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RISE registry study shows Prednisone Rx before rheum consult ends up with more long-term Pred. 1,733 RA pts; 715 on GC (41% 0.5-2 mos before rheum care). mean GC use =157 d. GC before rheum care associated with longer GC use https://t.co/UpeK4hwIN0 https://t.co/F8cuoX0ACq

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Dr. John Cush RheumNow ( View Tweet)
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All in the Family (8.23.2024)

d Jack Cush, MD

Dr. Jack Cush picks highlight reports from the past week on RheumNow.com, with reports on the challenge of lupus nephritis, perplexing skin issues, you don't know JAK (about Tyk) and the value of a good family history.

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GCA,woman

Pulse Steroids with Tocilizumab in Giant Cell Arteritis

d Jack Cush, MD

A pilot study assessed pulse methoprednisolone with weekly subcutaneous tocilizumab (TCZ) in patients with large vessel-GCA (LV-GCA) and showed that a sizeable minority will relapse after the TCZ is discontinued. 

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Metanalysis of 50 RCTs (3,231 pts w/ lupus nephritis (LN) related starting pred dose to rates of complete response (CR), serious infections, & death. PO pred 25 mg/D assoc w/ 20%, 3.2% & 0.2%, respectively. Pred 60 mg/day incr rates to 35%, 12% & 2.7% https://t.co/6FH9BWsmaz https://t.co/0cQPAIuvRw

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Dr. John Cush RheumNow ( View Tweet)
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CARRA Consensus Treatment for Refractory Juvenile Dermatomyositis

d Jack Cush, MD

CARRA has developed consensus treatment plans for the use of biologic disease-modifying antirheumatic drugs (bDMARDs) in patients with refractory, moderately severe juvenile dermatomyositis. Juvenile dermatomyositis is the most common form of idiopathic, inflammatory myositis in childhood, with an estimated incidence of 3.2 per million children per year in the United States.

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TRUST: 10 Yr Japanese study of tacrolimus in 1355 SLE nephritis pts; half on TAC x 10yrs. TAC use assoc w/ signif reduction corticosteroid use (~16 mg/d @4wks to 7.2 mg/d @ 1Yr(P < 0.001). 9.7% w/ serious AEs. https://t.co/PsfCVZF4tk https://t.co/l3HkTRc4oC

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Dr. John Cush RheumNow ( View Tweet)
Literature review - Glucocorticoid use in elderly to be problematic. GC use may be assoc w/ remission, but GC increases AE rates, & there is difficulty w/ GC discontinuation. Goal: D/C GC early, but some may require for up to yrs to control Dz activity https://t.co/6liN0mubIv https://t.co/PiGKGSYrof

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Dr. John Cush RheumNow ( View Tweet)
alveolar hemorrhage acute

PEXIVAS: Diffuse Alveolar Hemorrhage in ANCA-Associated Vasculitis Patients

d Jack Cush, MD

A secondary analysis of the PEXIVAS study showed antineutrophil cytoplasmic antibody–associated vasculitis (AAV) patients complicated by diffuse alveolar hemorrhage (DAH) may have improved with plasma exchange and glucocorticoids, the results did not achieve significance. 

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192 RA pts on MTX: GI Sxs studied w/ MISS (MTX intolerance severity score). GI intolerance seen in 56%, Nausea & pain post-MTX most common. More in afro-descendants, w/ FM, Steroids, or JAKi. MISS results unrelated to Route, Gi Dz, age, MTX dose https://t.co/EROmZQo1Zs https://t.co/SOMzzXXj0b

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Dr. John Cush RheumNow ( View Tweet)
RT @yuz6yusof #EULAR2024 OP0180 Can we safely taper GC in #lupus patients who are in remission? Single study in Italy showed in pts with SLEDAI=0 + pred =&lt;5mg/d + stable IS/HCQ, GC discontinuation after proper tapering appeared safe and was associated with a low risk of flare

Dr. John Cush RheumNow ( View Tweet)

RT @drminidey OP0165- incidence &amp; risk factors of D2T RA in an early RA cohort Factors assoc with D2T RA: 🩸 Seropositivity 🦴 Erosions 📈 Disease activity 📊 D2T pts have higher steroid doses &amp; more commonly develop iatrogenic-related #comorbidities, e.g. osteoporosis

Dr. John Cush RheumNow ( View Tweet)

GCA,woman

JAK Inhibitors in Giant Cell Arteritis

d Jack Cush, MD

Trials are underway evaluating the potential benefits of JAK inhibitors (JAKi) in giant cell arteritis (GCA) patients who are refractory to standards of care.

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EULAR24,Roundup

EULAR 2024 Rheumatology Roundup (6.21.2024)

d Jack Cush, MD

Drs. Artie Kavanaugh and Jack Cush discuss highlights from the EULAR 2024 meeting in Vienna

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Update on low-dose glucocorticoids in SLE GC have been the mainstay of treatment in SLE for nearly 75 yrs. GC induce anti-inflammatory effects, quickly relieve symptoms, and reduce mortality in life-threatening flares through various actions. https://t.co/uEtWftvwEz https://t.co/nJlpELMj5W

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Dr. John Cush RheumNow ( View Tweet)
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EULAR 2024 – Day 4 Report

d Jack Cush, MD

The final day of EULAR 2024 was rich in posters, Late-breaking oral presentations and EULAR updates and recommendations.  Below is a synopsis of the half-day's action.

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Update on low-dose glucocorticoids in SLE

d Md Yuzaiful Md Yusof, MRCP(UK), PhD

Glucocorticoids (GC) have been the mainstay of treatment in SLE for nearly three quarters of a century. GC induce a range of anti-inflammatory effects, quickly relieve some symptoms and lower mortality in some life-threatening flares. However, they also have multiple side effects that limit the duration of treatment, as well as the dose used. Accordingly, the 2023 EULAR recommendations for SLE set a target dose of ≤5mg/day. Is low dose GC an achievable target?

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Voclosporin and Steroids in Lupus Nephritis Dr. Jack Cush reports on abstract OP0059 presented at Eular 2024 in Vienna, Austria. https://t.co/y9QPieV0py https://t.co/GzwntEJLve

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Dr. John Cush RheumNow ( View Tweet)
PMR patients get too much steroid. Data across 27 million people in England, n=39,438 with PMR. The blue are getting more pred than guidelines. Like everything in rheum: we need to be giving less pred, not more. Lumping PMR in with GCA won’t help. #EULAR2024 POS0411 @RheumNow https://t.co/bsi3lrAafm

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David Liew drdavidliew ( View Tweet)
Steroids are often started before pts see a rheumatologist This associates with long-term low-dose steroid use Need better collaboration between referrers and rheum to reduce this avoidable steroid burden POS0137 @RheumNow #EULAR2024

Mrinalini Dey DrMiniDey ( View Tweet)

« Glucocorticoids are such old drugs and we still use them so much » says Josef Smolen Summary slide from « 75th anniversary of GCd, what have we learnt? » @RheumNow #EULAR2024 https://t.co/XSRt44zupw

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Aurelie Najm AurelieRheumo ( View Tweet)

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