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Hmmm Really? (7.11.2025)
Dr. Jack Cush reviews the news and journal reports from this past week - some obvious, other new thoughts and some - hmmm, reallly?
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ICYMI: Clinical and Therapeutic Challenges in Connective Tissue Disease and ILD
Connective tissue diseases (CTDs) and interstitial lung disease (ILD) represent a challenging intersection of systemic autoimmunity and progressive respiratory impairment. Research presented at EULAR 2025 continues to highlight the importance of CTD-ILD and the evolving landscape of therapeutic options for patients with autoimmune ILDs.
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ICYMI: ACP: Best Practice Advice on Cannabis or Cannabinoids Use for Chronic Noncancer Pain
The American College of Physicians published a best practice advisory on cannabis or cannabinoids in the Annals of Internal Medicine.
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ICYMI: Channeling Bias and Cancer Risk with Biologic or Targeted Synthetic DMARDs
A retrospective US administrative claims cohort study of RA patients on tumor necrosis factor inhibitors (TNFis), non-TNFi biologics, or Janus kinase inhibitors (JAKis) found a statistically significantly higher risk of incident cancer in patients receiving rituximab, abatacept, or JAKis (compared with TNFis).
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MRI-detected erosions in clinically suspect arthralgia pts do not portend future Xray erosive disease or progression. Study of 405 CSA pts; 47% had MRI erosions that incr odds of Xray erosion [OR 5.2] but 96% of MRI-detected erosion had no assoc. Xray erosion. https://t.co/PXkEC3LO6n
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Can you predict disease from serum biomarkers? Comparison of 5 controls, 36 individuals at risk, 74, RA, & 97 PsA pts finds RA w/ higher levels of sICAM-1, MMP1, MMP3, PP, c-Peptide, CRP SAA. Also CRP, SAA, GLP-1, GIP-1, Leptin, PP precede disease onset https://t.co/zqWxsbTSlC https://t.co/Kgv2ZAuzIR
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Rheums! Question or case for Jack Cush? Record it here and we may feature it on an upcoming podcast.
https://t.co/HsqM9xLNtP https://t.co/voONsOLeSK
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Early DMARD Initiation Benefits in Psoriatic Arthritis
Mease et al has published the results of a cohort study showing early initiation of disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis (PsA) resulted in better outcomes compared to late https://t.co/EdbnpBmnPe
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1 yr study of falls studied in 100 RA & 80 PsA pts. 33% of RA & 46% of PsA reported falls, w/ a higher frequency in PsA Pts (p=0.02). Falls associated w/ disease duration and HAQ score. As falls are assoc w/ high morbidity & mortality risk, pts should be questioned about FALLS https://t.co/tP7zmGCZcw
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MRI-detected erosions in clinically suspect arthralgia pts do not portend future Xray erosive disease or progression. Study of 405 CSA pts; 47% had MRI erosions that incr odds of Xray erosion [OR 5.2] but 96% of MRI-detected erosion had no assoc. Xray erosion. https://t.co/hvxJRv1r0R
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Case–control study RA pts > 65yrs in US. SEER (cancer) database (2014–2019). Overall cancer risk not associated with use of JAKi (adjOR 1.04), TNFi (0.98) or other bDMARDs (0.98). But, JAKi use was assoc w/ incr risk of lung CA (OR 1.40), esp in Males (2.12) & >2 yrs JAKi. Lower https://t.co/u2psafyN1I
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Granzyme expression is upregulated in RA, esp early RA. Blood & synovium from early arthritis & TNFi nonresponders (R4RA RCT) gene expression five granzymes, perforin, & serglycin determined by bulk RNA-sequencing data. GZM A, B, H, K, M, PRF-1, SRGN was higher in lymphoid https://t.co/v1rdFZHuuh
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#RA linked to 40% incr risk of serious dental Infx. National Inpatient Sample (2016-2022) retrospective study of ~15 million adult inpatient records, 10.7K (0.07%) had oral Infx Hosp. Risk factors included RA (1.9%; OR 1.4, male (1.79), Black (1.23), smoking (1.33) https://t.co/pr4Uf6ywJ7
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1,494 Ehrlangen RA pts - machine learning used baseline variables to predict remission at 6 mos. Best/most predictive results w/ AdaBoost modelingdemonstrated strongest accuracy of 85.71% (based on DAS28, Age, VAS and swollen joints. https://t.co/h9UgUKUFo4
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❓️Is early intensive therapy with combination csDMARDs or TNFi superior to standard step care for the treatment of moderate to severe #psoriatic_arthritis?
🅰️ Yes
🔅Check out the SPEED RCT presented by @DrLauraCoates at #EULAR2025
OP0089
@RheumNow
#Strategy
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Sex differences in biologic response in PsA.
DISCOVER-2 post hoc analysis showed:
•Radiographic progression at Week
♂️: 2.22 units
♀️: 1.10 units
•Early ACR-like response (cDAPSA LDA at 8wks) linked to less damage in men (0.39 vs 2.24)
Women less likely to progress https://t.co/hvRxKTMJT5
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What happens in pre-RA when you stop #abatacept after 1 yr Rx
At 6 yrs approx 60% on #Placebo
V
50% who initially got #ABA
Prolonged damped effect of development of #RA
NNT for 1 yr is ~10 with a range as low as 6
#EULAR2025 @RheumNow @eular_org
Abst#OP0004 https://t.co/eCXEWQhvWM
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If you successfully taper off DMARDs in RA patients in remission, do you risk bringing new joints in the mix?
Leiden post-hoc trial: these patients don’t do worse than those who never get off drug.
Drug-free remission tricky but new joints not a worry. #EULAR2025 @RheumNow https://t.co/bwXgrB875k
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Clinical determinants of multiple drug failure in D2T RA
2000+ RA cohort 250+ refractory
-Low financial status
-Cancer Hx
-CV comorbidities
-Chronic use of NSAID or GCs
Protective: Regular participation in leisure activities
#POS0030 @RheumNow #EULAR2025 https://t.co/mdePGkHU82
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ICYMI: Introducing Polyrefractory RA: A New Frontier in Difficult-to-Treat RA
At a EULAR 2025 session titled “What makes ‘Difficult-to-treat RA’ so difficult to treat? And what can we do?”, Drs. Paula David and Dennis McGonagle introduced the emerging concept of polyrefractory https://t.co/Qy9fy3GWKm
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