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Dr. Jack Cush reviews the news and Journal reports from this past week on RheumNow.com - including problems w/ falls, pain and treatment of Dupuytren’s contractures.
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RheumNow Live 2024 provided a wealth of clinical insights, particularly in the realm of rheumatoid arthritis (RA) management. Here are the top five clinical pearls from the event's opening session, "Success in Rheumatoid Arthritis."
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The large vessel vasculitis, Takayasu arteritis (TAK), carries a significant morbid risk and a cohort analysis shows these patients are also at high risk of serious infection with resultant higher risk of death.
Dr. John Cush
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13 Risk Factors for RA-associated Interstitial Lung Disease (ILD)
ILD is the most widespread and fatal pulmonary complication of rheumatoid arthritis (RA). A recent metanalysis shows the pooled prevalence of RA-ILD was approximately 18.7%.
https://t.co/x1YFv0ZlL9 https://t.co/XGeilz2tus
Dr. John Cush
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Pearl: Three "S" Rule (Smoking, Seropositivity, Sex/Male): if present the risk of RA-UIP (ILD) goes up nearly 13 fold (ACR23 Abstract 1269) https://t.co/2YFosInpGs https://t.co/rOVN79JJRz
Dr. John Cush
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Pearl: 40% of acute gout attacks will have a normal serum uric acid (that will elevated during intercritical phase) - Draw the lab during and after the attack. https://t.co/CynZOal9jc
Dr. John Cush
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Neuropsychiatric (NP) Sxs compared in SLE (n 609), controls (463) & IA patients (489).
Hallucinations and severe headache were most directly attributable to NP-SLE. https://t.co/JWbyHmpWcq https://t.co/gBubdEjq63
Dr. John Cush
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337 PMR pts studied by FDG PET, followed 6 mos - 9% (31) had subclinical vasculitis (GCA)
- 21 had isolated LG vessel
- 3 isolated cranial vasculitis
- 7 both cranial & LG vessel vasculitis.
Steroid use higher w/ subclinical vasculitis, but not relapse https://t.co/uwXf4ucVnQ https://t.co/AOacTnQZaS
Dr. John Cush
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How do you communicate risk/benefit to patients? @RADoctor's recent publication highlighted by Dr. H. Gabalawy at #RNL2024
-Increase awareness
-Include numbers for context
- Make it easy for patients to understand those numbers
-Use absolute risks
- Avoid 1 in X format
Dr. John Cush
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Aging in RA: "(RA is due to a poorly functioning immune system which increases a patients risk of CVD, infection, and cancer. The aging immune system additionally affects this process.
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We must consider this clinically, we must protect our aging patients without over immunosuppressing them." Dr. Weyand #RNL2024
Dr. John Cush
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H2H study of secukinumab vs adalimumab biosimilar in axial-SpA pts saw no difference & little change in Xray progression for both Rxs. 859 pts showed no signif diff w/ NO Xray progr (66%, 67%, 66%) or mSASSS (0.54, 0.55, 0.72) change https://t.co/QqB1aCjfN7 https://t.co/Ktfi7xVoC6
Dr. John Cush
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Polycyclic Aromatic Hydrocarbons Increase Lupus Risk
A case-controlled study shows environmental exposure to polycyclic aromatic hydrocarbons (PAH) may increase the risk of developing systemic lupus erythematosus (SLE).
https://t.co/kztA4s5UY3 https://t.co/QJ6DXXCBh8
Dr. John Cush
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We're back again on 4/9 with another Tuesday Night Rheumatology! We'll be focusing on PsA Hot Topics. Register to attend today!
https://t.co/Ssbv020MOi https://t.co/qL6EGegCVf
Dr. John Cush
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10 SLE pts w/ ITP and thrombocytopenia were Rx w/ belimumab IV (age 34.3 ± 14 yrs). Overall response rate of thrombocytopenia was 90%, w/ improvement in platelets, lymphocyte count, Hgb, dsDNA, C3, C4 and SLEDAI https://t.co/0IXjqXa8lS https://t.co/pNiu4TCnky
Dr. John Cush
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Among 3.2 million people who starting opioids, there were 506 573 serious fall, esp w/ increasing age; Opioid use associated with increased risk of serious falls, esp. if >85 yrs (adj IRR 6.35) and within the first 28 days of commencing opioid use https://t.co/IifmEE9Q5n https://t.co/N2PkLofA4r
Dr. John Cush
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Oral Surveillance study revisited: the risk of Venous thromboembolism & Pulmonary emboli were higher with tofacitinib (10>5 mg BID) versus TNFi and were generally consistent over time. VTE & PE risk incr by age, BMI, and VTE Hx https://t.co/v7ISjw5Rvd https://t.co/10oE7MiAAj
Dr. John Cush
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"#RNL2024
Brittany Weber on Cardio-Rheumatology:
""Everything has changed"" on inflammation and CVD
- Canakinumab 150 mg v PBO HR 0.85, p =0.02
- Colchicine v PBO HR 0.69, P<0.001
2023: FDA approval for colchicine as 1st anti-inflammatory for reducing CV events
Dr. John Cush
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#RNL2024 @RheumNow
@Bweber04
Asymptomatic Lupus has higher rate of atherosclerosis at all age grps
35-44 yo F with SLE: 50X increased risk of MI compared to healthy pts in Framingham
RA pts at 1.5x risk of CVD https://t.co/wL4U8Gh5JM
Dr. John Cush
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#RNL2024
ASCVD Risk Calculators underestimate risk in patients of RA
Inflammatory disease was added as a "risk enhancer" in 2019 update
"A low ASCVD and/or absence of symptoms may be not be reassuring" https://t.co/Cz1LRda9xx
