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Rheumatoid Poor Outcomes Not Linked to Comorbidity

Jack Cush, MD

Disease activity leads to poor outcomes; but does comorbidity add to this?  A recent analysis suggests that while comorbidities do not affect long-term, functional outcomes, sociodemographic factors do affect outcomes in rheumatoid Arthritis (RA).

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DMARD Effects on COVID-19 Outcomes

Jack Cush, MD

Sparks and colleagues have published data from the Global Rheumatology Alliance noting that among rheumatoid arthritis (RA) patients afflicted with COVID-19 infection, there was little influence of their baseline biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drug

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Growing Cannabis Use in Arthritis Patients

Jack Cush, MD

The National Databank for Rheumatic Diseases reports a significant increased in cannabis use amongst arthritis patients between 2014-2019, suggesting patients are more frequently engaged in self-management of pain and the unmet need for a pain relieving, opioid-sparing alternative.

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Canakinumab Fails to Improve COVID-19 Survival

Jack Cush, MD

JAMA has published the findings of trial wherein the anti–interleukin-1β antibody canakinumab (CAN) failed to improve survival in patients hospitalized with severe COVID-19.

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Arthritis as a Harbinger of Pediatric Cancer

Jack Cush, MD

Lancet Rheumatology has published a cohort analysis showing that a small but significant subset of children presenting with arthralgia or arthritis may have a pediatric malignancy.

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Potential Birth Defects with Hydroxychloroquine

Jack Cush, MD

Hydroxychloroquine (HCQ) is one of the safest meds used in rheumatology, but there is new claims data suggesting a small increase in the risk of malformations associated with first-trimester HCQ use.

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New ACR Rheumatoid Arthritis Guideline: Emphasis on Methotrexate The ACR has issued new guidelines on the treatment of RA, addressing questions about initial treatment with methotrexate and minimizing reliance on glucocorticoids. https://t.co/J9wmcZr17D https://t.co/Tf3G9sFgm9

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Fracture Risk with Low Dose Steroid A large RA cohort analysis shows that low-dose glucocorticoid therapy in rheumatoid arthritis (RA) patients may carry an increased risk of vertebral osteoporotic (OP) fractures. https://t.co/HcYpx8IDcB https://t.co/iVPjJHLNBX

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Fracture Risk with Low Dose Steroid https://t.co/HcYpx8IDcB A large RA cohort analysis shows that low-dose glucocorticoid therapy in rheumatoid arthritis (RA) patients may carry an increased risk of vertebral osteoporotic (OP) fractures. https://t.co/1bc5nyZUzG

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Steroid (GC) withdrawal studied in T2T RA cohort of 207 RA pts (F/U 39 mos); Only 60% discontinued GC, w/ low risk of flare. BUT D/Cs were SLOW w/ only 9.7%, 26.6%, 48.0% & 58.6% at 6 mos, 1, 2 & 3 yrs - median time to cessation = 27 mos https://t.co/h02aueYKwN

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In a study of 15123 RA pts >50 yrs; 1640 osteoporotic fractures occurred. Low-dose glucocorticoids (≤7.5 mg/D) was not associated with overall risk of OP Fx (adj HR 1.14) but was assoc w/ increased risk of vertebral Fx (adj HR 1.59, 1.11–2.29) https://t.co/ZJtYAAQ3KW

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ICYMI: 263 RA patients with ILD were treated w/ Abatacept (ABA mono, ABA+MTX or ABA+nonMTX) - all improved their DAS28, stabilized their FVC, DLCO, Chest CT; Only difference was that steroid sparing best when ABA used in combo. https://t.co/1dGufcsRpC

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Study of 647 RA pts wanting to get pregnant finds only 3.9% SSA+ & 1.1% SSB+ (higher in RF+ pts); ~1/2 had SSA titre of >240 units/mL - but No cases of neonatal lupus or heart block seen. In a French register, SSA related CHB was 1.5% https://t.co/FmZzPpmB7D

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Carpal Tunnel Syndrome has an annual incidence of 0.4%. Population based study shows more likely in women, 50-59 years, w/ obesity, gout, rheumatoid arthritis or a prior hx of wrist injury. https://t.co/X7U5yh0R3l

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Rheums--Have a rheumatology question or case for Jack Cush? Record it here and we may feature it on an upcoming podcast. Tell us your name and where you practice rheumatology. https://t.co/wzNmOzH4VE https://t.co/kKoBTHWX6z

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ICYMI: New ACR Rheumatoid Arthritis Guideline: Emphasis on Methotrexate https://t.co/J9wmcZr17D https://t.co/9fUNrdVWuP

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Of 100 newly diagnosed #RA patients, Foot Involvement was the 1st manifestation in 29%. Pattern: 59% w/ forefoot involvement, 27% hindfoot and 14% midfoot. Pts were 58-63% RF+/CCP+. https://t.co/OGS2Fzfgg3 https://t.co/AKCj4pipYG

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Metanalysis of 33 clinical trials show that corticosteroids are anaglesic, especially in 1st 3 mos (mean drop VAS pain -12mm); after that benefit wanes to -8mm @3-6 mos and -6mm (95% CI, -10mm, -2mm) after  6 mos. https://t.co/IKZhqqwhPO

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Top June Tweet: Pain Persists in RA, Even Without Inflammation One-third of patients with rheumatoid arthritis had unacceptably high levels of pain 5 years after diagnosis, often despite low levels of inflammation, Swedish researchers found. https://t.co/K8zf1pE9jM https://t.co/XwdCXnktQN

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Dr. John Cush RheumNow ( View Tweet)
Septic arthritis MIMICs (all presenting as acute monoarthritis) - consider: cellulitis, bursitis, abscess, osteonecrosis, gout, pseudogout, Lyme, Osteomyelitis, reactive arthritis, Lyme disease,, Rheumatoid arthritis, & Transient synovitis (kids) https://t.co/uNirAcoBds

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