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RWCS Highlights - Day 3

Rachel Tate, DO

Day 3 report from the 2021 RWCS meeting in Maui (and virtually) includes pearls from the PsA 2020 Year in Review; fact vs. fiction on evidence based medicine: diet and rheumatic diseases; hot topics in allergy/immunology; and pediatric rheumatology highlights.

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ACR Promotes New COVID-19 Vaccine Clinical Guidance for Rheumatic Patients

Jack Cush, MD

The American College of Rheumatology has published a draft guidance on the use of COVID-19 vaccination in rheumatic disease and musculoskeletal disease patients, based on the efforts of the North American Task force. The document provides guidance to rheumatology providers on the use of the COVID-19 vaccine and the associated management of RMD patients around the time of vaccination. Here is a summary of the recommendations.

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Comorbidity and Drugs Drive COVID-19 Severity and Survival in Rheumatic Disease

Jack Cush, MD

While comorbidities are associated with severe COVID-19 infection, it appears they also influence severity and survival in rheumatic disease (RMD), according to a a French cohort study,

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IVIg in MIS-C

Jack Cush, MD

Among children with multisystem inflammatory syndrome (MIS-C), treatment with IVIG and methylprednisolone vs IVIG alone was associated with a more favorable fever course. MIS-C is a rare but serious pediatric condition associated with COVID-19 where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs.

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RheumNow Podcast – Tofacitinib Safety Concerns (2.5.2021)

Jack Cush, MD

Dr. Jack Cush reviews and discusses the news and journal reports from the past week on RheumNow.com.

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Hydroxychloroquine Fails to Prevent COVID-19

Jack Cush, MD

There is a preponderance and mounting evidence that hydroxychloroquine is ineffective in COVID-19 infection; and now the NEJM reports a the results of a trial where HCQ given as post-COVID exposure therapy failed to prevent SARS-CoV-2 infection or symptomatic Covid-19 in healthy persons.

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Email Survey study of HSS rheumatic pts 7,094 responded 1,547 were women (18-50yrs) & 61 (4%) were pregnant during COVID. COVID prevalence was similar in PREG vs nonPREG (8% vs.9% ), PREG COVID pts had shorter Sxs, more loss taste/smell. https://t.co/4HDuXbZVrs

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Dr. John Cush RheumNow ( View Tweet)

Common mucocutaneous findings in 35 kids w/ MIS-C & COVID: 1) conjunctival injection (21), palmoplantar erythema (18), lip hyperemia (17), periorbital erythema/edema (7), strawberry tongue (8), & malar erythema (6) https://t.co/mcSOXtXaEh

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Dr. John Cush RheumNow ( View Tweet)

Could the PEG portion be responsible for IgE and non-IgE mediated COVID vaccine reactions? Both Moderna and Pfizer use the same 2000kd PEG for stability of the lipid nanoparticle. (Recall Miralax and PEG reactions...) Dr. A Postolova #RWCS2021 #RWCS @RWCSmtg @RheumNow https://t.co/ALXvR2h21z
Dr. Rachel Tate uptoTate ( View Tweet)
Vaccinated COVID-19 pts appear less contagious; report from Israel - among 650,000 received two-doses of Pfizer vaccine, 2,897 later tested positive for COVID-19, but nasal swab samples showed 4-fold less virus - hinting protection https://t.co/UBE4q6aE63

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Dr. John Cush RheumNow ( View Tweet)

ACR Promotes New COVID-19 Vaccine Clinical Guidance for Rheumatic Patients The ACR has published a draft guidance on the use of COVID-19 vaccination in RMD patients, based on the efforts of the North American Task Force. https://t.co/uSPfvJB8EC https://t.co/9bwBdtHw5e

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Dr. John Cush RheumNow ( View Tweet)
Preprint from UK trial shows tocilizumab efficacy in COVID-19. 2022 TCZ vs 2094 usual care pts (also on dexamethasone), in hospitalized pts on ventilators. 28 day mortality was 29% on TCZ Vs 33% with usual care - TCZ had 23% incr probability of discharge https://t.co/Curd6W20qK https://t.co/0TbhJYh5vM

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Dr. John Cush RheumNow ( View Tweet)
Comorbidity and Drugs Drive COVID-19 Severity and Survival in Rheumatic Disease While comorbidities are associated with severe COVID-19 infection, it appears they also influence severity and survival in RMD according to a French cohort study. https://t.co/8rh1YvtqoE https://t.co/dxVGkdTPKg

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Dr. John Cush RheumNow ( View Tweet)
Congrats to ACR Task Force who published guidelines on RMD drug use w/ COVID vaccines. My views on their recs: 1. I agree, no change most DMARD, biologics 2. I disagree; I would NOT hold Orencia, I would NOT hold JAKi 3. I disagree: I would not hold MTX https://t.co/uSPfvJB8EC https://t.co/SznUJosmpo

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Dr. John Cush RheumNow ( View Tweet)

Hydroxychloroquine Fails to Prevent COVID-19 The NEJM reports the results of a trial where HCQ given as post-COVID exposure therapy failed to prevent SARS-CoV-2 infection or symptomatic Covid-19 in healthy persons. https://t.co/lt71GAtL3D https://t.co/9OyUpQBpzL

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Dr. John Cush RheumNow ( View Tweet)
Between March - Oct 2020, 10 US states with mask mandates reported a 4.9% decline in weekly COVID-19 hospitalizations, significant for those under 65 yrs (5.5%). Results most notable > 3 weeks after the mask mandate. https://t.co/umjiFVNACF

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Dr. John Cush RheumNow ( View Tweet)

RheumNow Podcast is up! Tofacitinib Safety Concerns - covering vagal nerve stimulation, IL-23 in PsA, Diet & RA, NSAIDs & COVID, Plaquenil side effects and more. Watch it here>> https://t.co/7RDZ0avZLC ListeniTunes>>https://t.co/FHJv01AAbC or SoundCloud>>https://t.co/yJWJNa6CRL

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Dr. John Cush RheumNow ( View Tweet)

HCQ Fails to Prevent COVID-19 Mounting evidence shows that HCQ is ineffective in COVID-19 infection; and now the NEJM reports that HCQ given as post-COVID exposure therapy failed to prevent SARS-CoV-2 infection or symptomatic Covid-19 in healthy persons. https://t.co/lt71GAtL3D https://t.co/VzmJgQlrrG

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Dr. John Cush RheumNow ( View Tweet)
OpenSAFELY analysis shows that NSAIDs safe w/ COVID. Study 1: 1/2 million NSAID users vs ~2 mill non-users found no difference in COVID-19 death (HR 0.96); Study 2: 1.7 million RA/OA pts, 10% on NSAIDs had a lower risk of COVID-19 death (HR 0.78) https://t.co/1f3JBmaf2e

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Dr. John Cush RheumNow ( View Tweet)

Adverse Events with Anti-malarials during the COVID Pandemic Despite very preliminary mixed results, the endorsement of chloroquine and hydroxychloroquine use to treat COVID-19 led substantial use (and drug shortages) for these drugs. https://t.co/UQYo3a8ZKI

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Dr. John Cush RheumNow ( View Tweet)

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