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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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ICYMI: Anti-inflammatory Diet Control of Rheumatoid Arthritis

Jack Cush, MD

The TOMORROW study assessed the relationship between diet and disease activity in rheumatoid arthritis (RA) patients and has shown that RA patients are more likely to have higher inflammatory diets, but that a change to an anti-inflammatory diet resulted in lower disease activity s

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2020 Year Review

ICYMI: 2020 Rheumatology Year in Review

Jack Cush, MD

2020 was historic, memorable and game-changing. Under the cloud of COVID-19, there were many significant and memorable advances and setbacks for the rheumatology world. In our accounting of most read articles for 2020, (not surprisingly) 17/20 were COVID-related.

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ICYMI: EULAR Guidelines on Intraarticular Therapy

Jack Cush, MD

EULAR has published evidence-based recommendations on the use of intra-articular therapies (IAT) based on the literature review and recommendations of a multidisciplinary international task force. These IAT recommendations apply to adult patients with peripheral arthropathies.

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ICYMI: Cardiac and Cancer Signals Tofacitinib Safety Alert from FDA

Jack Cush, MD

The FDA has notified healthcare professionals of a safety alert concerning tofacitinib (Xeljanz), noting that preliminary results from a long-term safety clinical trial show an increased risk of serious heart-related problems and cancer with tofacitinib (compared to adalimumab) when given to at-risk rheumatoid arthritis patients. These findings are in addition to the thrombotic risks (added to the label), potential risks including blood clots in the lungs and death.

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ICYMI: JAK Inhibitor Misses Endpoint in Safety Study. Now What?

MedPage Today

Pfizer announced results Wednesday from its FDA-mandated postmarketing safety study of tofacitinib (Xeljanz), and they don't bode well for the drug and possibly others in its class.

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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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Dr. John Cush RheumNow ( View Tweet)

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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Dr. John Cush RheumNow ( View Tweet)
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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Dr. John Cush RheumNow ( View Tweet)
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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Dr. John Cush RheumNow ( View Tweet)

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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Dr. John Cush RheumNow ( View Tweet)

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

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Dr. John Cush RheumNow ( View Tweet)

Rifampin is safest! 2 RCTs of 6485 latent TB pts compared 9 mos of isoniazid vs 4 mos of rifampicin. RIF had half the adverse events compared to INH; roughly half the rate of rash (1.5% v 2.7%); No grade 3-4 hepatotoxicity w/ RIF, compared 6%) w/ INH https://t.co/n1cVKyEPf6

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Dr. John Cush RheumNow ( View Tweet)

Comparison of oral and parenteral MTX shows oral MTX in RA is non inferior to subcutaneous MTX treatment (in 640 RA pts) with regard to disease activity, but oral MTX had fewer adverse events than SC ( 41% vs 52%, p= 0.005). https://t.co/WYcZU7M677

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Dr. John Cush RheumNow ( View Tweet)

"Arthritis Mutilans" - worse outcome to chronic inflammatory arthritis is due to 5 disorders: 1) RA 2) Psoriatic arthritis 3) Tophaceous gout 4) polyarticular JIA 5) Multicentric reticulohistiocytosis (Ive never seen this!!) https://t.co/XYmBEW1F0R https://t.co/010QYkOO7E

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Dr. John Cush RheumNow ( View Tweet)
Psoriasis has greatest risk of MTX liver dz - a Danish Population study of PsO, PsA & RA pts taking MTX. Risk of liver Dz was most in PsO, followed by PsA, then RA. PsO had 1.6-3.4 fold risk (mild-severe) liver dz (vs RA). PsA was 1.3-1.6x higher) https://t.co/pAo9KFr5fO

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Dr. John Cush RheumNow ( View Tweet)

1/3 of patients with rheumatoid arthritis had unacceptably high levels of pain 5 years after diagnosis, often despite low levels of inflammation, Swedish researchers found. Read more: https://t.co/K8zf1pE9jM https://t.co/eu2Byo6dx4

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Dr. John Cush RheumNow ( View Tweet)
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