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Multi-omics, biomarkers, rheumatoid arthritis and pulmonary fibrosis

Jack Cush, MD

Rheumatoid arthritis (RA) is a common autoimmune disease, and approximately 30%-40% of patients develop pulmonary complications such as idiopathic pulmonary fibrosis (IPF), but the causal relationship between the two has long been unclear.

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steroid prednisone lab

Higher Medical Costs with Corticosteroid Use

Jack Cush, MD

Rheumatoid arthritis (RA) health insurance claims database study from Japan shows that RA patients initially treated with glucocorticoids (GCs) and disease-modifying antirheumatic drugs (DMARDs) experienced greater medical costs and healthcare utilization than patients not trea

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Osteoporosis in Older Men

Jack Cush, MD

JAMA has publish an invited commentary on Screening for Osteoporosis (OP) in Older Men. They point out that a simple screening strategy for older men based on previous fracture history and bone density screening at age 70 or 75 years is a reasonable means of screening for OP in older men.

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Methotrexate intolerance in rheumatoid arthritis

Jack Cush, MD

Methotrexate (MTX) is the most commonly used DMARD in rheumatoid arthritis (RA); however, there is significant intolerance to this drug among adult RA patients - especially at doses above 15 mg per week. 

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Prenatal acetaminophen linked to increased autism and ADHD

EurekAlert!

Researchers at the Icahn School of Medicine at Mount Sinai have found that prenatal exposure to acetaminophen may increase the risk of neurodevelopmental disorders, including autism spectrum disorder and attention-deficit/hyperactivity disorder (ADHD), in children.

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High unemployment in Dutch SLE patients, linked to SLE Sxs & Dz duration. Supervisor support helps with employment. https://t.co/E5jqmUHqo7
Dr. John Cush RheumNow ( View Tweet)
J&J announced it has halted its combination biologic study in difficult to treat RA. Phase 2a DAISY proof-of-concept studied the combo of nipocalimab and TNFi in refractory RA, but 12 wk results failed to evidence of efficacy. https://t.co/T4n4GNqtVC v https://t.co/eSAwrEIYHc

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Dr. John Cush RheumNow ( View Tweet)
GLP-1 receptor agonists use assoc w/ lower risk of uveitis compared vs controls. EHR study 258 026 ea on GLP-1RA or not. GLP-1RAs exhibited roughly half the risk of developing uveitis. Protective effect greater than that of metformin & insulin but lower than SGLT2i https://t.co/w311b6swc3
Dr. John Cush RheumNow ( View Tweet)
High cancer risk in myositis patients linked to autoantibodies- TIFF1g, NXP2, HMGCR. https://t.co/CECO78ESHi
Dr. John Cush RheumNow ( View Tweet)
Anti-MDA5 DM is assoc w/ rapidly progr ILD & mortality risk. 26 MD5+ DM pts (age 56.6 yrs; 7/26 male) Sxs: Gottrón’s (81%), ILD (73%), periungual erythema (69%), heliotrope (61%), V-sign (42%), arthritis (42%), weakness (38%), mechanic’s (35%), Raynaud’s (19%). 7/19 RP-ILD died https://t.co/ugbmKlXsBp
Dr. John Cush RheumNow ( View Tweet)
Long-term Lab Monitoring in RA is Inefficient Annals of Internal Medicine has published a retrospective study of long-term routine laboratory toxicity monitoring (lt-RLTM) in patients receiving disease-modifying antirheumatic drug (DMARD) therapy showing that most very abnormal https://t.co/hytyH1qqED
Dr. John Cush RheumNow ( View Tweet)
Wait! FDA approved the Chikungunya Virus Vaccine 2 yrs ago, but just pulled the vaccine, Ixchiq, citing serious safety concerns (specifically CBER reports of >20 serious adverse events, including 21 hospitalizations, 3 deaths, w/ 1 fatality directly linked to vaccine-derived https://t.co/aaC38VX7rF
Dr. John Cush RheumNow ( View Tweet)
Recombinant zoster vaccine effective in #SLE without flare. Retrospective Medicare & commercial claims data on pts given 2 RZV doses, matched 1:4 to unVAX. 3592 pts F?u ~1.5 yrs. Vax effectiveness 70% in Medicare; 54% commercial. SLE flare rates HR 0.91& 0.94. https://t.co/WCBOQhb4Ad
Dr. John Cush RheumNow ( View Tweet)
Osteoporosis in Older Men JAMA has publish an invited commentary on Screening for Osteoporosis (OP) in Older Men. They point out that a simple screening strategy for older men based on previous fracture history and bone density screening at age 70 or 75 years is a reasonable https://t.co/bpa4N4mdOp
Dr. John Cush RheumNow ( View Tweet)
Methotrexate intolerance in rheumatoid arthritis Methotrexate (MTX) is the most commonly used DMARD in rheumatoid arthritis (RA); however, there is significant intolerance to this drug among adult RA patients - especially at doses above 15 mg per week. https://t.co/aizooTPNTe https://t.co/FZ52bwHBfq

Links:

Dr. John Cush RheumNow ( View Tweet)
Prenatal acetaminophen linked to increased autism and ADHD Researchers at the Icahn School of Medicine at Mount Sinai have found that prenatal exposure to acetaminophen may increase the risk of neurodevelopmental disorders, including autism spectrum disorder and ADHD, in https://t.co/Zpo9dymPPf
Dr. John Cush RheumNow ( View Tweet)
While the live-attenuated vaccine, Ixchiq, was pulled for safety concerns, there is another chikungunya vax still on the marked - a virus-like particle vaccine, Vimkunya. Travelers or the elderly at higher risk of chikungunya exposure should consider getting vaccinated

Dr. John Cush RheumNow ( View Tweet)

Rapid rituximab infusions are safe & efficient. Metanalysis of 7 RCTs, 538 pts w/ autoimmune/rheumatic dz, showed infusions(RTX 1000 mg) of 90-120 min (w/ premedication) had low risk (3-15%) of mild (Grades 1, 2) infusion Rxns; only 6 Grade 3 Rxns https://t.co/uVKuhhc80F https://t.co/NIMMhgIRzH

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TriNetX database study shows Beta blocker use assoc w/ more hip replacements (THA). 23K propensity matched pts (mean age 69) on or off BB compared. After 3 yrs BB use was assoc w/ higher risk of THA (HR 1.49; 1.4–1.59), esp w/ alpha-BBs (HR 1.64) https://t.co/W6ocMYI653 https://t.co/EiQ4WH94cD

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Dr. John Cush RheumNow ( View Tweet)
New IDSA recommendation: In hospitalized on systemic steroids w/ severe, critical, progressing COVID-19, when baricitinib or tocilizumab are not available, IDSA guideline panel suggests infliximab. https://t.co/ZCkkZXUDpi https://t.co/gbgkvj5R8Y

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Dr. John Cush RheumNow ( View Tweet)
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