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ACP/AAFP Guidelines on Managing Musculoskeletal Pain

RheumNow

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line therapy in a new guideline for treating acute, non-low back pain from musculoskeletal injuries in outpatient settings.

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RheumNow Podcast - The SARS-CoV-2 Update (8-14-20)

Jack Cush, MD

Dr. Jack Cush updates the news and journal articles from the past week on RheumNow.com, with information on enthesitis, nr-Ax-SpA, UAB, Blockbuster Rheum Drugs and use of ACE inhibitors.

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Rheumatic Diseases, Drugs and COVID-19 Guidelines

Jack Cush, MD

Several recent publications have focused on the risk and outcomes of rheumatic disease (RDD) and autoimmune patients who become infected with SARs-CoV-2.

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RheumNow Podcast – Why Do We Love Rheumatology Fellows? (8.7.20)

Jack Cush, MD

Dr. Jack Cush reviews why we all love our rheumatology fellows and our best advice for them stemming from these articles.

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More Rheumatology Fellow Advice from the Mentors

Jack Cush, MD

If you’re looking for some great advice to consider or rebuke, here is the generous guidance of nearly two dozen leaders in rheumatology who sincerely offer you their wisdom and best wishes.

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ACR Advice on Reopening Strategies

The American College of Rheumatology (ACR) has issued a guidance document for rheumatologists and rheumatology health professionals to consider as practices, business and patient care begins to reopen in this next phase of the COVID-19 pandemic.

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Are there delays in Dx-ing RA? 2019 UK NHS study shows median delays from 1st Sx to seeing a rheumatologist was 27 weeks, with 20% seen w/in 1st 3 mos. Includes a patient delay (5.4 wks), GP delay (6.9 wks) & hospital delay (4.7 wks) https://t.co/vwNALZKkiR

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Dr. John Cush RheumNow ( View Tweet)

NY Times article about a "guy and aching legs". 48 yrs old w/ myalgias, wt loss, SOB, sinusitis, high inflammatory markers, pulmonary infiltrates, microscopic hematuria, red & swollen ears; but no fever/chills. You're a rheumatologist, you know the Dx. https://t.co/fbrRMNA5u4 https://t.co/JFOcM0MBxB

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Dr. John Cush RheumNow ( View Tweet)
Check out my Virtual Video Exam - 5 minutes of a combo of Simon Sez and the Macarena hits the high points of a functional virtual examination. https://t.co/iwHTJKQtEC

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Dr. John Cush RheumNow ( View Tweet)

RheumNow Podcast - Why we Love Rheumatology Fellows (8.7.20) Watch it here>> https://t.co/ftrycqoWRR or Listen to the podcast on iTunes or on SoundCloud>> https://t.co/gi5hO0HaIl

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Dr. John Cush RheumNow ( View Tweet)

Analysis of PPI use from the Nurses Health Study shows regular PPI use was associated with increased risk of RA in women, higher with a longer duration of PPI use. With 1.7 million PY F/U, Regular PPI users had a 44% higher RA risk (adjHR 1.44; 1.10–1.89) https://t.co/pmBf88zGKH

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Dr. John Cush RheumNow ( View Tweet)

Virtual Video Joint Exam Pearl #5: The worst/most ineffective Virtual visits done with the Patient (or MD) driving in their CAR for the virtual visit!! Amazingly I have had a half dozen of these & requested the patient pull over so I could deliver a rheum Citation.

Dr. John Cush RheumNow ( View Tweet)

Virtual Video Joint Exam Pearl #5: Its easier to see gouty Tophi and rheumatoid nodules than nail changes of PsA or subtle rashes. For Rashes and oral lesions its BEST to have the patient take multiple pix with the cell phone and send them in by EMR or Email.

Dr. John Cush RheumNow ( View Tweet)

Virtual Video Joint Exam Pearl #4: Professor Paul Emery was right! THe MCP squeeze (done by the patient) and MTP squeeze is fairly predictive of RA/inflammatory arthritis AND outperforms the "Finger" (distal hand) squeeze. Hence the MCP/MTP is my main squeeze!

Dr. John Cush RheumNow ( View Tweet)

Virtual Video Joint Exam Pearl #3: Despite cam setups designed to do upper extremity exams, patients can easily move cams and limbs to examine spinal movt, gait, knee, ankle and foot problems with great accuracy.

Dr. John Cush RheumNow ( View Tweet)

Virtual Video Joint Exam Pearl #2 : Despite being in my video on the Virtual joint exam; asking the patient to show you their fist (AKA fist bump the camera) to see potential MCP swelling has thus far been a largely useless maneuver...but it looks good on cam...

Dr. John Cush RheumNow ( View Tweet)

Virtual Video Joint Exam Pearl #1: pain elicited by cervical lateral bending (in someone w/ otherwise normal Cx ROM) is highly correlated with Tender trigger points in the neck region (hence #FM)

Dr. John Cush RheumNow ( View Tweet)

The RheumNow Podcast is up - Top 13 Rheumatology Centers in the US; anakinra & colchicine in COVID, unload the loading dose, CB2 in Scleroderma. Watch it here>> https://t.co/5LIIi7Pwg1 or listen to the podcast here>> https://t.co/5LIIi7Pwg1

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Dr. John Cush RheumNow ( View Tweet)

Safety & efficacy of rituximab in Older RA (>65; n=97) vs younger (<65yrs; n=276) showed no difference in drug survival over 2 yrs (72% vs 74%)or SDAI activity. BUT.. there were more SIE (14.2 vs 6.6/100 PY) & pneumonia (10.7 vs 5.1/100 PY) in older pts https://t.co/dxqPg2fOlV

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Dr. John Cush RheumNow ( View Tweet)

Analysis of administrative health data (1984‐2016) on 12984 #RA pts shows RA w/ psychiatric comorbidities (depression, anxiety, bipolar, schizophrenia) had more additive visits (10.9), hospitalizations, hospital days (3.6), more drugs (7.3) & FP visits https://t.co/5py0i2tWqL

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Dr. John Cush RheumNow ( View Tweet)

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