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ERA, APPs, & Alpha GAL (3.21.2025)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. Listen in for 2 new case questions - Ask Cush Anything.
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Disease activity during Pregnancy in Rheumatoid arthritis and Spondyloarthritis
A prospective French study of rheumatoid arthritis (RA) or spondyloarthritis (SpA) patients showed that most maintained stable disease activity during pregnancy, but over one-third flared and required major changes in treatment.
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Increasing Prevalence of Osteoporosis
Research published in Osteoporosis International studied NHANES data showed increasing trends in osteoporosis in the United States of America. The key findings showed statistically significant results.
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NP and PA Growth in the USA
Forbes has published a thoughtful perspective on the declining number of US physicians and the growth in the number of advanced practice providers or APPs (nurse practitioners and physician assistants) in the US clinical workforce. Gastroenterologist Dr. Spencer Dorn writes that in the US, there are fewer physicians per capita (2.6 per 1,000) than most developed nations (average 3.6 per 1,000), with a physician shortfall of 125,000, that is projected to be ~200,000 by 2037.
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J&J announced the FDA jas granted the investigational drug, nipocalimab (FcRn recpt Ab), with Fast Track designation for its study in adult patients with moderate-to-severe Sjögren’s disease https://t.co/5rEYHkGVp2 https://t.co/ny2dv6Jtr5
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Glucocorticoid Toxicity Index
Dr. John Stone has led the effort to develop the GTI - glucocorticoid toxicity index. In this review article he acknowledges the need and benefit of steroids, but details a novel means to identify and limit the untoward effects of glucorticoids https://t.co/foTaoYrfDn
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Comprehensive review of the management of knee osteoarthritis - topicals, analgesics, narcotics, intraarticular, metabolic, nutraceuticals, TENS, acupuncture and biologics. https://t.co/3UjPQeZut9 https://t.co/kpGsVFDzAV
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2024 Rheumatology Year in Review
2024 was a year of surprising new growth in technology, with the expansion of new therapeutic options for many patients and clinicians.
https://t.co/JjG8oYTkKQ https://t.co/YgHMMiAQ9Z
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617 seropos ARTHRALGIA pts - 34% got inflamm. arthritis (avg time ~20mos). Arthritis risk factors: high ACPA (HR 4.7) or double positive(HR 6.8); 1st degree relative (1.5); intermittent Sxs(1.6); <12 mos Sxs (HR 0.71); AM stiff ≥1hr (1.6); joint swelling (1.5). IF > 2 https://t.co/tHL19ro5C8
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Large GWAS study of smokers, shows that polygenic risk scores (PRS) for RA & ILD were assoc w/ their intended phenotypes in whites (OR 1.32 & 1.88, respectively) but no in blacks https://t.co/FflF2f1orq https://t.co/NlxcASrj9K
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For the first time ever, https://t.co/4UQlqwujiR 2025 is Available On Demand!
✔️ STEP Talks from top rheumatologists
✔️ Lectures on the biggest clinical challenges
✔️ Speaker slides and handouts you’ll use
Non-CME, practical, and finally here.
👉 Register today: https://t.co/YNgLfp4IMb
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ACR Frustrated with Congress Failures on Physician Fee Schedule and Research Programs
The ACR expressed deep dissatisfaction that the recent passage of the Full-Year Continuing Appropriations and Extensions Act, failed to address payment cuts imposed in the CY25 Medicare https://t.co/hObTXHMhRA
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PAFLAR Guidelines for Polyarticular Juvenile Idiopathic Arthritis
The Pediatric African League against Rheumatism (PAFLAR) initiative has published its guidelines for the diagnosis and treatment of polyarticular juvenile idiopathic arthritis (pJIA).
https://t.co/4MbU8ZDLZf https://t.co/o3Oym9ff0f
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Axial Involvement in Psoriatic Arthritis
Analysis of a Greek Psoriatic Arthritis (PsA) cohort shows that nearly one quarter of patients have axial involvement, and among them, ∼30% have isolated spinal axPsA and nr-axSpA, respectively.
https://t.co/MmRMlEp7zR https://t.co/ZAbfpIWwRM
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The FDA has approved guselkumab(Tremfya) for both subcutaneous (SC) and intravenous (IV) induction therapy treatment of adults with moderately to severely active Crohn’s disease (CD). It is the only IL-23 inhbitor available for SC and IV use in CD https://t.co/ekXRVOwNnS https://t.co/6zveRR5WjD
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Systematic review of colchicine and pregnancy in #FMF pts included 25 studies. Miscarriage was not increased w/ colchicine in FMF (RR 0.87). Birth defects were similar to unexposed pts (range 0.6% to 4.0%). Colchicine showed no effects (men/women) on fertility. 1 study reported… https://t.co/axiH9jhEJr https://t.co/oBpew71fZw
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Spatial transcriptomic profiling on pre- and post-Rx synovial tissue Bxs from RA - Tx naive pts on DMARDs or adalimumab. Rx refractory patients had high expression of COMP, and fibroblast TGFβ signaling driving synovial tissue fibrosis https://t.co/1xFVvoddCD https://t.co/kYvhyX8VuS
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Mizoribine Effective in Lupus Nephritis
A randomized clinical trial has shown that oral mizoribine, a common immunosuppressant in Japan, was noninferior to intravenous cyclophosphamide (CTX) as induction therapy in patients with active lupus nephritis.
https://t.co/OS3yaJlEm7 https://t.co/1YcyfarF09
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Systematic literature review of sleep Rx in Fibromyalgia - 47 RCTs, 11094 pts, found cognitive behavioral Tx (CBT) significantly benefitted insomnia, but not pain. Pregabalin & sodium oxybate had small effect, but Amitriptyline, milnacipran, & duloxetine showed no benefit for… https://t.co/ReommvC5qO https://t.co/UnSM3HnWLV
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J&J announced the FDA jas granted the investigational drug, nipocalimab (FcRn recpt Ab), with Fast Track designation for its study in adult patients with moderate-to-severe Sjögren’s disease https://t.co/TB2cESMLQi https://t.co/IC7PQP2fcx
Dr. John Cush RheumNow ( View Tweet)