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CD19 CAR T-Cell Therapy in Autoimmune Disease

Jack Cush, MD

The NEJM has published the results of CD19 B cell depletion (by CAR-T cell therapy) in autoimmune disease patients, demonstrating it to be feasible, safe, and efficacious.

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Curbside Consults (2.16.2024)

Jack Cush, MD

Dr. Jack Cush answers audience clinical case questions sent by email or "ask Cush anything". Cases and questions from:

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VITAL Info on Autoimmune Disease (2.9.2024)

Jack Cush, MD

Dr. Jack Cush reviews the journal reports from the past week on RheumNow.com. Highlights are summarized by three songs: "Stairway to Heaven", "You're No Good", and "How Long (has this been going on)".

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Determinants of Gout Flares

Jack Cush, MD

Approximately 12 million US adults in the US have gout. Two recent literature reports highlight contributors to gout flares.

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Prevalence of Cardiovascular Disease in Rheumatoid Arthritis

Jack Cush, MD

A prospective study of the BioSTAR registry estimates the prevalence of cardiovascular disease in rheumatoid arthritis (RA) to be 4.6%.

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Methotrexate Nodulosis (1.19.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. How good (or not) are rheumatologists and what to do about MTX nodulosis?

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Rituximab Efficacy in MAINRITSAN Long-Term Studies

Jack Cush, MD

The original randomized controlled, prospective MAINRITSAN study of 115 patients (87 with granulomatosis with polyangiitis, 23 with microscopic polyangiitis, and 5 with renal-limited ANCA-associated vasculitis [AAV]) demonstrated superiority of rituximab (RTX) over azathioprine (AZA) for maintenance of remission at 22 months in ANCA-associated vasculitis patients after CYC remission induction.

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Increased CV Comorbidity in Dermatomyositis

Jack Cush, MD

A cohort study suggest that patients with dermatomyositis (DM) are at an increased risk for multiple comorbidities, including chronic kidney and cardiovascular disease,

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2023 Rheumatology Year in Review

Jack Cush, MD

Here is my top 10 list (in no particular order) of 2023 advances, game-changers, and developments that changed, or will soon change, rheumatologic practices.

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Best of 2023: Treatment and Management of Neuropsychiatric Lupus

Eric Dein, MD

At the 2023 ACR State of the Art conference in Orlando, Florida, Dr. Michelle Petri reviewed the treatment and management of neuropsychiatric lupus. Dr. Petri, a lupus expert from Johns Hopkins Rheumatology, reviewed the latest clinical and animal model studies that offer hope in treatment and gave wide-ranging pearls on a variety of issues that can be faced in this disorder. 

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Long-Term, open-label study enrolled EGPA (MIRRA study) required prednisolone ≥5 mg/d, pts cont mepolizumab 300 mg Sc q 4 wks +SOC. 100 pts - 71% completed, 3% d/C due to AEs. Exposure~38 mos; 38% serious AEs (30/100PYs) (worsening of asthma, EGPA https://t.co/GKxXN8p2Wz https://t.co/TFd9s3tfjK

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Dr. John Cush RheumNow ( View Tweet)
Retro study of 1,169 pts (age 66 yrs) receiving intra-articular steroids & changes on A1C. A1C increases were assoc w/ higher baseline A1C (OR 1.84) for A1C 7–8 (vs <7%) or A1C >8% (OR 4.8 ). YET most patients do not experience increase A1C after IACS https://t.co/eWyO0nHgdy https://t.co/4UQRbrUyz7

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Dr. John Cush RheumNow ( View Tweet)
Many #RA pts remain on Steroids despite b/tsDMARD use! Study 228 #RA pts, 68% Rx low-dose GCs (32% no GCs). After 3 yrsof b/tsDMARDs, 32% still on GCs, 23% D/C GCs, & 20% go on & off, 25% never took GCs. GCs use assoc w/ HTN (20 v 11%) & MI (2.3% vs 0) https://t.co/lWVfvJrAyp https://t.co/uTIWqDAjRG

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Dr. John Cush RheumNow ( View Tweet)
Do you have GCA patients on low dose prednisone? Feel reassured. Dr. @philseo provides data showing that low dose prednisone may be helpful in remission maintenance. #RNL2024 @RheumNow https://t.co/oyOsczfkfv

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Dr. Rachel Tate uptoTate ( View Tweet)
Do you need to pulse steroids in GCA? ACR 2022 abstract#0459 data says oral only may be sufficient Oral vs IV MP - p=0.621 Still favor IV in severe cases @philseo #RNL2024 @RheumNow

Eric Dein ericdeinmd ( View Tweet)

#RNL2024 @RheumNow @philseo: I now give Tociliizumab for nearly all patients with GCA GiACTA shows we weren't doing well enough with steroid monotherapy GiACTA shows dosing frequency does not make a big difference in new diagnosis, but makes a difference in relapsing disease https://t.co/JBgUQtZSAr

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Eric Dein ericdeinmd ( View Tweet)
Rapid GC taper in ANCA vasculitis #RNL2024 @RheumNow @anisha_dua PEXIVAS - reduced GC is safe, decreased ifns Retrospective real world - 234 pts. Reduced dose GC+RTX increased death/ESKD HR 2.42. No difference in infections https://t.co/SWIUSyVbWb

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Eric Dein ericdeinmd ( View Tweet)
QD Clinic - GCA & Steroid Weaning Weaning steroids in chronic GCA patient https://t.co/HtrzP43Ivr https://t.co/xZZlNmeqP1

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Dr. John Cush RheumNow ( View Tweet)
There is a dose, duration and recency-dependent relationship between previous GC use and MACE. GC doses 5mg/day, durations of 30 days, and use one year prior to MACE were all associated with an increased risk of MACE, Wallace B Abst#2430 #ACR23 #ACRBest https://t.co/VOUmsvAs2r https://t.co/LKtuuoD3xa

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Dr. John Cush RheumNow ( View Tweet)
Full Read review of #PMR in Lancet: - Start @ 12·5–25mg prednisone qd - Remission in most but, relapses in 40–60% - Onset sudden; AM stiffness predominates; Shoulders>Pelvic ~50% have distal MSK Sxs - US: look for B/L sub-acromial/deltoid bursitis https://t.co/NwrbdMMdLU https://t.co/eRls0fLMJs

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Dr. John Cush RheumNow ( View Tweet)
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