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14d study of 30 #RA pts collected data from iPhone + Apple smartwatch +PROs showed that AI analysis of sensor data augmented PRO data (by 10%) regarding RA status & severity. Sensor + PRO correlated well w/ RAPID3 status (r2, 0.692) https://t.co/3izpHiqRHG https://t.co/vMvtqOZCjF

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Brazilian registry of 1316 RA pts on bDMARDs or JAKi-Added use of antimalarials reduced SAEs & total AEs, & incr survival. 19% were on HCQ, & had signif less SAEs (mIRR: 0.49); AEs (0.68); serious infections (0.53); hepatic AEs (0.21); & mortality (P=.003) https://t.co/cOeg3KL8Z3 https://t.co/pPRqD7PkXB

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Poly-Refractory Rheumatoid Arthritis Refractory of difficult to treat (D2T-RA) rheumatoid arthritis (RA) comprises a minority of patients that can be categorized by clinical and imaging parameters to formulate a better therapeutic approach. https://t.co/IKAojQFdaw https://t.co/paBwWw2nmh

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Dr. John Cush RheumNow ( View Tweet)
Full read overview of SJOGRENS SYNDROME, which can be Primary SS or Secondary (15% in SLE, 20% RA, & 30% systemic sclerosis). SS Organ involvement: - CNS 2-17% - Renal <=10% - ILD 10-20% -MSK 45-56% https://t.co/RElOFfP2xr https://t.co/aJI041VCuE

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Dr. John Cush RheumNow ( View Tweet)
Danish registries study shows maternal Autoimmune Dzs (all) were assoc w/ incr risk of childhood cancers (OR=1.25, 95% CI 1.06, 1.47), acute lymphoblastic leukemia (OR =1.52), Burkitt lymphoma (OR=2.6) & CNS tumors (OR=1.45); same seen for RA mothers https://t.co/HQO972ch9R https://t.co/dDEJUo8unq

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Dr. John Cush RheumNow ( View Tweet)
RheumNow Podcast square

VITAL Info on Autoimmune Disease (2.9.2024)

d Jack Cush, MD

Dr. Jack Cush reviews the journal reports from the past week on RheumNow.com. Highlights are summarized by three songs: "Stairway to Heaven", "You're No Good", and "How Long (has this been going on)".

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Resolvin (RvT)4 - orchestrates macrophage responses to limit atherosclerosis during inflammatory arthritis. (RvT)4 negatively correlates w/ vascular lipid load in inflammatory arthritis; RvT4 can be used to reduce blood vessel inflammation. https://t.co/H38cFvDcvE https://t.co/ptZpjWf1F6

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Dr. John Cush RheumNow ( View Tweet)
VITAL Study - Autoimmune Prevention Requires Continued Supplements https://t.co/jXTq11R8fE https://t.co/QaCGBdAMAj

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Dr. John Cush RheumNow ( View Tweet)
RA,Rx,puzzle

Poly-Refractory Rheumatoid Arthritis

d Jack Cush, MD

Refractory of difficult to treat (D2T-RA) rheumatoid arthritis (RA) comprises a minority of patients that can be categorized by clinical and imaging parameters to formulate a better therapeutic approach. 

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PSS.scleroderma.arthritis.contractures

Inflammatory Arthritis in Systemic Sclerosis is Problematic

d Jack Cush, MD

Inflammatory arthritis (IA) is a common manifestation in systemic sclerosis (SSc), affecting nearly one-third of patients.

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Many #RA pts remain on Steroids despite b/tsDMARD use! Study 228 #RA pts, 68% Rx low-dose GCs (32% no GCs). After 3 yrsof b/tsDMARDs, 32% still on GCs, 23% D/C GCs, & 20% go on & off, 25% never took GCs. GCs use assoc w/ HTN (20 v 11%) & MI (2.3% vs 0) https://t.co/lWVfvJrAyp https://t.co/uTIWqDAjRG

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Dr. John Cush RheumNow ( View Tweet)
649 # RA pts (291 ACPA+) from the Leiden Early Arthritis Clinic shows Disease activity incr by: - Obesity: + 0.32 higher DAS - Obese + ACPA+: + 0.43 DAS - ACPA+ RA: SJC incr 60%, TJC 55%, CRP + 3.7 mg/L https://t.co/WH0tpybe4a https://t.co/jkgDLQdfRH

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Dr. John Cush RheumNow ( View Tweet)
VitD

VITAL Study - Autoimmune Prevention Requires Continued Supplements

d Jack Cush, MD

In the 2 years that followed the termination of the VITAL study, the preventative effect of vitamin D on incident autoimmune disease disappeared with supplement discontinuation; but n-3 fatty acid treated individuals had a sustained benefit in reducing the risk of autoimmune disease.

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Study of 78 #RA pts(83% CCP+) showed signif. discordance between office visit DAS scores & telephone eval by RAPID3 (w/in 2 wks of F2F visit). By RAPID3, 27% were in remission, vs F2F DAS-CRP 71%) or DAS-ESR (33%) kappa= 0.48 (mod) & 0.14 (low agreement) https://t.co/DsgR0aMUGf https://t.co/smnFe13m5W

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Dr. John Cush RheumNow ( View Tweet)
Study of 235 newly Dx #RA patients (157 females) found that 11 pts (5%) had carpal tunnel syndrom (CTS) at the time of initial RA diagnosis. Such pts were more likey to be older, female, CCP negative and have a longer Sx duration. https://t.co/Nny9HSD5zX https://t.co/2Dnhrjz8ud

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Dr. John Cush RheumNow ( View Tweet)
240 consecutive estab. RA pts underwent cervical spine X-rays looking for ant. atlantoaxial subluxation (aAAS >3 mm); aAAS found in 25 (10.4%) mean interval =4.2mm. One-third had no neck pain. aAAS predicted by lower BMI, CCP, erosions & joint prostheses https://t.co/VTMdv6wudB https://t.co/RDbjjuJAjD

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Dr. John Cush RheumNow ( View Tweet)
Greek study finds 251/1264 #RA pts (20%) had difficult to treat RA (D2T). D2T Predictors were Younger age, fibromyalgia, OA, no change in DAS28-ESR in 1st 6mos b/ts-DMARD Rx. Mental-/pain-/metabolic-Dz contributed to LT worsening https://t.co/A5bfth79L2 https://t.co/f5AOvFW9Yu

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Dr. John Cush RheumNow ( View Tweet)
labs2.jpg

Pre-Treatment Testing with Biologics Falls Short

d Jack Cush, MD

US commercial insurance claim analysis of laboratory screening and monitoring practices in chronic inflammatory skin disease (CISD) patients shows that < 60% received the recommended pretreatment testing when starting systemic immunomodulatory treatment.

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US.MTP1_.synovitis.PD_.gout_.jpg

Half of Subclinical Synovitis Patients May Remit

d Jack Cush, MD

Ultrasound subclinical synovitis is found in a third of individuals at risk of rheumatoid arthritis (RA) patients; in half of these, subclinical synovitis resolves with a favorable outcome.

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Metabolic Syndrome increases RA risk. UK Biobank (369,065) study saw 4901 incident RA (12 yrs F/U). Signif hi RA risk with MetS (HR 1.22), waist circumf (1.21), incr TG (1.12), decr HDL (1.31) & hyperglycemia (1.15) - all additive. https://t.co/jN15axxTmu https://t.co/DP5bFwOB3F

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Dr. John Cush RheumNow ( View Tweet)

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