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More Rheumatology Fellow Advice from the Mentors

Jack Cush, MD

If you’re looking for some great advice to consider or rebuke, here is the generous guidance of nearly two dozen leaders in rheumatology who sincerely offer you their wisdom and best wishes.

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Uric Acid Targeting in Gout Management

Jack Cush, MD

A study from 2 gout clinics implementing different treatment strategies has shown that a treatment strategy that aims to strictly achieve low uric acid (UA) results in a higher a rate of targetd serum UA lowering and less gout flares.

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Methotrexate Improves Pegloticase Efficacy and Tolerability

Jack Cush, MD

The efficacy of intravenous pegloticase (PEG) therapy in gout can be limited by its toxicity, but when coadministered with weekly methotrexate, higher response rates and less toxicity was observed.

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The Burden of Gout

Jack Cush, MD

Danve and Neogi have an editorial in the current Arthritis & Rheumatology about the burden of gout that affects 41 million adults worldwide, according to the Global Burden of Disease Study 2017 (GBD 2017) also published in the same issue.

This makes gout twice as prevalent as rheumatoid arthritis (19 million).  This prevalence of this most common inflammatory arthritis is undermined by numerous challenges in the diagnosis and examples of insufficient disease management. The editorial points out the magnitude of the disease and the many challenges facing rheumatologists.

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SEMIRA Study: Best to Continue Low Dose Steroids in RA

Jack Cush, MD

The SEMIRA trial studied the  tapering vs continuing oral glucocorticoids in rheumatoid arthritis (RA) patients who achieved a low disease activity state (with tocilizumab) were more likely to show safety and better disease control with continuing steroids - even though two-thirds of patients were able to safely taper their glucocorticoid dose.

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RheumNow Podcast – COVID-19 Responds to Steroids (7.24.20)

Jack Cush, MD

Dr. Jack Cush reviews the News and Journal Reports from the past week on RheumNow.com.

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Spanish registry of 3679 SLE pts finds 13.6% had polyautoimmunity (SLE plus another autoimmune Dz), Dx as thyroiditis (8%), Sjogrens (14%) secondary APS (14%). Incr odds in female, w/ ILD, Raynauds, SSA/SSB/RNP but LESS w/ antimalarial drugs [0.50] https://t.co/duTqepvmLR

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Dr. John Cush RheumNow ( View Tweet)

Based on a small number of studies (n = 5), there is little evidence to support the superiority (efficacy & safety) of Loading dose regimens when starting biologic (abatacept, certolizumab and secukinumab) therapy. https://t.co/0lNUzTFIOK

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Dr. John Cush RheumNow ( View Tweet)

Sandoz rituximab biosimilar(SDZ-RTX; Rixathon) compared with reference rituximab (Ref-RTX) and shown to have same efficacy outcomes (DAS28 Remission, ACR20/50/70, CDAi/SDAI, HAQ), B cell depletion levels, adverse events & low level antidrug Abs https://t.co/0XWQs23Xcv

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Dr. John Cush RheumNow ( View Tweet)

Safety & efficacy of rituximab in Older RA (>65; n=97) vs younger (<65yrs; n=276) showed no difference in drug survival over 2 yrs (72% vs 74%)or SDAI activity. BUT.. there were more SIE (14.2 vs 6.6/100 PY) & pneumonia (10.7 vs 5.1/100 PY) in older pts https://t.co/dxqPg2fOlV

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Dr. John Cush RheumNow ( View Tweet)

FDA recommends health care professionals discuss naloxone with all patients when prescribing opioid pain relievers or medicines to treat opioid use disorder. Naloxone can be administered(+/- medical training) to help reduce opioid overdose deaths https://t.co/9B0hPhOm57

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Dr. John Cush RheumNow ( View Tweet)

Lenabasum (cannabinoid rcptr agonist) studied in Systemic Sclerosis - LEN (n=27) vs PBO (n=15). At wk 16 LEN had better responses by CRISS (skin) score (0.33, vs 0; P=0.07) w/ reduced gene expression for inflammation & fibrosis & improved skin histology https://t.co/oddSMvjnc9 https://t.co/HLFPNfigFD

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Dr. John Cush RheumNow ( View Tweet)
Platelet Rich Plasma Versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis: a Meta-Analysis of 26 randomized controlled trials #osteoarthritis #knee #PRP #HA metanalysis favours PRP! https://t.co/Z5Olucs3ku

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Peter Nash drpnash ( View Tweet)

Analysis of administrative health data (1984‐2016) on 12984 #RA pts shows RA w/ psychiatric comorbidities (depression, anxiety, bipolar, schizophrenia) had more additive visits (10.9), hospitalizations, hospital days (3.6), more drugs (7.3) & FP visits https://t.co/5py0i2tWqL

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Dr. John Cush RheumNow ( View Tweet)

Rising evidence of the link between hyperuricemia & hypertension, yet not enough that lowering uric acid (SUA) lowers HTN & its consequences. Some evidence SUA leads to suggest that activation of the renin-angiotensin; would blocking RA mimic ULT #gout https://t.co/yTxrReCaoF

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Dr. John Cush RheumNow ( View Tweet)

CHMP of the EMA (European Medicines Agency) has recommended approval of filgotinib (Jyseleca) for moderate to severe active rheumatoid arthritis (RA) in adults not responding to DMARDs. The daily drug has been studied at 100mg and 200 mg doses. https://t.co/pEybIZALFq

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Dr. John Cush RheumNow ( View Tweet)

Retropective study of 22 French severe COVID-19 pneumonia pts - 10 Rx w/ standard-of-care vs 12 with SOC plus IV anakinra (300 mg⋅d−1 x5 d, tapered over 3 d). All of anakinra pts rapidly improved w/ no deaths, less O2, No mech ventilation (P < 0.01) https://t.co/JhYHDZK0A7 https://t.co/YJASi4eMsR

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Dr. John Cush RheumNow ( View Tweet)
French cohort analysis of 104 kids taking Tocilizumab (mostly for Stills dz or polyJIA) shows 25% with serious AE (15.3/100 PY), mostly seriou infections or infusion reactions. at TCZ initiation. Most occured in systemic JIA or another autoinflammatory Dz https://t.co/oFSxQlZEwx?

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Dr. John Cush RheumNow ( View Tweet)

Belimumab FDA approved in kids (same dose 10mg/kg/IV) based on PLUTO trial - 93 SLE pts Rx w/ BEL or PBO. By wk 52, BEL had more SRI4 responders (52.8% vs 43.6%; OR 1.49;95% CI 0.64 to 3.46), more PRINTO/ACR 30 or 50 w/ stable PK. https://t.co/1xX0VLgl4q

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Dr. John Cush RheumNow ( View Tweet)

The RheumNow Podcast is up - COVID-19 Responds to Steroids & TCZ, statin myopathy, Lung Dz in AOSD, TNFi & Liver, IL-23 in Psoriasis. Watch it here>> https://t.co/DrrFZSWmZa or listen to Podcast on iTunes>> https://t.co/FHJv01AAbC or on SoundCloud>> https://t.co/nSPI9lcaY9

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Dr. John Cush RheumNow ( View Tweet)

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