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Insights on Postinfectious ME/CFS
The medical community is challenged by myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS - its origins, pathogenesis outcomes and treatment. JAMA has reviewed a recent Nature paper wherein an NIH led team of multidisciplinary experts performed an inpatient study of postinfe
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Ides of March (3.15.2024)
Dr. Jack Cush has advice for Caesar and the superstitious, and covers pregnancy, platelets, dialysis and vaccinations in Lupus.
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MMWR: Vaccination and Multisystem Inflammatory Syndrome in Children
CDC
Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition typically occurring 2–6 weeks after SARS-CoV-2 infection and characterized by fever and multiorgan involvement. The current MMWR report shows that MIS-C case numbers have decreased by 98% since 2021.
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MMWR: Vaccination and Multisystem Inflammatory Syndrome in Children
MIS-C is a rare but serious condition typically occurring 2–6 weeks after SARS-CoV-2 infection and characterized by fever and multiorgan involvement.
https://t.co/PN2MPQxqSR https://t.co/eIzB4pjner
Dr. John Cush RheumNow ( View Tweet)
In RA, NO selective response with Seropositivity. Study of 28 eligible RCTs shows pts Rx w/ cs- or bDMARD that seropositivity did not predict better bDMARD response (ACR20 RRR ~1). Comparable resp in RF+ & RF- w/ TNFi or non-TNFi bDMARDs. https://t.co/AUWPgkzayt https://t.co/om9AYhNsQ9
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9 Facts about Leflunomide
Medscape has published an informative review of leflunomide, drawn from Dr. Eric Ruderman’s recent lecture on the subject at the February RWCS meeting in Maui.
https://t.co/X9lyrOs3D7 https://t.co/TGh2LnGdJ8
Dr. John Cush RheumNow ( View Tweet)
Retro study 109 oligoarticular JIA pts (~8 yrs) Rx w/ intraarticular steroids w/ 4.3 yrs F/U: 38% needed no Rx, 15.5% needed more IAS; 46% systemic Rx(MTX; 8 mos) &22% biologics(2.2 yrs later). @FUV 89% were inactive. Persistence predicted by ANA+ & B27+ https://t.co/5YLkYyA84l https://t.co/wClhEiKOIw
Dr. John Cush RheumNow ( View Tweet)
Japanese study of 672 autoimmune pts on TNFi & tocilizumab - 1.6% (n=9) developed non-tuberculous Mycobacteria (NTM) infx post biologics. 2 disseminated NTM, 2 died. NTM pts had higher mortality [(22% vs 2.6%) & took more steroid (17 vs 3 mg, P=0.004).https://t.co/fGGafrTeiL https://t.co/DkmiC2hVEA
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JAMA Review of DMARD Use in Rheumatoid Arthritis
JAMA has reviewed the "2022 EULAR Recommendations for the Management of Rheumatoid Arthritis With Synthetic and Biological Disease-Modifying Antirheumatic Drugs".
https://t.co/fpAigPpKzv https://t.co/GkbqW2BxpA
Dr. John Cush RheumNow ( View Tweet)
JAK-pot: 46913 Rx courses on JAKi, TNFi, other MOA. Rx D/Cs for AEs:
- TNFi = JAKi (HR 1.0)
- Other MOA > JAKi (HR 1.11)
- TNFi < tofacitinib (0.81)
- TNFi > baricitinib (1.15)
- TNFi < JAKi; if >65yrs w/ CV risk (0.79) https://t.co/jCtLG3SNvP https://t.co/FN5U5Z1M9M
Dr. John Cush RheumNow ( View Tweet)
Effective Treatments for Still's Disease
A systematic review of pharmacological treatments for adult-onset Still disease (AOSD) supports the efficacy of tocilizumab (TCZ), anakinra (ANK), and canakinumab (CNK).
https://t.co/r7RGD5WlvO https://t.co/Jfq7zPR0ci
Dr. John Cush RheumNow ( View Tweet)
JAK inhibitors maybe an option in refractory Juvenile Dermatomyositis. Metanalysis of 26 reports (195 pts) JDM Rx w/ JAKi (median 5 rys); most Rx w/ tofacitinib (57%), ruxolitinib(27%), baricitinib (15%), w/ Improvement in 90%, 69%, 93%, respectively. https://t.co/tfISYVtwUN https://t.co/zv88Vdy6c0
Dr. John Cush RheumNow ( View Tweet)
Again, a High Mortality with Depression and RA
Last week we reported on a Korean study showing a 66% elevated mortality risk in RA patients with depression. This week, a new report shows depression in RA increases the mortality risk by more than 5 fold.
https://t.co/C7Z7djny4S https://t.co/J9B6DUqcIC
Dr. John Cush RheumNow ( View Tweet)
Study 1189 males athletes sanctioned for doping with Androgenic anabolic steroids compared to 59 450 controls. Anabolic steroids signifi. increased the mortality risk (HR 2.81) from both unnatural (accidents) & natural causes (CVD, etc) https://t.co/XJr1oUw1gM https://t.co/YIQhdCXd2y
Dr. John Cush RheumNow ( View Tweet)
9 Facts about Leflunomide
Medscape has published an informative review of leflunomide, drawn from Dr. Eric Ruderman’s recent lecture on the subject at the February RWCS meeting in Maui.
https://t.co/M0wtGTYkdO https://t.co/dvYqz4WEH2
Dr. John Cush RheumNow ( View Tweet)
HS-Related Autoinflammatory Syndromes
HS is an autoinflammatory skin disorder of the terminal hair follicle, manifesting with painful nodules, abscesses, draining tunnels, and hypertrophic scarring, typically occurring in apocrine gland bearing skin.
https://t.co/02Svwj99Bm https://t.co/9oy1UngII7
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Dr. John Cush RheumNow ( View Tweet)
SLE & remission on hemodyalysis (HD)? Cohort of 137 pts starting HD & the # off SLE Rx increased w/ time: 67% (HD start), 76.0% (1st Yr), 83% at 3 yrs (less w/ younger). Lupes flares most in 1st yr of HD; @12 mos 52% minor and 12% had severe flares. https://t.co/8N7CJWkIUY https://t.co/48eOclzrJH
Dr. John Cush RheumNow ( View Tweet)
Japanese study of 672 autoimmune pts on TNFi & tocilizumab - 1.6% (n=9) developed non-tuberculous Mycobacteria (NTM) infx post biologics. 2 disseminated NTM, 2 died. NTM pts had higher mortality [(22% vs 2.6%) & took more steroid (17 vs 3 mg, P=0.004).https://t.co/cLqt3FSzBk https://t.co/eD84WPZyuq
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Dr. John Cush RheumNow ( View Tweet)
Long-term safety of Ixekizumab (IXE) - 26 RCTs (22k PYs) in PSO, PsA, AS & nr-axSpA
- nasopharyngitis most common AE; AEs did not incr over time
- D/C from AE 3-5/100Pys
- ISRs: 5.9-11.6/100PYs
- Candida 1.2-2/100PYs
- IBD: 0.1 PsO - 0.8/100PY for axSpA
https://t.co/nOoCE3VOxD https://t.co/F4gP1yR1Je
Dr. John Cush RheumNow ( View Tweet)
Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory tract infections were most frequent with recurrence rate that remained stable over time https://t.co/zwELL2yevG https://t.co/GLbidGvjp3
Dr. John Cush RheumNow ( View Tweet)
