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Treatment Options for Still's Disease
Are you treating “systemic” or “articular” (arthritis) Still’s disease? Most Still’s patients have a dominance of one or the other. With certainty, the right therapy for the right symptoms can be chosen. What about patients who have an incomplete or no response, or who become unresponsive to a drug that once worked well?
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Early, Aggressive and Seropositive (7.22.2022)
Dr. Jack Cush covers the news and journal reports from the past week on RheumNow.com. This week we have Insights NAFLD, overdose deaths, septic arthritis, refractory stills, & when MTX doesn’t work.
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Treatment Options for Still's Disease
Gotta know if you're treating “systemic” or “articular” (arthritis) Still’s disease. Most Still’s patients have a dominance of one or the other. With certainty, the right therapy for the right symptoms can be chosen.
https://t.co/fPBk6PdCaD https://t.co/u3RfWsnyv6
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Dr. John Cush RheumNow ( View Tweet)
Review of Clinical Trial measures in systemic sclerosis:
-RCTs focus on skin dz, ILD or Pulm HTN using mod. Rodnan skin (MRSS), 6-min walk
-FVC is surrogate measure for SSc-ILD
- Composites: CRISS, the EUSTAR-AI
-Future: Skin mRNA biomarkersTHBS1 and COMP https://t.co/2KD892VIUy https://t.co/9giddEl9I4
Dr. John Cush RheumNow ( View Tweet)
11.5% of Crohns pts have TNFi use contraindications (either MS, CHF, neoplasia, infx risk, TNFi AE, comorbidities, SLE. Alternatively GI survey respondents use ustekinumab (76%), vedolizumab (249%), or tofacitinib (0.5%) https://t.co/6ApUz93iS0 https://t.co/PTmnsTd2Wh
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Dr. John Cush RheumNow ( View Tweet)
Novel autoinflammatory disease with an ALPK1 gain-of-function mutation:
▶️ R etinal dystrophy
▶️ O ptic nerve oedema
▶️ S plenomegaly
▶️ A nhidrosis
▶️ H eadache
https://t.co/9GbjZLMFCo https://t.co/Bh0MkYmrDA
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ARD & RMD Open ARD_BMJ ( View Tweet)
🌏 Today is World Sjögren's Day!🌍
🩺 Sjögren's is not Just Dry eyes👁️ and Dry Mouth👅👄 - there's much more to it
There's still a lot about this 'invisible' #Autoimmune Disorder, we don't know
Clinical Features and Pathogenesis
#LetstalkaboutSjögrens
#MedTwitter
#RheumTwitter https://t.co/t9toed8MG7
EnvisionRheumat ERheumat ( View Tweet)
Anyone who thinks BA.5 is just another variant isn't paying attention
>200,000 new cases yesterday. Vertical. https://t.co/x7wziHMZ9K
Eric Topol EricTopol ( View Tweet)
Successful use of ixekizumab for glucocorticoid-free remission maintenance in giant cell arteritis https://t.co/6f9yZwUFPb Another IL17 looking promising in GCA!
Peter Nash drpnash ( View Tweet)
213 #SLE pts were screened for Cryoglobulinemia (2013 -2017); CG is frequent in SLE (66%), but mostly asymptomatic. Mean levels 40mg/L (0-228). Cryo Vasculitis in 15% w/ purpura, ulcers, digit ischemia, arthritis, GN (5%) or CNS (19%) https://t.co/jRVXCj4MlV https://t.co/gamOOwkJ5R
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Dr. John Cush RheumNow ( View Tweet)
Overdose deaths increased to 107 000 deaths in US in 2021, with significant racial disparity. Higher overdose rates seen in American Indian, Alaska Natives and Blacks. WORSE during COVID - 2020, overdose rates were 7 times higher in Blacks than Whites https://t.co/PMRo9gbzZl https://t.co/CgxgemyEA7
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Dr. John Cush RheumNow ( View Tweet)
JAMA patient (resource) handout on Lumbar Spinal Stenosis! https://t.co/fl5K5Ve6fY https://t.co/aLHs6sKE1o
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Dr. John Cush RheumNow ( View Tweet)
French study from 362 septic arthritis pts over 2 yrs., mean age was 64yrs, w/ high Charlson comorbidity index 3.5. Most common was Knee (39%), Staphylococcus (51%), Abx used 47d, surgery in 48%; 28% serious complications & 9.2% died https://t.co/PdddHsagFg https://t.co/3oHbW0tAjU
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Dr. John Cush RheumNow ( View Tweet)
Spinal Findings on MRI May Not Signify SpA
Research indicates that rheumatologists should be cautious about diagnosing SpA on the basis of imaging alone.
https://t.co/Z4gox4cx9N https://t.co/PI9BCty8Bx
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Dr. John Cush RheumNow ( View Tweet)
Leflunomide versus azathioprine in lupus nephritis? Study of 215 bx proven LN given either LEF or AZA - Renal flares were equal (15.7% v 17.8%), as was time to flare (16 mo vs AZA 14 mo); 24-hr proteinuria, creatinine, C3 and C4 improved similarly. https://t.co/2TWmweS2wy https://t.co/0YzlU4vfXP
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Dr. John Cush RheumNow ( View Tweet)
Sometimes the journey impacts as much as the destination.
TREAT-EARLIER now @TheLancet:
pre-RA (CSA+MRI)
DBRCT: po MTX for 1y (+im mpred120x1) vs placebo
eventual RA same
but persistent benefit at 2y (1y post-MTX cessation):
function, Sx, presenteeism, MRI
a short thread🧵1/7 https://t.co/64b7us6hvS
David Liew drdavidliew ( View Tweet)
During 2021-22, there was 387,112 deaths due to pneumonia, influenza, or COVID-19. At least 72% were dut to COVID-19 and 0.6% was due to influenza https://t.co/0ljpXJt0yr https://t.co/1Sp4RULVAY
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Dr. John Cush RheumNow ( View Tweet)
Sign up for Tuesday Night Rheumatology at 7pm!
https://t.co/MLI4MW7eRW https://t.co/xGln5QN8kp
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Dr. John Cush RheumNow ( View Tweet)
Rheums: Got a Rheumatology question or case for Jack Cush? Record it here and we'll feature it on an upcoming podcast. Tell us your name and where you practice rheumatology.
https://t.co/QUTIbK3r89 https://t.co/FZcTLREida
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Dr. John Cush RheumNow ( View Tweet)
The Still’s Continua The concept of a “Still’s disease continuum” that encompasses both sJIA and AOSD is based on the many common clinical, genetic and laboratory features shared by both sJIA and AOSD. https://t.co/XvtzGBX4MS https://t.co/WJC8U9JNXO
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Dr. John Cush RheumNow ( View Tweet)