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Dead Words Eulogy
The trouble with rheumatology may be the words we live by. Welcome to the eulogy for rheumatology 'dead words'. We're here today to celebrate the loss of rheumatology past. These are dead words in rheumatology, words fortified unfortunately by history and habit. The lexicon of rheumatology is unique, it's challenging and it's mostly incomprehensible to those who don't know...but those are the cornerstones of the greatest of medical subspecialties.
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Methotrexate Nodulosis (1.19.2024)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. How good (or not) are rheumatologists and what to do about MTX nodulosis?
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Rheumatologists and the Early Diagnosis of Spondyloarthritis
SPACE study of adults referred to rheumatology with less than 2 years of chronic back pain (CBP), shows that only one-third can be reliably diagnosed with axial spondyloarthritis (axSpA).
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BASDAI tends to be higher in women while there is no appreciable difference in ASDAS scoring in men compared to women.
Dr. L. Eder believes this could be due to the pain scoring in both indices.
#RNL2024 @RheumNow @lihi_eder https://t.co/i7XPenrmGG
Dr. Rachel Tate uptoTate ( View Tweet)
With regard to SpA patient journey:
On average, women are diagnosed 2.3 years later than men.
Additionally, women tend to have more visits to rheumatology to reach diagnosis of PsA, AS, and RA!
Remember your inherent bias along with sex/gender disparities.
Dr. L. Eder… https://t.co/o0Hv3NrXpB https://t.co/vsMN3HkSv6
Links:
Dr. Rachel Tate uptoTate ( View Tweet)
My volume of referrals for OCI or degenerative disease (or sometimes completely normal SI joints) read as "sacroiliiitis" really does seem to have been increasing lately @lihi_eder @RheumNow #RNL2024 https://t.co/vksNCaADck
Richard Conway RichardPAConway ( View Tweet)
The different outcomes and response to treatment in males and females are related to sex differences in pain mechanisms and gender roles. Women report a higher BASDAI level, the ASDAS is equal in both sexes, Lihi Eder #RNL2024 @RheumNow https://t.co/7jjkgmmUg8
Links:
Dr. Antoni Chan synovialjoints ( View Tweet)
Picking the right tools to measure disease activity may be difficult because these tools may perform differently in men and women. The ASDAS show to differences between sexes but the BASDAI was significantly higher in women than in men. – Dr. Eder #RNL2024 @rheumnow https://t.co/KSBMrxio5P
TheDaoIndex KDAO2011 ( View Tweet)
Potential board question: be able to differentiate between osteitis condensan ilii vs sacroiliitis. With osteitis condensan, the SI joint is normal, with no irregularity, erosions, or loss of joint space. Sclerosis is predominantly on the iliac bone @rheumnow #RNL2024 @rheumnow https://t.co/mimcdoufEE
TheDaoIndex KDAO2011 ( View Tweet)
Dr. Eder on gender differences – we need to move from gender blind to gender specific approach to treating our patients. There are biological, cultural, and social differences between males and females. #RNL2024 @rheumnow https://t.co/gnzU6FKIPR
TheDaoIndex KDAO2011 ( View Tweet)
“TNFi, IL17i, JAKi--- note that these are the only classes of drug that work for axial spondyloarthritis!” – Dr.
@AlexisOgdie noted ustekinumab, apremilast, and abatacept do not work for inflammatory back pain.
@rheumnow #RLN2024 https://t.co/BHV6qCUdYi
TheDaoIndex KDAO2011 ( View Tweet)
#RNL2024 @RheumNow
@AlexisOgdie
Many therapies for SpA - but ONLY TNFi, IL17i, and JAKi for AxSpA
Check out https://t.co/V7JGc6t72C to help guide treatment decisions: Prior therapies? enthesitis? concomitant IBD/uveitis? comorbidities? Pt preferences? https://t.co/hfFikMs9YL
Links:
Eric Dein ericdeinmd ( View Tweet)
Thinking of joint, skin, axial disease in psoriatic arthritis and extra-articular manifestations leading to shared decision making, Alexis Ogdie #RNL2024 @RheumNow https://t.co/F57sEicht7
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Dr. Antoni Chan synovialjoints ( View Tweet)
@AlexisOgdie discusses the current and expected future SpA therapeutic options.
However, and I also discuss this with my patients, we are more limited in AxSpA vs PsA (with axial disease.)
#RNL2024 @RheumNow https://t.co/dlVgWblSXy
Dr. Rachel Tate uptoTate ( View Tweet)
Importance of focusing on patient goals in psoriatic arthritis, use shared decision making and apply the clinical guidelines and treatment options within this context, Alexis Ogdie #RNL2024 @RheumNow https://t.co/jCFWUqJNn3
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Dr. Antoni Chan synovialjoints ( View Tweet)
Dr. @AlexisOgdie describes her decision tree when assessing SpA/PsA patients. #Rheumtwitter What do you do?
#RNL2024 @RheumNow https://t.co/T4ZRKDplqe
Dr. Rachel Tate uptoTate ( View Tweet)
Do you use the ASA24?
Dr. Gabalawy asked Dr. Guma about this index at the #RNL2024. These indices don't quite encompass all aspects of the ACR recommended Mediterranean diet, for example, but could be useful in developing better assessments for patients and their diet.… https://t.co/v4Fu43u7et https://t.co/CTV2IaJ1xW
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Dr. Rachel Tate uptoTate ( View Tweet)
16% of patients with nr-axSpA progressed to r-axSpA within 5 years. Male sex, fulfillment of the imaging arm of the ASAS criteria, and good response to nonsteroidal anti-inflammatory drugs were predictors of radiographic progression https://t.co/eargDLHUZ2 https://t.co/xG52uMmYK8
Dr. John Cush RheumNow ( View Tweet)
Rheumatologists and the Early Diagnosis of Spondyloarthritis
SPACE study of adults referred to rheumatology with less than 2 years of chronic back pain (CBP), shows that only one-third can be reliably diagnosed with axial spondyloarthritis (axSpA).
https://t.co/EwrrunyZs7. https://t.co/T0OqlsuU2P
Dr. John Cush RheumNow ( View Tweet)
Prior RCT showed continuous NSAID slowed XRay progress in SpA. New 2 yr RCT of 109 pts shows when celecoxib added to TNFi Rx (golimumab) in high risk SpA there was no added Xray benefits (by mSASSS). https://t.co/i0KTPAaLFz https://t.co/dB2Q3PHhcK
Dr. John Cush RheumNow ( View Tweet)
