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Dr. Jack Cush reviews the news, FDA approvals, and journal articles. In this episode: HMGCR Abs, FDA approvals and Cush eats crow.
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Dr. Jack Cush reviews the news, journal reports and important associations in rheumatology from the past week on RheumNow.com.
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Dr. Jack Cush reviews the news and journal articles from RheumNow.com. Pool therapy, Fibrosis, NSIE's and what's best for knee OA.
Bella Mehta
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When MAS is suspected. Soluble IL2 receptor alpha and CXCL9 may be useful (however t cell lymphomas and viral infections like hepatitis may also have them)
#ACR25 @RheumNow
Key takeaways below https://t.co/wJv1dvwU88
Bella Mehta
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Soluble IL2 receptors help assess macrophages behavior. Ferritin also asses the same in Macrophage activation syndrome.
ADA2 is the newer biomarker for hemophagocytic syndromes.
#ACR25 @RheumNow
Interferon gamma also a newer important target in MAS https://t.co/7sWwninBTM
Bella Mehta
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Simultaneous measurements if S100, Ferritin and IL-18 increase diagnostic utility of these biomarkers in Stills disease.
@RheumNow #Acr25 https://t.co/3wmijNcpVY
Bella Mehta
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Low percentage of glycosylated Ferritin was more specific for Stills disease but not used frequently in clinical practice.
@RheumNow #ACR25 https://t.co/wTK1eIcSKX
Bella Mehta
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Biomarkers in Stills disease and MAS. #ACR25 @RheumNow
IL 6 may not be helpful compared to CRP, and IL 1 beta is difficult to measure
IL-18 seems to be the best one. https://t.co/u3oBTd4eaP
Bella Mehta
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IL- 18 go together sometimes with glycolytic enzymes such as aldolase
Also MAS may not be a switch on and off mechanism.
Lastly MAS with Stills may have increased IL18 levels but not in other disease like SLE
#ACR25 @RheumNow https://t.co/BW1fD7usBT
Bella Mehta
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What do we know about IL-18
Normal levels less than 500
Non specific 500 to 15000
Stills (quiet) 2000 to 10000
Mas/glares 20000 and more
@RheumNow #ACR25 https://t.co/ZAltAD5Q8V
Bella Mehta
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AOSD And sJIA aren't the same disease!!!. Another take on this by Scott Canna..because the clinical syndrome might have somethings distinct!!
#acr25 @RheumNow
Mrinalini Dey
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#0777 Big news for VEXAS! 🎯
The first validated disease activity index (VEXAS-DAI) has been developed via international Delphi consensus. A 12-domain, 40-point tool to standardise assessment & power trials in this complex syndrome. Validation underway! @RheumNow #ACR25 https://t.co/DSeHb7eNeV
Janet Pope
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Why do pts with #Still’s #AOSD
Get hospitalized?
#Sepsis
1827 unweighted & 9135 Weighted #US #hospitalizations
Worse in
men
Black
Medicaid
But is it truly #infection or Still’s flare or both?
Abst#0163
ACR25 @RheumNow @rheumacr
#ACRBest as largest N ever! https://t.co/fLMNyQQNNj
Gabriela Martinez Zayas, MD
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From Eye on Cytokine Storm- Decoding MAS by Dr Grant Schulert : “IL-18 is highly elevated in SJIa and other autoinflammatory disorders…can amplify innate signaling as well as induce IFN-gamma”. @RheumNow #ACR2025 https://t.co/6e5yfeDepX
Dr. John Cush
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Retrospective study of 42 adult Still' pts Rx after 2010 w/ IL‐1 inhib if given < 6 mos (early) or > 6mos of Sxs. Early IL-1i had more inactive dz (CID)(67% vs 38%; P = 0.17) & steroid d/c w/in 6 mos. 10 major flares observed (62% after IL‐1i suspension or spacing) https://t.co/uD1meQuYvj
Dr. John Cush
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Systematic review of Still's Dz (240 articles, 95 sJIA, 134 AOSD, 23,136 pts); sJIA Dx by ILAR in 78% & AOSD used Yamaguchi criteria 98%. While clinical and lab findings were matched betw AOSD & sJIA, there was variability in MAS , outocmes & trajectory. Standarization needed
Dr. John Cush
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German survey of 124 AOSD pts - Dz duration 7 yrs (Dx delay 2 yrs), 2/3 on biologics, 84% responding, 81% inactive by CRP. MDs report 35% of pts Sx-free. More Patients report Persistent Sxs LBP (39.5%), fatigue/weakness (39%), & joint inflammation (27%). https://t.co/2FGUPrhB8H
Dr. John Cush
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Chronic urticaria (CU) may be a presenting feature of an autoinflammatory syndrome (monogenic or multifactorial) - disorders to consider: cryopyrin-associated periodic (CAPS), Schnitzler, Still's disease, & neutrophilic urticarial dermatosis https://t.co/GKYqFzX6A0 https://t.co/QEEaw9zNjH
Dr. John Cush
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Canakinumab in VEXAS - 47 males Rx w/ anakinra (44), canakinumab (9), or both(6). Response @1 mos: ANAK 34% vs CANK 100%; 22% vs 78% @ 3 mos. Drug survival was 54 mos CANK 300/m; 7 mo CANK 150/m; 1 mo ANAK. More ISR (47% v 0) & infx w/ ANAK https://t.co/Y3iSfajTal https://t.co/qTNamGDwVI
Dr. John Cush
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Hyperferritinemia is common in Hyperinflammatory syndromes but is a hallmark of Macrophage activation syndrome and Sepsis; and is a poor prognostic sign too. MAS is excessive activation of T-lymphocytes & macrophages leading to cytokine storm & multi-organ damage. https://t.co/MUKXC0Tw3M
