2020

Danish comparison of 15K RA, 301K Diabetes adn 75K gen population; RA assoc w/ increased risk of CHF (HR 1.51), MI (HR 1.58), stroke (HR 1.22) vs gen. population; but RA had 20-40% lower CHF/MI/CVA than diabetes pts (who had highest 10 yr mortality). https://t.co/R20EUPAlML

Links:

https://bit.ly/33gT5dP

Dr. John Cush RheumNow ( View Tweet)

Oct 02, 2020

RheumNow Podcast is up! COVID effects on Rheum; drug approvals, Difficult RA, SLE complement & remission. Watch it here> https://t.co/490T6k1ytk or listen to the podcast on iTunes> https://t.co/FHJv01AAbC OR on souncloud> https://t.co/dAJ0827c3B

Links:

https://bit.ly/33lRJyo

Dr. John Cush RheumNow ( View Tweet)

Oct 02, 2020

RheumNow Podcast is up! COVID effects on Rheum; drug approvals, Difficult RA, SLE complement & remission. Watch it here> https://t.co/490T6k1ytk or listen to the podcast on iTunes> https://t.co/FHJv01AAbC OR on souncloud> https://t.co/dAJ0827c3B

Links:

https://bit.ly/2WXXRIy

Dr. John Cush RheumNow ( View Tweet)

Oct 02, 2020

RheumNow Podcast is up! COVID effects on Rheum; drug approvals, Difficult RA, SLE complement & remission. Watch it here> https://t.co/490T6k1ytk or listen to the podcast on iTunes> https://t.co/FHJv01AAbC OR on souncloud> https://t.co/dAJ0827c3B

Links:

https://bit.ly/33nVdAt

Dr. John Cush RheumNow ( View Tweet)

Oct 02, 2020

RA Hands Difficult deformity

Defining Difficult Rheumatoid Arthritis

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d Jack Cush, MD

Oct 01, 2020

‘Difficult-to-treat RA’ is an oft-used term that carries various clinical qualities and therapeutic disappointments. A EULAR Task Force was established to develop recommendations for the management of difficult-to-treat rheumatoid arthritis and as a first step, have put forth their definition of this rheumatoid arthritis (RA) subset.

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Swiss cohort of 666 axSpA, RA & PsA pts seen before, during & after COVID; consults dropped 52%, remote visits increased 129%, & non-compliance slightly increased during COVID (axSpA 20% vs 13% before, p=0.003); but no incr in flares(<15%) or Dz activity https://t.co/lWb7WCwGbN

Links:

https://bit.ly/3cMZ1OK

Dr. John Cush RheumNow ( View Tweet)

Oct 01, 2020

14203 early RA cohort looked at adherence to quality standards of care (DMARD use, steroids, early F/U care) and showed adherence lessened need for future hospitalisation (adj HR 0.85); most impact from early DMARDs, worst from steroid use https://t.co/hzICGWyht2

Links:

https://bit.ly/3iib5IX

Dr. John Cush RheumNow ( View Tweet)

Sep 30, 2020

Today Janssen announced the FDA has approved golimumab (Simponi Aria) for use in children (> 2yrs) with active Polyarticular Juvenile Idiopathic Arthritis and for pediatric Psoriatic Arthritis https://t.co/ntWJXjEJvc

Links:

https://prn.to/2GqJyba

Dr. John Cush RheumNow ( View Tweet)

Sep 30, 2020

Pfizer announced the FDA has approved tofacitinib (Xeljanz) in children (>2yrs) w/ polyarticular JIA. Approval based on a 225 pt, Phase 3, 18 wk Open Run-in followed by 26-wk randomized, withdrawal study of placebo vs tofa 5 mg qd (or wt based oral soln) https://t.co/9Xo3lriINH

Links:

https://bwnews.pr/3jc3o8r

Dr. John Cush RheumNow ( View Tweet)

Sep 28, 2020

Among a 112 patient inflammatory myositis cohort, inclusion body myositis was rare (4 pts) - they tend to be older (67 yrs), male predominance, lower CK (1326-1968), less severe weakness 3.75/5) and poor response to immunosuppressives. https://t.co/VxLOAjstWo

Links:

https://bit.ly/3cCkl9u

Dr. John Cush RheumNow ( View Tweet)

Sep 28, 2020

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Filgotinib Approved by the EMA for Rheumatoid Arthritis

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d Jack Cush, MD

Sep 27, 2020

On Friday, Gilead and Galapagos announced that the European Commission (EC) has granted marketing authorization for filgotinib (trade name, Jyseleca) their oral, once-daily, JAK1 inhibitor for the treatment of adults with moderate to severe active rheumatoid arthritis (RA) who have resp

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Swedish GWAS study of >850,000 individuals shows Genetically predicted BMI (obesity) significantly increases RA riskk, but no correlation of RA risk to waist-to-hip ratios. https://t.co/YkzwjPOVyE

Links:

https://bit.ly/2RRAsqi

Dr. John Cush RheumNow ( View Tweet)

Sep 24, 2020

young.doctors.business.talent

Young Adults are Driving Up COVID-19 Rates

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d CDC/MMWR

Sep 23, 2020

CDC reports that since June 2020 individuals infected with COVID-19 have largely been young adults in the 20-29 year age bracket. Moreover, younger adults appeared to be driving community transmission of COVID-19.

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Cluster analysis of 168 antiphospholipid pts shows that having arterial thromboses and cardiovascular risk factors was associated with mortality and poorest prognosis in APS. https://t.co/Nb7lZNu4jT

Links:

https://bit.ly/2Hj6eKB

Dr. John Cush RheumNow ( View Tweet)

Sep 23, 2020

Ann Int Med shows again that steroids increase serious infection risk in a dose dependenet manner, but even 5 mg of prednisone or less also gives a small but significant risk of serious infection in RA patients on DMARDs (claims data from Medicare & Optum) https://t.co/bj41SqKP0K

Links:

https://bit.ly/3iVkGGA

Dr. John Cush RheumNow ( View Tweet)

Sep 22, 2020

Outcomes survey of 229 relapsing polychondritis patients shows that 59% had auricular-onset (AO) and 21% had respiratory -onset (RO), 20% w/ miscellaneous-onset (MO- eye MSK CNS). Poorer prognosis seen in RO & MO subgroups than AO subgroups https://t.co/rzVU42z3EA

Links:

https://bit.ly/2ZUeUxq

Dr. John Cush RheumNow ( View Tweet)

Sep 22, 2020