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Rheumatoid Arthritis Thrombotic Risk Influenced by DMARD Choice

Jack Cush, MD

RA patients have an increased risk of venous thromboembolism (VTE) related to disease activity and inflammation, yet a large real-world study of older RA patients shows methotrexate to be associated with a 2-fold increased VTE risk (compared to hydroxychloroquine).

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How Should Patients With Autoimmune Diseases Approach COVID Vaccination?

MedPage Today

Healthcare is a personal and individualized relationship between a provider and patient. Each patient is treated according to their particular symptoms and personal health characteristics.

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RheumNow Podcast – Rheumatologist Smoke-Enders (10.22.2021)

Jack Cush, MD

Today I have a few questions: Is tramadol really a weak narcotic? Should we really still be doing placebo-controlled trials? What are we going to do about our patients who are smokers? This and more, in this week's review of the news and journal articles.

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Smoking Impairs Methotrexate Efficacy

Jack Cush, MD

The Journal of Rheumatology reports that current smoking significantly reduces the clinical efficacy of methotrexate (MTX)-based therapy, as studied in an early rheumatoid arthritis (RA) cohort.

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Heart Failure in RA: Inflammation Matters

MedPage Today

Patients with rheumatoid arthritis (RA) who had high levels of inflammation at baseline were at increased risk for later heart failure, a large cohort study found.

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Is It OK to Continue TNF Inhibitors with COVID-19 Infection?

Jack Cush, MD

Registry level data of patients with immune-mediated inflammatory diseases (IMIDs) diagnosed with COVID-19 should continue their TNF inhibitor (TNFi) therapy as such patients were less likely to experience adverse COVID-19 outcomes (compared to other immunomodulatory treatments).

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Are You a High or Low Glucocorticoid Prescriber?

Jack Cush, MD

A recent analysis shows thta glucocorticoids (GCs), usually recommended for short-term use in rheumatoid arthritis (RA), are variably used by rheumatologists, and that provider preference is a strong predictors of long-term glucocorticoid use.

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RheumNow Podcast – Quackademia (10.15.2021)

Jack Cush, MD

Dr. Jack Cush reviews the FDA approvals, news and the latest journal articles from the past week on RheumNow.com.

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Nature has published a full read over of "Homing in on an oral link to inflammatory disease" how the microbiome may be a pathogenic link to diseases like RA. https://t.co/wwB9Eg9nsH

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Baricitinib long-term safety in #RA - 3770 pts (14744 PYs). Incid rates/100 pt-yrs: - Serious infx 2.6 - H. Zoster 3 - MACE 0.5 - In pts ≥50yr w/ ≥1 CV risk MACE = 0.77 for 1st 2 yrs, then 0.6 - Cancer SIR 1.07 w/ low SMR 0.74 - DVT/PE risk 0.5 & 0.4 https://t.co/amdzvXSZb4 https://t.co/3Si98fL6Z9

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Dr. John Cush RheumNow ( View Tweet)
Rheumatoid Arthritis Thrombotic Risk Influenced by DMARD Choice https://t.co/gOLhO2aNOo https://t.co/FwKP3slExA

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Dr. John Cush RheumNow ( View Tweet)
Rheumatic pts admitted to ICU, #SLE is most common & Sepsis most common reason. 80 ARD pts adm to ICU: Dx were SLE (42%), RA (26%), vasculitis (12%) FOR Sepsis (31%), (10%) CHF (10%). 20% died in ICU, 5% 30d after ICU, 7.5% w/in 1 yr https://t.co/lX0m3vOukI

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Dr. John Cush RheumNow ( View Tweet)

Short (3 min) walks intstead of sitting benefits RA w/ anticytokine effect (TNF, IL1RA), improved glucose, c-peptide, insulin. Crossover study 15 RA women who had 1) prolonged sitting, 2) 30-min mod-vigor exercise or 3) 3-min of light walking every 30 min https://t.co/36AnhHL9OI

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Dr. John Cush RheumNow ( View Tweet)

New podcast up! Rheumatologist Smoke-Enders https://t.co/o35tuNgk8R https://t.co/iEqVoggl32

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Dr. John Cush RheumNow ( View Tweet)
Risk of Herpes zoster from upadacitinib RCTs: UPA > ADA > ADA+MTX > MTX. 5306 RA pts, HZ/100 Pt-Yrs was 0.8 MTX mono; 1.1 ADA+MTX; 3.0 UPA 15 mg and 5.3 UPA 30 mg. 71% of UP HZ cases involved a single dermatome. Higher risk w/ prior HZ & Asians https://t.co/0QUvXmFrJ3

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Dr. John Cush RheumNow ( View Tweet)

ICYMI: Hepatitis B Reactivation with Rituximab and Abatacept A serologic study of rheumatoid arthritis patients shows that HBV reactivation is seen with rituximab, and less so with abatacept, especially in patients without HBsAb positivity. https://t.co/l1qCrWCyZd #RheumNow https://t.co/EUoWt9xGdB

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Dr. John Cush RheumNow ( View Tweet)
ICYMI: Triple DMARD Rx - MSH vs MLH (Lef). 136 active #RA pts given OL MTX/SSZ/HCQ vs MTX/HCQ/LEF. Equal efficacy (EULAR-Good) was seen at wk 12 (54% vs 59%) and wk 24 (65% vs 62%) - hence LEF substitution was noninferior. https://t.co/F5CGj0w7Bh https://t.co/OuDMgNIKTA

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Dr. John Cush RheumNow ( View Tweet)
CXCL13 predicts worse Xray status in early #RA. Study of 158 pts, followed 11-years. Baseline CXCL13 correlated with Xray progression (ΔTSS) at 11 years. CXCL13 was superior to CRP, DAS28CRP, SJC28, CCP predicting 11-yr Xray damage https://t.co/1WAdZoYQ1P

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Dr. John Cush RheumNow ( View Tweet)

Among 2359 RA & PsA pts (3169 TNFi courses 1778/1391), serious infection (SIE) rates were higher in RA 4.17/100PY vs PsA 2.16/100PY. PsA had 41% lower SIE risk (HR 0.59, p=0.004) - Registry data from the NOR-DMARD study https://t.co/llH07TFHOI

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Retrospective study hospitalized new-onset systemic JIA (2008-19):52 children’s hospitals & 534 sJiAshows 29% rx w/ biologics & 58% steroids. Over time Biologic use increased & MTX decreased. Biologic correlated w/ Hi hospital volume, ICU stay, later years https://t.co/blbOps9zVQ

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Dr. John Cush RheumNow ( View Tweet)

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