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Wearable Technology to Measure Arthritis Outcomes

Jack Cush, MD

In this lockdown, virtual medicine, post-COVID world, wouldn't it be ideal to have an reliable digital readout on patient activity as a measure of health?

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Lovastatin Fails to Lower CRP and Activity in RA

Jack Cush, MD

Ridker and colleagues have shown that statins (3-hydroxy-3-methylglutaryl coenzyme-A (HMG Co-A) reductase inhibitors) are effective at treating hyperlipidaemia and lowering C-reactive protein levels; Aranaow and colleagues have shown that lovastatin, when given to rheumatoid arthritis (RA) patients with elevated CRP levels failed to significantly lower disease activity. 

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Fighting Hydroxychloroquine Misinformation

Jack Cush, MD

JAMA Internal Medicine has posted an Editor's note on the use of hydroxychloroquine for COVID-19; noting the sequence of dysfunction since the president promoted its use on March 21, 2020, when he said “What do you have to lose? I’ll say it again: What do you have to lose? Take it.”.

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RheumNow Podcast - Top 13 Rheumatology Centers (7-31-20)

Jack Cush, MD

Dr. Jack Cush reviews the news and TOP 13 list of Best Rheumatology Hospitals.

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Study of 662 temporal artery Bx shows that when diagnosing #GCA, the TAB length should be at least 5 mm and should analyze at least 3 further sections at deeper levels for maximal yield. https://t.co/6zM9hBUsXy

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Dr. John Cush RheumNow ( View Tweet)

Analysis of PPI use from the Nurses Health Study shows regular PPI use was associated with increased risk of RA in women, higher with a longer duration of PPI use. With 1.7 million PY F/U, Regular PPI users had a 44% higher RA risk (adjHR 1.44; 1.10–1.89) https://t.co/pmBf88zGKH

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Dr. John Cush RheumNow ( View Tweet)

Virtual Video Joint Exam Pearl #5: The worst/most ineffective Virtual visits done with the Patient (or MD) driving in their CAR for the virtual visit!! Amazingly I have had a half dozen of these & requested the patient pull over so I could deliver a rheum Citation.

Dr. John Cush RheumNow ( View Tweet)

Virtual Video Joint Exam Pearl #4: Professor Paul Emery was right! THe MCP squeeze (done by the patient) and MTP squeeze is fairly predictive of RA/inflammatory arthritis AND outperforms the "Finger" (distal hand) squeeze. Hence the MCP/MTP is my main squeeze!

Dr. John Cush RheumNow ( View Tweet)

Virtual Video Joint Exam Pearl #3: Despite cam setups designed to do upper extremity exams, patients can easily move cams and limbs to examine spinal movt, gait, knee, ankle and foot problems with great accuracy.

Dr. John Cush RheumNow ( View Tweet)

Virtual Video Joint Exam Pearl #2 : Despite being in my video on the Virtual joint exam; asking the patient to show you their fist (AKA fist bump the camera) to see potential MCP swelling has thus far been a largely useless maneuver...but it looks good on cam...

Dr. John Cush RheumNow ( View Tweet)

Retrospective study of 20 RA pts w/ resolved hepatitis B (HBcAb+; HBsAg neg). 16/20 were Rx w/ tocilizumab & 8/20 w/ tofacitinib (nearly all HBsAb+). 25% recv antiviral Rx w/in 2 yrs of TCZ or Tofa; 6 had mild LFT elevations & No one had HBV reactivation https://t.co/EeFXo7mLhQ

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Dr. John Cush RheumNow ( View Tweet)

Systematic literature finds a connection between ankylosing spondylitis (AS) and dementia (RR 1.19 [95% CI 1.01‐1.41]). From a total of 6562 articles reviewed, only 4 met criteria - analysis included 156418 pts. Cause? inflammation, inactivity?

Dr. John Cush RheumNow ( View Tweet)

The RheumNow Podcast is up - Top 13 Rheumatology Centers in the US; anakinra & colchicine in COVID, unload the loading dose, CB2 in Scleroderma. Watch it here>> https://t.co/5LIIi7Pwg1 or listen to the podcast here>> https://t.co/5LIIi7Pwg1

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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)

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)

Metanalysis of 10 studies ( p534 patients) shows that exercise in ankylosing spondylitis improves pain, function and disease activity. Statistically signif improvement in pain (P<0.0001), BASDAI (P <0.00001), and BASFI (P<0.00001), but not CRP and ESR. https://t.co/fKo9kNOrmO

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Dr. John Cush RheumNow ( 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)

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)

Down syndrome-associated arthritis (DA) presents as a seronegative erosive polyarthritis. Besides an Avg 19-month delay in Dx, most are treated same as JIA but JIA agents are often poorly tolerated & less effective in DA. Prevalence=8.7/1000 Downs kids https://t.co/hEtAbo2tY6

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Dr. John Cush RheumNow ( View Tweet)

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