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RA.gout.hand.MCP

Coexistent Gout and Rheumatoid Arthritis

d Jack Cush, MD

While it is often said there is a negative association between gout and rheumatoid arthritis (RA), cases of coexistent disorders are uncommonly seen. A recent VA study describes 121 patients whith both RA and gout.

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A Genetic Probability tool used to calculate risk of rheum Dz in 3 pt cohorts (1211 eMERGE, 245 Partners & 243 early inflam arthritis. Dx AUc: 0.69, 0.81 & 0.84. Likely dx made in 64% & r/o in 45%. ?Could be used to improve Dx accuracy in clinical practice?https://t.co/JiRIxtx3j5

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Dr. John Cush RheumNow ( View Tweet)

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Premature Atherosclerosis in Autoimmune Rheumatic Diseases

d Jack Cush, MD

The VITAL study is a VA registry that has shown that both systemic lupus erythematosus  (SLE) and rheumatoid arthritis (RA) patients carry higher odds of both premature and extremely premature atherosclerotic cardiovascular disease and its consequences.

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Schulz-Koops reports 2 #RA patients Rx with RTX who died from COVID pneumonia and ARDS. Both were older, had comorbidities (COPD, HTN, OP) and had received last RTX either 2 wks and 6 mos before COVID infection onset; both had nl IgG levels https://t.co/j043Tggdbg

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Dr. John Cush RheumNow ( View Tweet)

sick.child

COVID's Multisystem Inflammatory Syndrome in Children

d Jack Cush, MD

Two recent reports further characterize the newly described, Kawasaki-like,  syndrome affecting children with COVID-19 infections.

The NEJM describes the childhood syndrome as having Kawasaki’s disease, fever, toxic shock syndrome, acute abdominal conditions, and encephalopathy; hence the label Childhood Multisystem Inflammatory Syndrome. The disorder emerged in late April 2020, first in the U.K., and then similar cases were reported from many other countries. The CDC named this multisystem inflammatory syndrome in children (MIS-C).

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Increased rate of hospital #COVID-19 cases associated with some but not all chronic #inflammatory or #autoimmune conditions compared with reference population. The risks seem to depend on age, the specific disease and previous therapies. https://t.co/8j6R0oO99y https://t.co/n3cEXFx9Kk

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ARD & RMD Open ARD_BMJ ( View Tweet)
Now with ~1,000 children and adolescents with multi-inflammatory syndrome in children (MIS-C), it can be considered a new disease. Today new @NEJM reports and an editorial on its status. I've made a summary of some key points to start https://t.co/1HSWSvumpv
Eric Topol EricTopol ( View Tweet)
60,596 RA Medicare patients with MBDA testing showed in those not taking biologic/JAK inhibitor Rx, the odds of adding new Rx was 9.0% (with a low MBDA), 11.8% (moderate MBDA), and 19.7% (high MBDA, p < 0.0001). Higher MBDA yields more Drug switches https://t.co/Tu7jChQi06

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Dr. John Cush RheumNow ( View Tweet)

Global prevalence of juvenile idiopathic arthritis is ~ 2,069,246 < 16 year olds compared with a prevalence of ~ 206,931 < 16 year olds with juvenile SLE. JIA is 10 times more prevalent than lupus in children < 16yrs. https://t.co/2xvhg59c1J

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Dr. John Cush RheumNow ( View Tweet)

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RheumNow Podcast – Lupus Mortality Declines, But… (6.26.20)

d Jack Cush, MD

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

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Retrospective study of 2369 patients with Kawasaki disease examined different doses of aspirin showing lower ASA doses of 20–29 mg/kg/day was as effective as 30–50 mg/kg/day in preventing coronary artery aneurysms with no change in IVIG resistance https://t.co/kJgkSSpjyw

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Dr. John Cush RheumNow ( View Tweet)

Study of 1362 #RA patients given TNF inhibitors, abatacept, tocilizumab between 2011-17 finds TCZ had best survival regardless of age; ABA had lowest D/C for adverse events & disease activity improved more with TNFi. https://t.co/7RRO9M4Wf0

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Dr. John Cush RheumNow ( View Tweet)

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TNFi Cycling vs. Swapping Biologics in Rheumatoid Arthritis

d Jack Cush, MD

For years, rheumatologists would rather fight to stay on a TNF inhibitor (TNFi) than switch to a non-TNFi biologic when rheumatoid arthritis (RA) therapy fails.

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Tocilizumab may be effective in refractory ocular-, neuro-, vasculo-Behcet's. Study of 47 Behcet's pts Rx w/ TCZ - good at ocular (24/25), CNS (6/6), vascular (7/7) & amyloidosis(2/2) but less effective w/ oral/genital (8/21), skin (6/14) or joints (4/11) https://t.co/lKY8D706bi

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Dr. John Cush RheumNow ( View Tweet)

TNFi, ABA, TCZ Retention rates looked at in 1362 RA according to age. For < 65 years, 3-year retention was best for TCZ 69%. For pts 65–74 years, retention rates highest for TCZ . For ≥ 75 years, 3-year retention rates best for ABA & TCZ (63% & 58%). https://t.co/7RRO9M4Wf0

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Dr. John Cush RheumNow ( View Tweet)

Comparison of elderly-onset (>60yrs) #RA (EORA) to younger-onset (YORA) finds significantly more treatment resistant synovitis and Xray progression in EORA pts with worse overall prognosis compared to YORA (clinical, UA, and pathology). https://t.co/17XSz3Ilap

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Dr. John Cush RheumNow ( View Tweet)

Metanalysis of 8 studies and >130,000 patients shows that IBD (Crohns & UC) have a significantly higher risk of developing #RA (RR = 2.59; 95% CI: 1.93–3.48). https://t.co/ipYRZ6DQPQ

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Dr. John Cush RheumNow ( View Tweet)

Pt w/ severe systemic JIA & recurrent macrophage activation syndr underwent whole exome sequencing & found to have gain in function CASP1 variant leading to inflammasome & NF-κB hyperactivation (hi IL-6, IL-1β IL-18, IFNγ) Rx w/ IL-1 & IL-6 inhib https://t.co/SE3p5CTEak

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Dr. John Cush RheumNow ( View Tweet)

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Adverse Events With Rheum Biologics Rise With Age

d RheumNow

Among patients with rheumatic diseases, age and female sex were important factors associated with the development of a first adverse event after initiating biologic treatment, Spanish researchers reported.

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WHO global safety database shows increased risk of DVT & PE with tofacitinib & baricitinib, who were likely to be older with preexisting VTE risk. In EU, TOFA risk for DVT/PE was OR 2.3; BARI risk was OR 3.4. No VTE risk for BARI in US, TOFA 2.0 VTE risk https://t.co/PUBUzfrydn

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Dr. John Cush RheumNow ( View Tweet)

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