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RheumNow Podcast – #ACA: Ask Cush Anything (10.8.2021)

Jack Cush, MD

Arthritis numbers are rising, and people are finally talking about osteoarthritis. Also, ACR 2021 is just a few weeks away - are you ready? Finally, I'll review cases and questions submitted by viewers in Ask Cush Anything (#ACA). This, and nearly a dozen news items and reports, are discussed in this week's podcast. Let's begin.

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PSS.scleroderma.arthritis.contractures

IL-6 Inhibition in Refractory Systemic Sclerosis

Jack Cush, MD

A small, single-center cohort analysis of difficult, refractory systemic sclerosis (SSc) patients showed that treatment with tocilizumab (TCZ), an interleukin-6 inhibitor, resulted in significant improvement in joint and skin involvement, regardless of SSc disease duration or subtype. 

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RheumNow Podcast – Do More DMARDs Mean More Switching? (9.17.2021)

Jack Cush, MD

Smartphones and diet; COVID-19 and the numbers - reassuring or not, and what about masks?; and do more drugs mean more switching, less persistence, and patient adherence goes up...or down? All this and more news and journal reports in this week's episode.

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pssfing.jpg

Risk Factors Associated with Systemic Sclerosis Hospitalization

Jack Cush, MD

A retrospective study of systemic sclerosis patients shows that acute hospitalization and mortality were not uncommon and were often linked to SSc-related lung disease.

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RheumNow Podcast – Driving in Pain (8.20.2021)

Jack Cush, MD

You know, I'm a very good driver. We all think we're great drivers - but consider what it's like to drive in pain: would you be a good driver? Also, I want you to consider the diagnosis of calcium pyrophosphate dihydrate disease (CPPD). But first, let's look at a study out of Scotland, looking at military service and greater risk of hip and knee replacement.

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PSS.hands_.Raynauds.jpg (keep)

Tocilizumab in Refractory Skin and Joint Scleroderma

Jack Cush, MD

The interleukin-6 inhibitor, tocilizumab (TCZ), was studied in a cohort of difficult systemic sclerosis (SSc)  and was shown to be effective in refractory joint and skin disease with good long-term retention rates and disease stabilization.

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ANCA, vasculitis, test

ACR/Vasculitis Foundation 2021 Guidelines for ANCA–Associated Vasculitis

Jack Cush, MD

Chung et al have published the 2021 treatment guielines for the management of antineutrophil cytoplasmic antibody–associated vasculitis, including granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis. These guidelines are put forth by the ACR and the Vasculitis Foundation as benchmark guidance to assist health care professionals in managing AAV.  

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Methotrexate is the most often-studied treatment and has best clinical outcomes in children and adults with localized scleroderma en coup de sabre. Metanalysis of 34 articles, only 4 RCTs, but 24 case reports. More research needed. https://t.co/fSEvDw2pge

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Dr. John Cush RheumNow ( View Tweet)

Having both Cancer & Systemic sclerosis (SSc) is rare. Study of 1481 SSc pts saw cancer Dx w/in 2, (1.35), 3 (2.1%) & 5 yrs (3.5%;mostly breast, GYN, Heme CA). Higher 2 yr risk w/ topoisomerase I Ab (OR 3.43), U1-RNP (5.54), but not RNA polymerase III) https://t.co/dVuchv8Afv https://t.co/azGmJYifrj

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Dr. John Cush RheumNow ( View Tweet)
ICYMI: https://t.co/wM1iRxtHvk The interleukin-6 inhibitor, tocilizumab (TCZ), was studied in a cohort of difficult systemic sclerosis (SSc) and was shown to be effective in refractory joint and skin disease with good long-term retention rates and disease stabilization. https://t.co/A8dfCksp3b

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Dr. John Cush RheumNow ( View Tweet)
A retrospective study of systemic sclerosis patients shows that acute hospitalization and mortality were not uncommon and were often linked to SSc-related lung disease. #RheumNow https://t.co/s5wSlndTrt https://t.co/KHz9LYZVAK

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Dr. John Cush RheumNow ( View Tweet)
Cardiac coronary Ca score (CCS) in 20 asymptomatic systemic sclerosis (SSc) pts vs controls.CCS incr (& higher scores) in 45% SSc vs 10% controls. CCS values higher in Limited vs diffuse SSc. CCS > 100 assoc w/ age, dz duration obesity https://t.co/aDWpoePqXK

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Dr. John Cush RheumNow ( View Tweet)

https://t.co/wM1iRxtHvk The interleukin-6 inhibitor, tocilizumab (TCZ), was studied in a cohort of difficult systemic sclerosis (SSc) and was shown to be effective in refractory joint and skin disease with good long-term retention rates and disease stabilization. https://t.co/UBjpHUlb1l

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Dr. John Cush RheumNow ( View Tweet)
NIAID will study COVID‐19 Booster Vaccine in Autoimmune Disease Non‐Responders (including MS, RA, SLE, Scleroderma,pemphigus); 20 sites, 600 pts (taking MTX, MMF or RTX) w/ poor resp to mRNA vax & recv 3rd booster vax. https://t.co/YwCvGnX21F https://t.co/th2WoRv1ng

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Dr. John Cush RheumNow ( View Tweet)

https://t.co/wM1iRxtHvk The interleukin-6 inhibitor, tocilizumab (TCZ), was studied in a cohort of difficult systemic sclerosis (SSc) and was shown to be effective in refractory joint and skin disease with good long-term retention rates and disease stabilization. https://t.co/XkJDVwJLwb

Links:

Dr. John Cush RheumNow ( View Tweet)
Biomarkers predict early ILD in systemic sclerosis: https://t.co/9z4Swjjy4p we need a biomarker for early disease!

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Peter Nash drpnash ( View Tweet)

Nice rvw of tx for SSc-ILD by @sclerodermaUM et al Endorse: "MMF is now considered the standard of care as first line therapy for the treatment of SSc-ILD" Reasonable chart, but wish we could offer more HSCT Also, I'm seeing a LOT of INappropriate early use of nintedanib https://t.co/n1R73EbrXZ
Mike Putman EBRheum ( View Tweet)
What predicts ILD progression in Systemic Sclerosis? Study of 138 SSc pts; 72% had ILD, 35% FVC decline (F/U 2.9y). Only Scl-70 A positivity predicted FVC decline at 5yrs. HRCT Esophageal dilation had nonsignificant DLCO decline, but not FVC https://t.co/fE0JCsZ44O

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Dr. John Cush RheumNow ( View Tweet)

NEJM Image: Salt-and-Pepper Skin Changes in Systemic Sclerosis. 68yoM with skin changes of chest and back and with shortness of breath. Exam:showed “salt-and-pepper” skin changes, w/ CT evidence of lung fibrosis. https://t.co/Pz7mKUD2Yx

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Dr. John Cush RheumNow ( View Tweet)

Hands-Down Rheumatology - Sarcoidosis usually presents as a monarthritis or oligoarthritis. Late sarcoid arthritis affects knees, ankles, fingers (dactylitis). Bony lesions show honeycomb trabecular pattern). https://t.co/lmXBbJz6ts https://t.co/oDYrBiPuIX

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Dr. John Cush RheumNow ( View Tweet)
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