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Is MTX Safe in the Elderly? (12.1.2023)

d Jack Cush, MD

Dr. Jack Cush reviews this past week's news and journal reports from RheumNow.com. Good news is that nearly 99% of adult rheumatology positions matched! But the challenge is that 45% of pediatric fellowship programs and 39% of pediatric rheum slots were unfilled in the 2024 NRMP match.

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ICYMI: Do Probiotics Improve Psoriatic Arthritis?

d Robert Chao, MD

Psoriatic arthritis and the gut microbiome have become more intertwined, especially in the past few years. It was to my amazement that one of the first abstracts I came across was the effect of probiotic modulation on gut dysbiosis and disease activity in psoriatic arthritis patients. 

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Rheum Fellowship Slots Fill Up for 2024

d Jack Cush, MD

While adult rheumatology programs continue to have high match rates, pediatric rheumatology programs remain less popular.The National Residency Matching Program announced yesterday that the 2024 rheumatology fellowship match filled 97.6% (124/127) of programs, and 98.9% (273/276) of rheumatology fellowship positions. This is on par with last years (2023) adult rheumatology match wherein 97.8% (265/271) of the rheumatology fellow positions were filled.

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Next generation JAK-inhibition strategies

d Md Yuzaiful Md Yusof, MRCP(UK), PhD

It has been just over a decade since the approval of tofacitinib (JAK1/JAK3-inhibitor) by the US FDA for the treatment of rheumatoid arthritis. Since then, baricitinib (JAK1/JAK2-i), filgotinib and upadacitinib (both selectively targeting JAK1) also have been licensed for the treatment of rheumatoid arthritis. As there are many more JAK-inhibitors evaluated in clinical trials currently, how do you stand out?

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MTX Toxicity in Older CKD Patients

d Jack Cush, MD

You know this; you've taught this; but here's a good study documenting a higher risk of methotrexate toxicity when used in the setting of older patients with chronic kidney disease.

Yesterday's JAMA published a higher 90-day risk of serious adverse events in older adults with CKD taking low-dose methotrexate, compared to hydroxychloroquine.

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Study from British Columbia, Canada, showed between 2010 & 2020, they saw 31% more new pt rheum consults (149,902); 1st time consults for inflammatory arthritis incr 28% to 51%. While time to 1st visit decr. 35%, time to DMARD initiation was unchanged https://t.co/Et7GzxKeNe https://t.co/2as2YuIV4d

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Watch: Effects of Apremilast on Cardiometabolic Effects in PsA https://t.co/aKMxEfbc4c https://t.co/wjcEjLtlaC

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NEW Health Policy—Diagnosis and investigation of suspected haemophagocytic lymphohistiocytosis in adults: 2023 Hyperinflammation and HLH Across Speciality Collaboration (HiHASC) consensus guideline https://t.co/WYNcVigb7n Free to read with registration on https://t.co/28wkm59DgB https://t.co/Qbm1y76o3E

The Lancet Rheumatology TheLancetRheum ( View Tweet)
Real World Experience with PEXIVAS Low Steroid Taper Dr. Mike Putman discusses abstract 0725 with Dr. Sophie Nagle at the 2023 ACR Convergence meeting in San Diego, CA. https://t.co/lXTyb93ata https://t.co/kC6J9Zuurf

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What do you think of the concept of "dysuricemia" - the concept that both hyperuricemia and hypouricemia influence diseases. “The lower, the better” is incorrect; the ideal is to maintain normouricemia, or optimal SU level, to reduce the urate burden https://t.co/Vi9htWTNwr https://t.co/fsx9Oq08Ak

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Dr. John Cush RheumNow ( View Tweet)
Reconsidering Steroids Not one of us in rheumatology hasn’t prescribed steroids, but we need to reconsider how much/how often we use them. In almost every disease state we treat, we are seeing progression towards lesser and shorter courses . https://t.co/VRlCeNXyKR https://t.co/k5Uy7IHr3h

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TNFi and RA-ILD – The Pendulum Swings Again Tumour necrosis factor inhibitors (TNFi) revolutionised the treatment of rheumatoid arthritis. They heralded the wave of advanced therapies, which has transformed the treatment landscape in rheumatic disease. https://t.co/zBwJKyDihL https://t.co/uCLnmaLC9j

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Single center obs. study 74 RA-ILD pts Rx w/ antifibrotics (40 nintedanib; 34 pirfenidone); F/U 89 wks, had signif improvement in FVC estimated decline after antifibrotics (-0.3% w/ vs -6.2% w/o). 35% died, 4 lung transplants. 55% AEs, 46% D/C Rx https://t.co/s6O5uU3z2i

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Dr. John Cush RheumNow ( View Tweet)

#ACR23 Abst#1629 from FORWARD registry showed RA pts (n667) with LONG COVID (15%) had worse RA pre-COVID and post-infx, and had worse COVID (more ABx & hospitalization). RA-long Covid pts had 3fold more fibromyalgia (13 vs 41%) https://t.co/VFNAnSxNzN https://t.co/WLqmdM3Nn2

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Watch: No Increased Mortality in Patients with RA Receiving Checkpoint Inhibitors Dr. Mike Putman discusses abstract 1071 with Dr. Madeline O'Sullivan at the 2023 ACR Convergence meeting in San Diego, CA. https://t.co/YdIlhLf5gh https://t.co/6dfWHakboh

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Dr. John Cush RheumNow ( View Tweet)
ACR Daily Recap - MONDAY Panelists: Drs. Kathryn Dao, Michael Putman and Eric Dein Moderator: Dr. Jack Cush https://t.co/b1k1gsHI2z https://t.co/BWu7GXFxhj

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IgG4 disease- the WInS withdrawal study results https://t.co/rg0YJ0LlZM https://t.co/L6SzcD7QlJ

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Theres a ustekinumab biosimilar, CT-P43 - In a multinational, phase III study in 509 plaque psoriasis pts, CT-P43 was equivalent to the originator, Stelara, with week 16 PASI75 scores of 78% vs 76%, and continued efficacy out to week 40 https://t.co/dEImEp8l90 https://t.co/UoqGgaad8H

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FDA issued a safety alert for BCMA- or CD19- Autologous CAR-T cell Immunotherapies; they've received reports & are investigating Risk of T-cell Malignancy (CAR-positive lymphoma) occuring in several products w/in this class (most for Cancer use) https://t.co/RpBhcGarGy https://t.co/mDuXmVW4Fz

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Rheumatoid Arthritis Topic Podcast https://t.co/ClEuz2bVzA https://t.co/19jZhSt3Dc

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