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ICYMI: Top 5 Clinical Pearls in RA Management
RheumNow Live 2024 provided a wealth of clinical insights, particularly in the realm of rheumatoid arthritis (RA) management. Here are the top five clinical pearls from the event's opening session, "Success in Rheumatoid Arthritis."
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Serious Infections in Takayasu arteritis
The large vessel vasculitis, Takayasu arteritis (TAK), carries a significant morbid risk and a cohort analysis shows these patients are also at high risk of serious infection with resultant higher risk of death.
Mortality in Psoriatic Arthritis
The Annals of Rheumatic Disease reports that mortality risk in psoriatic arthritis (PsA) is about 10% higher than in the general population, primarily from excess comorbidity and with increased risks in women, with longer disease durations.
Polycyclic Aromatic Hydrocarbons Increase Lupus Risk
A case-controlled study shows environmental exposure to polycyclic aromatic hydrocarbons (PAH) may increase the risk of developing systemic lupus erythematosus (SLE).
#RNL2024
ASCVD Risk Calculators underestimate risk in patients of RA
Inflammatory disease was added as a "risk enhancer" in 2019 update
"A low ASCVD and/or absence of symptoms may be not be reassuring" https://t.co/Cz1LRda9xx
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Dr. John Cush RheumNow ( View Tweet)
13 Risk Factors for RA-associated Interstitial Lung Disease (ILD)
ILD is the most widespread and fatal pulmonary complication of rheumatoid arthritis (RA). A recent metanalysis shows the pooled prevalence of RA-ILD was approximately 18.7%.
https://t.co/oqb37RWPuZ https://t.co/tp3qBh1wRC
Dr. John Cush RheumNow ( View Tweet)
Pearl: Three "S" Rule (Smoking, Seropositivity, Sex/Male): if present the risk of RA-UIP (ILD) goes up nearly 13 fold (ACR23 Abstract 1269) https://t.co/heiTtarS1Y https://t.co/EkHbmMgIEC
Dr. John Cush RheumNow ( View Tweet)
RCT 302 Dupuytren contracture pts Rx w/ Surgery (n 101), needle fasciotomy (101), or collagenase injx (100). 292 & 284 completed; Success (>50% improved) @3 mos was same: 71%, 73% & 73%. @ 2 yrs, surgery was superior (78% vs. 50% or 65%) https://t.co/K74p1xpnZx https://t.co/xaC4pdPSFQ
Dr. John Cush RheumNow ( View Tweet)
JAMA: Industry Payments to Physicians ($12.13 billion 2013-22)
1 Ortho: $1,360,744,428
2 Neuro: $1,322,668,751
3 Cardio: $1,293,613,594
4 Heme/onc: $825,799,685
5 Int medicine: $588,249,423
6 Endo: $546,513,674
7 FP: $479,105,369
8 Rheum: $464,858,022
https://t.co/GCWchn9IMz https://t.co/6sRwOWm83y
Dr. John Cush RheumNow ( View Tweet)
soluble Fms‐like tyrosine kinase‐1 (sFlt-1)/placental growth factor (PlGF) ratio, biomarkers of placental function and adverse pregnancy outcomes. Study of 158 RA pts, 1/2 on TNFi during Preg. TNFi assoc w/ incr birthweight; no effx on sFlt‐1 & PlGF https://t.co/JFvDxrTAfr https://t.co/CRxSEbm2Ru
Dr. John Cush RheumNow ( View Tweet)
CDC surveillance data 2019–2021 identified cases:
- 59,655 coccidioidomycosis
- 3,595 histoplasmosis
- 719 blastomycosis (unusually high fatality rate in 2021 of 17%; typically 8%–10%) https://t.co/cDC0nuZLsb https://t.co/Q4QkNtNvJc
Dr. John Cush RheumNow ( View Tweet)
FDA Curriculum and Toolkit on Biosimilars for educators; Fact sheets on:
- Biologicals, Biosimilars & InterchangeableProducts
- Generics & Biosimilars
- Manufacturing & Variation
- Biosimilar Regulatory Approval Pathway https://t.co/bHYFPb8VxU https://t.co/bA8I567H8U
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Dr. John Cush RheumNow ( View Tweet)
There is world wide variability the prevalence of #PsA - the global prevalence=112 per 100K adults; and is more common in Europe (207/100K) and North America (64/100K) compared with Asia (37/100K) and South America https://t.co/UY25S00w26 https://t.co/AZMbZ3hG2c
Dr. John Cush RheumNow ( View Tweet)
Systemic Inflammation Index [SII]= PMN# x Plt # / Lymphs# (all from CBC) has predictive value. Review of 16 studies (2893 immune pts & 2346 controls). SII significantly higher in ID vs controls, active vs remission, & those w/ & W/O immune disorders https://t.co/qDDQL88wbv https://t.co/IW1fnaoJRo
Dr. John Cush RheumNow ( View Tweet)
ICYMI: Eating for Rheumatoid Arthritis
The majority of practicing rheumatologists at RheumNow Live were unaware of the new ACR guidelines issued in 2022 regarding dietary and lifestyle recommendations for patients with Rheumatoid Arthritis (RA) (1).
https://t.co/0Z1lYzsxuI https://t.co/2atX1B4hQb
Dr. John Cush RheumNow ( View Tweet)
Epigenetics and Autoimmune Skin Disease
The central dogma proposed that genetic information predominantly transfers from DNA to RNA during gene expression to make a functional product protein.
https://t.co/VgQE2yYYmq https://t.co/fAWBifCyWv
Dr. John Cush RheumNow ( View Tweet)
Metrics Used by Rheumatologists in RA
https://t.co/Lfzqdzehb7 https://t.co/uc5WTIdbTY
Dr. John Cush RheumNow ( View Tweet)
Activity & Pain Tolerance
Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow, including where you should sit in clinic and why you should worry about secondary Sjogren's in RA.
https://t.co/a9eoMFKvF1 https://t.co/lZg89dul5e
Dr. John Cush RheumNow ( View Tweet)
#RNL2024
2022 ACR Guideline for Integrative Interventions for RA
- Conditionally recommend Mediterranean diet
- Conditionally recommend Against other diets or dietary supplements
*Low or very low to moderate evidence due to absence of good studies
🍇🫒 https://t.co/H14pMWc1V9
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Dr. John Cush RheumNow ( View Tweet)
Pearl: 40% of acute gout attacks will have a normal serum uric acid (that will elevated during intercritical phase) - Draw the lab during and after the attack. https://t.co/nNdFWx3gjY
Dr. John Cush RheumNow ( View Tweet)
