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Higher Cancer Rates (8.16.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com, noting his concerns about diet, cancer, ILD, death and dosing challenges.

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Depends on Where You’re Looking (8.9.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from RheumNow.com this week.

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Location, Location, Location (7.26.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Location matters; Geo-rheumatology?

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alveolar hemorrhage acute

PEXIVAS: Diffuse Alveolar Hemorrhage in ANCA-Associated Vasculitis Patients

Jack Cush, MD

A secondary analysis of the PEXIVAS study showed antineutrophil cytoplasmic antibody–associated vasculitis (AAV) patients complicated by diffuse alveolar hemorrhage (DAH) may have improved with plasma exchange and glucocorticoids, the results did not achieve significance. 

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Bad News Coronary Artery Calcium in Rheumatic Patients

Jack Cush, MD

A recent presentation at the 2024 Society of Cardiovascular Computed Tomography meeting by Brittany Weber MD, PhD (Brigham and Women’s Hospital) has shown that incidental findings of coronary artery calcium on chest CTs in patients with immune-mediated inflammatory diseases may be associated with poorer outcomes, even if they don’t have preexisting atherosclerotic cardiovascular disease.

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scleroderma,month,organ,heart

Systemic sclerosis sine scleroderma

Jack Cush, MD

Systemic sclerosis sine scleroderma (ssSSc), which accounts for nearly 10% of systemic sclerosis (SSc) patients and was first described in 1962, is a subset of SSc.

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Mass General Brigham Study 172 RA-ILD pts w/ 6.5 yrs F/U (age 62 yrs): noted (4%) lung transplants & 44 (26%) ILD-related deaths. FVC rapidly declining pts (14%) had aOR 19x lung transplant & aOR 2.8 ILD-related death. Slow decline in 54%, no decline 32% https://t.co/fKDnJIu9a7 https://t.co/ondzN4WZ1F

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Lit review of ILD in anti-synthetase syndrome finds no conclusive evidence of effective treatment. 10 studies, 514 pts (68% female); Hi Res CT positive in 87% w/ 49% having NSIP pattern. 48% Jo-1+, 28% Ro52+. Low improvements w/ RTX (12%), CYC (17%). https://t.co/B7R0xQrUyw https://t.co/2hMzO8hyiV

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EU study of 1052 systemic sclerosis pts failed to show early immunosuppressive use (vs late) lowered ILD risk. Early Rx (Dz Dur < 3yrs) group (n=547, 52%) more male, diffuse Dz, 60% Rx w/ MTX (1.7% biologics); ILD in 47% after3.6yrs (HR 1.13;0.93–1.38) https://t.co/PtQlgyX0TE https://t.co/R7X3zvPvIg

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The adipokine Resistin - predicts disease severity and survival in patients with pulmonary arterial hypertension. High resistin levels (>4.5ng/mL) in PAH assoc w/ older age, shorter 6-min walk, decr CV performance, incr death (HR 2.6) https://t.co/TUR4KnVsR9 https://t.co/rc6IMNWH4w

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Calif Cohort of 19340 rheumatic pts, finds Cardiovascular events (CVE) in 1.4% & antiphospholipid syndr in 5.5%. CVE increased risk of adverse pregnancy outcomes (>50%), including Sm for Gestational age (aRRs 1.2-1.5), Premature birth (aRR 1.6) https://t.co/9lxzrOVEks https://t.co/Jcm7tH61cv

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Dr. John Cush RheumNow ( View Tweet)
Lit review of ILD in anti-synthetase syndrome finds no conclusive evidence of effective treatment. 10 studies, 514 pts (68% female); Hi Res CT positive in 87% w/ 49% having NSIP pattern. 48% Jo-1+, 28% Ro52+. Low improvements w/ RTX (12%), CYC (17%). https://t.co/oJ0EMAE7d0 https://t.co/bDiA1h9hO7

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Dr. John Cush RheumNow ( View Tweet)
Bad News Coronary Artery Calcium in Rheumatic Patients In the 2024 SCCT meeting, Dr. Brittany Weber presented findings showing that incidentally discovered CAC in patients with IMID can lead to worse outcomes, even without prior ASCVD. https://t.co/aJhf0IL1WW https://t.co/uMl89rXjBK

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Dr. John Cush RheumNow ( View Tweet)
Full read overview of myositis associated - ILD (and treatments), including: - Case examples - Antisynthetase Syndrome - Anti-MDA5 Amyopathic DM - Interstitial Lung Disease in Myositis https://t.co/PhfuuBHOYf https://t.co/OC1GmWkYyO

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Dr. John Cush RheumNow ( View Tweet)
Full read overview of myositis associated - ILD (and treatments), including: - Case examples - Antisynthetase Syndrome - Anti-MDA5 Amyopathic DM - Interstitial Lung Disease in Myositis https://t.co/zQpfstnGy8 https://t.co/XogyyxuVMk

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Dr. John Cush RheumNow ( View Tweet)
ICYMI: Community-Acquired Pneumonia (CAP) https://t.co/geb8y2AK26 https://t.co/cB3y5vQoz1

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Dr. John Cush RheumNow ( View Tweet)
CHANCE-3 DBR-PCT of 8343 adults (>40yrs) w/ CVA or TIA & hsCRP ≥2 mg/L showed that colchicine (0.5mg) x 90d did not prevent (6.3% vs 6.5%; HR 0.98; 0.83 to 1.16) subsequent stroke within 90 days compared with placebo https://t.co/APiMYVkBTV https://t.co/VgFiCKfMqB

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CT angio in 75 pts w/ Takayasu arteritis (40 w/ cDMARDs, 35 biologics) showed reduced arterial thickness in 73% (31% w/ >25% decr in wall thickness). 1st immunosuppressives (p= 0.012) & bDMARDs(p= 0.026) reduced art. wall thickness (relative to cDMARDs) https://t.co/16eGmgVoWr https://t.co/AyNyT7FsYZ

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How do you manage new progressive ILD?

Dr. John Cush RheumNow ( View Tweet)

No Risk of Interstitial Lung Disease with Methotrexate Use JAMA reports a cohort study that investigated the association between methotrexate (MTX) use and Interstitial lung disease (ILD) in patients with dermatomyositis (DM). https://t.co/qauRelAkG0 https://t.co/bhSLYrfzlv

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Dr. John Cush RheumNow ( View Tweet)
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