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Comorbidities Impact Disease Activity in Spondyloarthritis

Jack Cush, MD

An analysis of a large population-based cohort of axial spondyloarthritis (axSpA) patients shows that comorbidities are common and are associated with higher disease activity and higher levels of functional impairment.

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RheumNow Podcast – The Bad News That’s Fit to Print (8.21.20)

Jack Cush, MD

Dr Jack Cush reviews the news and journal reports from the past week on RheumNow: filgotinib rejection, delays in diagnosis, metformin benefits COVID, Abx and IBD, and UPA beats MTX.

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DLE discoid lupus

New Criteria for Discoid Lupus

Jack Cush, MD

JAMA Dermatology has proposed an initial validation of classification criteria for discoid lupus erythematosus (DLE), primarily for research purposes, but with clinical applicatility.

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Low Risk of COVID in Biologic Treated Rheum Patients

Jack Cush, MD

In an Annals of Rheumatic Disease report, Italian investigators performed consecutive testing for SARS-CoV-2 (IgM and IgG) between 25 March to 25 May 2020 and compared test results between rheumatic disease (RMD) patients and the general population. 

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Risankizumab Outduels Secukinumab in Psoriasis

Jack Cush, MD

The IMMerge trial has demonstrated the superiority of interleukin (IL)‐23 over IL-17A inhibition adults with plaque psoriasis.

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ICYMI: The Nine Lives of Hydroxychloroquine (Updated)

Martin J. Bergman, MD

Hydroxychloroquine is one of many medications frequently used in rheumatology practice. Its remarkable versatility is attested by its routine use in lupus, in patients with an autoimmune coagulopathy, in patients with rheumatoid arthritis, as well as in those with a low-level inflammatory arthropathy.

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Is IL-23 Better than IL-17 Inhibition in Psoriasis?

Jack Cush, MD

Data presented at the recent American Academy of Dermatology meeting suggests that interleukin (IL)-23 inhibition with risankizumab was more effective than the IL-17 inhibition (secukinumab) based on a 52 week randomized head-to-head trial in moderate to severe psoriasis patients.

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Study of 211 SSc pts (70% with limited SSc) & during 120 (50-216) mos F/U, 105 (50%) had 1 or more skin ulcer (SU); 66% recurrent/persistent SUs. Being younger at Dx, articular involvement and telangiectasia were independently associated with SUs https://t.co/yLurnaft5X

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Dr. John Cush RheumNow ( View Tweet)

Successful treatment of refractory palmoplantar psoriasis in a psoriatic arthritis patient with the JAK inhibitor tofacitinib https://t.co/bdhppoUkmz

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Dr. John Cush RheumNow ( View Tweet)

Hong Kong study Myositis-specific autoantibodies in 201 pts with idiopathic inflammatory myopathies (IIM) shows MDA-5 (14%), TIFF-1γ (14%), Jo-(12.4%). MDA5 seen w/ DM, digital ulcers, amyopathy, ILD. TIF1γ was associ w/ refractory rash and cancer https://t.co/3E365F5SON

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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)

Lenabasum (cannabinoid rcptr agonist) studied in Systemic Sclerosis - LEN (n=27) vs PBO (n=15). At wk 16 LEN had better responses by CRISS (skin) score (0.33, vs 0; P=0.07) w/ reduced gene expression for inflammation & fibrosis & improved skin histology https://t.co/oddSMvjnc9 https://t.co/HLFPNfigFD

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Dr. John Cush RheumNow ( View Tweet)
The RheumNow Podcast is up - COVID-19 Responds to Steroids & TCZ, statin myopathy, Lung Dz in AOSD, TNFi & Liver, IL-23 in Psoriasis. Watch it here>> https://t.co/DrrFZSWmZa or listen to Podcast on iTunes>> https://t.co/FHJv01AAbC or on SoundCloud>> https://t.co/nSPI9lcaY9

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Dr. John Cush RheumNow ( View Tweet)

Cross-sectional survey of 3200 PsA/Pso patients. 65% had both joint & skin involvement. Latter pts had worse QoL, work impairment, higher TJC (5.2) & SJC (4.8) (vs 2.0 & 1.5); more flares (35 vs. 23%, p < 0.001). Jts bigger burden (62%) vs skin (38%) https://t.co/mpmpF4LiLR

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Dr. John Cush RheumNow ( View Tweet)

Metanalysis of 7 RCTs looked at melanoma risk comparing 34 029 biologic Tx vs 135 370 non-biologic conventional systemic Tx pts, showing no signif. increased risk in IBD (RR 1.20; 0.60-2.40), RA (pRR 1.20; 0.83-1.74), or psoriasis (HR 1.57; 0.61-4.09) https://t.co/PCOddiwKv0

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Dr. John Cush RheumNow ( View Tweet)

FDA has approved a 6th adalimumab biosimilar - called Hulio (adalimumab-fkjp) with indications of rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, adult Crohn’s disease, ulcerative colitis, psoriasis. https://t.co/zMNsDjVewU

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Dr. John Cush RheumNow ( View Tweet)

Skin is often involved w/ ANCA+ vasculitis - 1184 AAV pt study shows skin involvement in 34% GPA; 28% MPA & 47% EGPA. Common are petechiae/purpura pruritus, urticaria, and maculopapular rash. AAV w/ skin Sxs have more systemic dz (GN, alveolar hemorrhage) https://t.co/egPdW2IEnu

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Dr. John Cush RheumNow ( View Tweet)

The CHMP of the European Medicines Agency has recommended the label expansion of IL-17 inhibitor, Cosentyx (secukinumab) for the treatment of moderate-to-severe plaque psoriasis in children and adolescents aged 6-18 years. https://t.co/1qYL5ASkrg

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Dr. John Cush RheumNow ( View Tweet)

Tocilizumab may be effective in refractory ocular-, neuro-, vasculo-Behcet's. Study of 47 Behcet's pts Rx w/ TCZ - good at ocular (24/25), CNS (6/6), vascular (7/7) & amyloidosis(2/2) but less effective w/ oral/genital (8/21), skin (6/14) or joints (4/11) https://t.co/lKY8D706bi

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Dr. John Cush RheumNow ( View Tweet)

23 yoF with 1 mos digital ulcers, hair loss, sicca Sxs, dysphagia; No sclerodactyly but finger tips cyanotic w/ distal pitting scars, ischemic ulcers, periungual erythema & dilated nailfold capillaries (no hemorrhages). +tests for ANA, Ro52, Ro60 and Scl-70 Abs. How to treat?

Dr. John Cush RheumNow ( View Tweet)

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