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Variability of Guidelines on the Perioperative Use of DMARDs in Rheumatic Diseases Patients
More effective treatments in patients with rheumatic diseases have resulted in less need for major surgery, yet a substantial number of RMD patients will undergo surgery often in the setting of DMARDs use. A scoping review looked at numerous clinical practice guidelines/recommendations for the perioperative management of DMARDs and found inconsistencies and low quality evidence, with great reliance on conditional (expert opinion) recommendations.
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Rheumatology: Believe It or Not (4/25/2025)
Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Should we believe the reviews and metanalyses?
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Earlier ACL reconstruction and a lower risk of knee osteoarthritis
EurekAlert!
A preclinical study by HSS investigators found that earlier anterior cruciate ligament (ACL) reconstruction led to lower immune cell activity, less inflammation and fewer joint changes associated with knee osteoarthritis compared to delayed surgery.
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Hospital for Special Surgery (HSS) reports that ear acupuncture applied during hip replacement surgery reduces pain and lessens opioid use over the weeks to follow. https://t.co/lOrwb1DzW5 https://t.co/6rkHNTwaAl
Dr. John Cush RheumNow ( View Tweet)
Tarsal Tunnel Syndrome: An Ultrasound Pictorial Review
https://t.co/Qr4ehZo41p
Tarsal tunnel syndrome (TTS) is an entrapment neuropathy caused by compression of the posterior tibial nerve or its branches as they pass beneath the flexor retinaculum at the medial ankle. Clinical https://t.co/FivPCl7EvU
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sergio serrano belmar sserranobmsk ( View Tweet)
PT in RA - Metanalysis of 17 RCTs, 1362 pts Rx w/ aerobic/resistance exercise, hydrotherapy, manual Rx, electrotherapy, multimodal Rx. 5 RCTs (n 307) signif reduced pain (SMD −0.347; interpreted as a small to medium effect favoring PT. https://t.co/UJGSGrgMV0 https://t.co/n4DzMSm9iJ
Dr. John Cush RheumNow ( View Tweet)
Survival in #RA pts undergoing cervical spine surgery is not good! Retrospective study of 139 RA pts who underwent Cx surgery shows higher mortality risk if they are older, w low albumin levels, high-dose pred. and have subaxial subluxation. https://t.co/hKvgaas2gh https://t.co/ygtJjb4mVl
Dr. John Cush RheumNow ( View Tweet)
Variability of Guidelines on the Perioperative Use of DMARDs in Rheumatic Diseases Patients
More effective treatments in patients with rheumatic diseases have resulted in less need for major surgery, yet a substantial number of RMD patients will undergo surgery often in the https://t.co/gjJOjZhSHU
Dr. John Cush RheumNow ( View Tweet)
Genicular nerve block (GNB) is effective intervention for Knee OA. Metanalysis of 6 RCTs & 420 KOA pts. GNB significantly reduced pain & improved function (p<0.003), w/ significant relief as early as 2wks and function by 12 weeks. https://t.co/wC2dPvVR7x https://t.co/HCFSXBfVGM
Dr. John Cush RheumNow ( View Tweet)
Genicular nerve block (GNB) is effective intervention for Knee OA. Metanalysis of 6 RCTs & 420 KOA pts. GNB significantly reduced pain & improved function (p<0.003), w/ significant relief as early as 2wks and function by 12 weeks. https://t.co/NMtiQPICpw https://t.co/gVJ0TyuY01
Dr. John Cush RheumNow ( View Tweet)
@RheumNow So rheumatoid nodule treatment might target some of that pathophysiology. Rituximab, abatacept, or JAKi?
And while surgery often isn’t great (plus they often grow back), definitely an option for some.
Christopher Edwards #EULAR2025 @RheumNow https://t.co/sFWnQN8uC4
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David Liew drdavidliew ( View Tweet)
1 shot will do!
#symptomatic #Knee #OA given #gene #therapy #intra-#articular
Seemed to last up to 104 weeks!
But no placebo
small safety study but sustained #WOMAC responses
Needs large #RCT but v interesting
#EULAR2025 @RheumNow @eular_org
Abst# POS0492 https://t.co/hqTqBorrbA
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Janet Pope Janetbirdope ( View Tweet)
Bullhead Sign in #SAPHO Syndrome
▶️Synovitis,
▶️Acne
▶️Pustulosis
▶️Hyperostosis
▶️Osteitis
👉🏽https://t.co/ownI4Q543w
via @MayoProceedings https://t.co/FXlTtmsDDX
Dr Ai Lyn Tan DrAiLynTan ( View Tweet)
Shanghai hospital retrospective cohort study of 249 pts w/ post-Unilat TKA & lat knee pain. 144 Rx w/ IA steroids vs 105 Rx w/ PO meds. Infection rate w/in 6 mos post-TKA found no signif difference (2.1% vs 2.9%); Injx pts had signif better pain relief, QOL & knee function (KSS) https://t.co/ULVO6KU7pn
Dr. John Cush RheumNow ( View Tweet)
JAMA Staphylococcus aureus Review
- s. aureus bacteremia leads to septic arthritis (7%), vertebral osteomyelitis (≈4%)
- bacteremia (≥48 hs) has 39% 90-day mortality risk
https://t.co/1UQoz7JDPU https://t.co/xTAkakv2he
Dr. John Cush RheumNow ( View Tweet)
Consensus Against Interventional Injections for Chronic Spinal Pain
BMJ has published a clinical practice guideline resulting from the work of an international, multidisciplinary panel addressing chronic spine pain (≥3 months duration) not associated with cancer or https://t.co/mCsz88JACh
Dr. John Cush RheumNow ( View Tweet)
Joint Implant Metals May Be Leaking
Patients with metal-containing joint replacements had significantly higher concentrations of cobalt in their cerebrospinal fluid (CSF) relative to patients without arthroplasties, researchers reported.
https://t.co/ubDhWqtTSL https://t.co/GjMnog8mcJ
Dr. John Cush RheumNow ( View Tweet)
Consensus Against Interventional Injections for Chronic Spinal Pain
BMJ has published a clinical practice guideline resulting from the work of an international, multidisciplinary panel addressing chronic spine pain (≥3 months duration) not associated with cancer or https://t.co/PfXM210PsZ
Dr. John Cush RheumNow ( View Tweet)
Peripheral Nerve Blocks for Hip Fractures
JAMA reviews the use of peripheral nerve block with hip fractures as an effective pain management strategy that can be performed by credentialed clinicians outside of the operating room.
https://t.co/baeLWVxeUo https://t.co/ZBTVDT0jGR
Dr. John Cush RheumNow ( View Tweet)
Japanese study of hip replacements (THA) - #RA pts undergoing THA at higher risk for dislocation and reoperation. Retrosp database study of THA - matching 3,951 RA vs 11,853 OA. w/ RA incr risk of dislocation (OR 2.8) & reoperation (OR: 2.25). No diff infx, Fx, VTE, death… https://t.co/Mz8niRlFaa https://t.co/mgcXTnw5Al
Dr. John Cush RheumNow ( View Tweet)
