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Implementing Smoking Cessation Programs

Jack Cush, MD

Rheumatologists are keen to the effects of smoking (increased arthritis risk, worse outcomes, blunted DMARD responses, added cardiopulmonary risks), but often do not have the resources or plan to encourage or implement smoking cessation from the rheumatology clinic. A new study details the success of a rheumatology staff‐driven protocol, Quit Connect, to increase the rate of electronic referrals to free, state‐run tobacco quit lines.

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Rheumatology Care Derailed by COVID-19

Jack Cush, MD

A survey study from the  ArthritisPower PPRN or CreakyJoints database shows that during the COVID-19 pandemic patient care was substantially affected in unforeseen ways.

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RheumNow Podcast – Upadacitinib Wins in PsA (4.2.2021)

Jack Cush, MD

Dr Jack Cush reviews the news and Journal reports and takes "Back Talk" questions from viewers.

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Inflammatory Conditions Up the Risk of Premature Myocardial Infarction

Jack Cush, MD

The European Journal of Preventive Cardiology reports that younger patients with their first myocardial infarction before age 50 yrs have a higher risk of having a systemic inflammatory disease (SIDs) and higher rates all-cause mortality.

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Beijing study of 207 RA patients starting DMARD and steroids (GC) shows after 3 years only 59% D/C GC (mean was 24 mos). Odds of stopping GC were 10% @ 6mos, 27% @Yr1, 48% @Yr 2 and 59% at 3 years. https://t.co/E2RchB9IAs https://t.co/uDEAqaM8GC

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Dr. John Cush RheumNow ( View Tweet)
New podcast up! Download wherever podcasts are available. Upadacitinib Wins in PsA Dr Jack Cush reviews the news and Journal reports and takes "Back Talk" questions from viewers. https://t.co/ZMAUgn10dU https://t.co/QTDqZW3GgG

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Dr. John Cush RheumNow ( View Tweet)
Another study suggests poorer outcomes in Rheum pts on Rituximab. French Cohort study of 1090 inflammatory rheumatic MSK pts -13% w/ severe COVID-19 & 8% who died. 63 RTX pts had more severe disease, longer hosp stays & more death (21% vs 7%) https://t.co/5UCvFeVWRS

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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/828kcG53iz

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Dr. John Cush RheumNow ( View Tweet)

Matched cohort Nurses’ Health Study looked at 283 pre‐RA pts (mean 9.7 years before RA Dx) and and 842 controls; 21% pre‐RA were ACPA+. ACPA+ was associated with increased risk of COPD (HR 3.04) that was not seen in ACPA- pts. https://t.co/HNB11eAiva

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Dr. John Cush RheumNow ( View Tweet)

Dr. Olga Petryna ( @drpetryna) weighing the future Rx in RA by Dr. Fleischmann: -CD22, new IL6i & GM-CSF show promises but far form being available -bDMARD or tsDMARD after MTX but work better wMTX -JAKS better choice for mono-therapy but safety is a concern #RNL2021

Dr. John Cush RheumNow ( View Tweet)

#RNL2021 coverage from @doctorRBC ACR’s conditional recommendations for tx of specific RA populations #RheumNow https://t.co/3uo9x42bPX
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/11vJCWOdSG https://t.co/yMF6imuFMV

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Dr. John Cush RheumNow ( View Tweet)
From Dr. Petryna ( @DrPetryna ) on Pneumonia & RA #RNL2021 : -PNA most common hospital inf in RA and main cause of hosp mortality -seropositivity assoc w/increase risk of PNA -COPD+RA bad combo: increase PNA & mortality #RheumNow https://t.co/IgXfJTMrcn
Dr. John Cush RheumNow ( View Tweet)
Metanalysis of 32 studies shows most forms of arthritis assoc w/ incr risk of CVA (ischemic stroke: RR=1.53 or hemorrhagic stroke: RR=1.45), esp for RA (RR=1.38), AS (RR=1.49), PsA (RR=1.33), gout (RR=1.4) --risk higher with age <45 years (RR=1.46) https://t.co/YDiebrqtbi

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Dr. John Cush RheumNow ( View Tweet)

From @KDAO2011 for #RNL2021 Is it better to taper the steroids or leave it? SEMIRA study. Tapering off low dose steroids cause more flares and more treatment side effects. Dr. Buttgereit says keep your low dose steroids (prednisone 5 mg/day or less) https://t.co/FpQnxUKWwF

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Dr. John Cush RheumNow ( View Tweet)

A prevention trial shows atorvastatin failed to prevent RA onset - 62 pts with preclinical RA (arthralgia, +CCP/RF) randomized to PBO or statin. After 14 mos, arthritis developed in 29% with atorvastatin and 19% with placebo. https://t.co/HikuDkwNu7 https://t.co/QyGy81lgcq

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Dr. John Cush RheumNow ( View Tweet)
Liver Management in RA - #RNL2021 Highlight by @DrPetryna While RA is not known to affect the liver directly, underlying liver disease and treatment-related effects on the liver can often become an obstacle in the mgmt of many RA patients. https://t.co/OeuloDIXMF

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Dr. John Cush RheumNow ( View Tweet)

#RNL2021 Highlights: Future Therapeutics for Rheumatoid Arthritis and Lessons Learned https://t.co/NxLyHeI2f4 https://t.co/df7lPEia0D

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Dr. John Cush RheumNow ( View Tweet)
Claims data analysis (MarketScan, Medicare, Optum) of 87,653 RA patients starting either TNF inhibitor or tofacitinib shows venous thromboembolism (VTE) is rare (<1 per 100) RA Rx with either. VTE risk was same for Tofa and TNFi (HR of 1.13 [0.77-1.65]) https://t.co/UoMQRp12vo

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Dr. John Cush RheumNow ( View Tweet)

Dr. Fleischmann vs. Dr. Matsumoto: get rid of MTX vs. get rid of biologic in RA remission. Both argue on sustained remission, risk for anti-drug antibodies, longterm safety. Dr. Buch’s perfect answer… “it depends on patient’s preference, cost.” #RNL2021 https://t.co/FBf2uoDx0B
k dao KDAO2011 ( View Tweet)
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