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

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