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Treating Enthesitis in Psoriatic Arthritis Patients

d Jack Cush, MD

A large prospective psoriatic arthritis (PsA) study examined the enthesitis outcomes when PsA patients received conventional (cDMARDs) or targeted disease-modifying antirheumatic drugs (tDMARDs) and showed an overall 86% response rates, regardless of the medication used.

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Continue the Methotrexate, Leave the Cannoli

d Jack Cush, MD

Placebo responses are to be expected in rheumatoid arthritis (RA) clinical trials, but are such placebo responses affected by continuing background DMARDs like methotrexate (MTX) even though there was an inadequate response (IR) to MTX? 

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Spinal Findings on MRI May Not Signify Spondyloarthritis

d Jack Cush, MD

For about one in six people considered healthy with no reports of back pain, lesions were visible on MRI in the lower spinal column and sacroiliac joint, researchers said -- a sign that rheumatologists should be cautious about diagnosing spondyloarthritis (SpA) on the basis of imaging.

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Abatacept Most Effective Early and in Seropositive RA

d Jack Cush, MD

An open-label, 2 year study evaluated the efficacy and safey (drug retention) of subcutaneous (SC) abatacept (ABA) in active rheumatoid arthritis (RA) and showed superior responses when ABA was given to biologic-naive and seropositive RA patients. 

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NHANES Cross-sectional study of 5672 psoriasis US adults (20-59 yrs) shows more NAFLD in PSO patients (33% vs 27% nonPSO) with an increased risk (OR 1.67) - moreso in men (OR 2.16), age 20-39 yrs (OR 2.48) & those without diabetes (OR 1.70) https://t.co/VfaJbMKboP https://t.co/dJlcLexDtn

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Dr. John Cush RheumNow ( View Tweet)
Rheumatologist Survey: What do you rely on MOST in diagnosing Still’s disease? Sxs? Labs? Both? Criteria? Fever? Vote here: https://t.co/oANKpKqJA5 https://t.co/LIjRSBHNBi

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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/kuXmskZKbB https://t.co/jPkIYrMnSN

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Dr. John Cush RheumNow ( View Tweet)
Metanalysis of 9 studies (RCTs, observational) looked @ DMARD effect (most Rx w/ biologics: TNFi, TCZ, RTX, Tofa) on lean & appendicular mass; shows despite bDMARD efficacy - no change in muscle mass! How will UR pts get STRONG? https://t.co/L7bRzPy02i https://t.co/gm5UZYOOeC

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Dr. John Cush RheumNow ( View Tweet)
2015 NEJM study of 4g acetaminophen vs PBO in 700 critically ill ICU patients with fever ≥38°C, showed Tylenol vs PBO had no differences in mortality, ICU stay or LFTs. Tylenol had small but signif reduction in Temp (38.4±1.0°C vs. 38.6±0.8°C; P<0.001) https://t.co/qnHgFRp20M https://t.co/2E4ZEsIFUV

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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/P2nxnhDnut https://t.co/KoZoe1yib4

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Dr. John Cush RheumNow ( View Tweet)
JAMA patient (resource) handout on Lumbar Spinal Stenosis! https://t.co/MR7aIrP0Pq https://t.co/Q6rvddbnvT

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Dr. John Cush RheumNow ( View Tweet)
162 #AOSD or #sJIA criteria+ pts underwent genetic testing - 31% (51/162) had a genetic variant for periodic fever Dx. 4 SJIA pts were confirmed to have FMF or TRAPS. Genetic testing may be smart, esp w/ atypical presentations https://t.co/hwZFgOL4j4 https://t.co/6y8r1Dyv1A

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Dr. John Cush RheumNow ( View Tweet)
Abatacept Most Effective Early and in Seropositive RA A 2 year study evaluated the efficacy and safey (drug retention) of subcutaneous ABA in active RA and showed superior responses when ABA was given to biologic-naive and seropositive RA patients. https://t.co/WdZ3YCeGXg https://t.co/4ZjFFrVmSJ

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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/NqGOislcIJ https://t.co/tqk3jF3Lxg

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Dr. John Cush RheumNow ( View Tweet)
Cochrane metanalysis of sleep meds - 170 trials (36 interventions, 47950 pts). Doxepin, seltorexant, zaleplon well tolerated, but efficacy data is scarce. Benzodiazepines, eszopiclone, zolpidem, were more efficacious, but zolpidem more dropouts due to AEs https://t.co/8mPYmfTAaR https://t.co/DqUFcgq9AR

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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/FEKwwyoJhZ https://t.co/zUyHXGjpOD

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Dr. John Cush RheumNow ( View Tweet)
Rheumatologist Survey: What do you rely on MOST in diagnosing Still’s disease? Sxs? Labs? Both? Criteria? Fever? Vote here: https://t.co/L1kyWXf68I

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Dr. John Cush RheumNow ( View Tweet)

Watch: Remote Monitoring Technologies in the Management of RA Dr. Antoni Chan interviews Dr. Johannes Knitza at EULAR 2022 https://t.co/SU9SUScHiS https://t.co/YoxQPZH5eQ

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Dr. John Cush RheumNow ( View Tweet)
Seminal Articles on Stills disease Tues Nite Rheum Journal Club tommorrow Discussants: Drs. Bella Mehta, Michael Weisman & Jack Cush 7pm EDT (4pmPDT) - The 1st articles on AOSD from Bywaters & Bujak https://t.co/yRgHlmZHhi https://t.co/ooexkgM6ga Register: https://t.co/kstge3gAcl https://t.co/XjQJi4FRmt

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Dr. John Cush RheumNow ( View Tweet)
Study of 50 #AOSD pts refractory to steroids (n=11), DMARDs (34) & biologics (n 30): given canakinumab 150–300 mg q 4wk (47) or q8wk(3). W/ 27 mos F/U: 78% complete resp w/in 3 mos (20% partial). Steroid sparing in 1/2, Low WBC 6%, 4%SIE https://t.co/QMCLictdrL https://t.co/5hkUOBFDG0

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Dr. John Cush RheumNow ( View Tweet)

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