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EMR Messaging Woes (4.11.2025)
Dr. Jack Cush reviews the news, journal reports and regulatory approvals from this past week on RheumNow.com
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Should Lupus Nephritis Receive PJP Prophylaxis?
A current review article suggests that the need for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in patients with systemic lupus erythematosus (SLE) and lupus nephritis will need to be individualized based on therapies and risk factors.
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Pregnancy-Related Deaths in the US
A CDC cross-sectional national study showed an increase in pregnancy-related deaths in the US from 2018 to 2022, with highest rates among American Indian, Alaska Native women, and non-Hispanic Black women.
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Patient info on Sweets Syndrome: acute febrile neutrophilic dermatosis
https://t.co/0q93q2NVc9 https://t.co/cE3LA8LaRQ
Links:
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RA Prevention through Deep Immunophenotyping
Researchers at the University of Colorado have identified pathogenic immune phenotypes in at-risk populations for RA. They have found the expansion of specific T cell subtypes, in the at-risk group, and postulate this could lead to https://t.co/AEo0GOr7Kn
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Metanalysis showed no increased risk of serious infx (SIE) w/ JAK inhibitors use in pts w/ immune-mediated inflammatory skin diseases -- 32 RCTs, 11,917 pts found SIE in 0.62% on JAKi vs 0.51% controls. Meta-analysis found no significant increase in risk of serious infection https://t.co/ugH72nk8bZ
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KORAIL (Korean RA-ILD) prospective cohort study of CT and biomarkers showed 35% ILD progressed over 3 yrs. Higher baseline KL-6 (HR 1.37) & hSP-D (1.51) levels assoc w/ progression. Increasing KL-6 at 1 yr showed the greatest progression (∆KL-6: HR 2.0) https://t.co/efowyCp1qu https://t.co/JVd7sRKzVF
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EPIC EHR data assessed pre- & post-COVID. Pt messaging increased w/ pandemic & remained elevated, w/ no change in pt phone calls. MD EHR time/wk increased for all MDs, post COVID-19: (PCP +6.5%), subspecialists (+9.9%), surgeons (+5.2%). https://t.co/nJZw0Ftjqi https://t.co/ty942TGblu
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Korean insurance claims study (2008–2021) 183,212 psoriasis & PsA pts, found Biologic Rx assoc w/ lower risk of new-onset & recurrent MACEs vs phototherapy (adj HR, 0.45 & 0.34). Nonbiologic systemic Rx lowered MACE risk (v photoRx) only in pts w/ prior Hx MACE (0.79) https://t.co/1RC8bMSZJ3
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Does DMARD Rx affect neurocognitive function in older pts? bDMARDs targeting TNF-α & IL-6 may mitigate neuroinflammation & preserve cognitive function. But, cognitive impact of csDMARDs (MTX) is complex, w/ conflicting reports on its role in vascular dementia. https://t.co/u3kSKHRvpI
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Shanghai hospital retrospective cohort study of 249 pts w/ post-Unilat TKA & lat knee pain. 144 Rx w/ IA steroids vs 105 Rx w/ PO meds. Infection rate w/in 6 mos post-TKA found no signif difference (2.1% vs 2.9%); Injx pts had signif better pain relief, QOL & knee function (KSS) https://t.co/ULVO6KU7pn
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Systemic sclerosis pts in the PRESS & STRIKE cohorts - High type I interferon (IFN) scores in diffuse SSc pts correlated w/ high disease activity & worse 12-month prognosis and overall survival. https://t.co/pdPjoVfQNH https://t.co/RB7li2ZIxX
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MMWR: While PRE-overdose opioid prescribing is a risk marker for fatal overdose from opioids alone, stimulants alone, or both; PRE-overdose stimulant prescribing might not be a risk marker for fatal overdose attributable to stimulants. https://t.co/ReVbpligeT https://t.co/PnjeqaCySX
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Diagnostically, Xrays are effective & sufficient at Diagnosing chronic low back pain; X-rays predicted MRI results in approximately 75% of the cases for common low back pain problems suggesting they may be a preferred initial imaging study for this condition. https://t.co/PYzd1zXIRz
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Inebilizumab, an anti-CD19+ (B cell)mAb was tested in myasthenia gravis in phase 3, 238 pt trial and shows to signif. improv function and reduce disease severity in acetylcholine recpt Ab+ or muscle-specific kinase Ab+ myasthenia gravis pts. https://t.co/vBBjf8AUug https://t.co/cUbK4PJEvf
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EMA's EudraVigilance (safety) database study of 10,319 MTX reports (age: 62 yrs, 73% F). Adverse rxns (ADR): 365 kidney & 1,082 liver related. MTX renal ADRs were older, w/ comeds (NSAIDs, Tylenol, metamizole, steroids). More deaths w/ renal ADRs than liver(21% vs 6%); mostly w/ https://t.co/tQ9PSOTtyx
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EMA has approved upadacitinib (Rinvoq) for use in the EU to treat adult patients with giant cell arteritis (GCA) - approval is based on data from the Phase 3 SELECT-GCA trial demonstrating sustained remission and key secondary endpoints https://t.co/Y2tyZPC9Et https://t.co/SHPz2Q94Vs
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JAMA Staphylococcus aureus Review
- s. aureus bacteremia leads to septic arthritis (7%), vertebral osteomyelitis (≈4%)
- bacteremia (≥48 hs) has 39% 90-day mortality risk
https://t.co/1UQoz7JDPU https://t.co/xTAkakv2he
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185 children with SLE (cSLE) were analyze for long-term outcomes. 38 (20.54%) had serositis. Pts w/ serositis were younger, had more Dz activity, acomorbidities, & mortality. Having both serositis and ESRD increased risk of poor 20 Yr survival. https://t.co/fw8wcuS48E https://t.co/LgS3Sxy7gd
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EPIC EHR data assessed pre- & post-COVID. Pt messaging increased w/ pandemic & remained elevated, w/ no change in pt phone calls. MD EHR time/wk increased for all MDs, post COVID-19: (PCP +6.5%), subspecialists (+9.9%), surgeons (+5.2%). https://t.co/j8zwPkdmp9 https://t.co/SyYpZwnMfN
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