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World Changers (3.14.2025)
Dr Jack Cush and his podcast friends are out to change the world. Here is his weekly review of the news and journal reports from the past week on RheumNow.
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Channeling Bias and Cancer Risk with Biologic or Targeted Synthetic DMARDs
A retrospective US administrative claims cohort study of RA patients on tumor necrosis factor inhibitors (TNFis), non-TNFi biologics, or Janus kinase inhibitors (JAKis) found a statistically significantly higher risk of incident cancer in patients receiving rituximab, abatacept, or JAKis (compared with TNFis).
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Earlier ACL reconstruction and a lower risk of knee osteoarthritis
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EurekAlert!
A preclinical study by HSS investigators found that earlier anterior cruciate ligament (ACL) reconstruction led to lower immune cell activity, less inflammation and fewer joint changes associated with knee osteoarthritis compared to delayed surgery.
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Is better earlier imaging needed for axial #PsA? to better visualize spinal ligamentous soft tissue Spinal entheseal soft tissue and contiguous ligamentous tissues are poorly visualized on MRI in early inflammatory back pain pts. https://t.co/4w4CamMT4I https://t.co/RQigMjMe9n
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Alpha-gal syndrome (AGS) is a (Lone Star) tick-borne allergy to the galactose-α-1,3-galactose carbohydrate, found in mammalian meat/products; Sxs (hives, itching, swelling, and GI issues) present 2-8 hrs after meat & be life-threatening. Time to Dx has dropped considerably, w/… https://t.co/p1M9Qaf1jz https://t.co/jTJzq7YtVJ
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Sobi announced it has submitted to FDA a supplemental (sBLA) for Gamifant (emapalumab-Izsg) for use in adult & kids w/ hemophagocytic lymphohistiocytosis (HLH)/macrophage activation syndrome (MAS) in Still’s disease with an inadequate response glucocorticoids, or with recurrent… https://t.co/a3I1fzHLdl https://t.co/WTFAs5PLWF
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Can you distinguish which PsA? Persistent inflammatory (PIPsA) vs non-inflammatory PsA (NIPsA)? NIPsA has normal ESR/CRP, w/ obesity, biomechanical pain, OA, fibromyalgia, secondary post-inflam damage or central pain mechanisms. https://t.co/WwhdIkpJFJ https://t.co/6b5KHQRfKo
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With GLP-1 agonists, is there a risk of aspiration during gen. anesthesia. Most advise against elective surgery/anesthesia unless the GLP-1 is held for 1-2 weeks. Based on MOA of delayed gastric emptying - 7/8 studies show Incr residual gastric contents in GLP-1, but none… https://t.co/BMeYVaBmIy https://t.co/DpTqKhb1Sg
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Are Combination Biologics Safe?
Real-life data from a French observational study suggests the overall risk of severe adverse events (SAE) with combotherapy does not seem to be increased (vs monotherapy), but certain combinations warrant caution.
https://t.co/zcmo9mTRoS https://t.co/Q1lB0LvymF
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Meta-analysis shows the combination therapy bDMARD with MTX in #PsA pts yields better bDMARDs drug survival, especially with TNFi. 20 observational studies, 30,634 PsA pts. Insufficient data for non-TNFi bDMARDs. But adding MTX to bDMARDs had better TNFi survival (HR=0.79… https://t.co/aU8j4d6pei https://t.co/Ft99jwzPB3
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In 7 Major countries worldwide, Still’s Disease Treatment Markets were valued at USD 1.33 Billion in the year 2024 and is projected to reach USD 1.92 Billion by 2035. https://t.co/zjrd7RgHkj https://t.co/iqFp877wnN
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Available the first time: https://t.co/4UQlqwujiR 2025 On Demand!
On Demand gives you access to all lectures, Q & A panels, and STEP talks, and all speaker slides and handouts — all packed with insights you won’t find anywhere else.
Non-CME, practical, and finally here.… https://t.co/qZb8OKjPpw https://t.co/Exr8u6QkNc
Links:
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Retrospective review of 781#RA pts; 78 Dx w/ILD (77 subclinical, most UIP on HRCT). w/ mean 10 yrs F/U, death rate was 1.5 vs. 7.1 per 100PY (without v with ILD) SMR equal betw RA & gen pop. but 2x higher in RA w/ ILD. Mortality higher w/ ILD (HR~3), age and low BMI… https://t.co/Vj0acewmK8 https://t.co/N1wHTjMfTr
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Still's Dz Afro-Caribbean study of 58 pts (57% AOSD). Sex differed betw kids F 36% vs F71% in adults. Kids had signif more typical skin rashes (100 vs 29%), coronary artery dilation (16 vs 0%), & MAS (52 vs 9%). Adults signif more polyarthalgia (91 vs 32%) & lung dz (51 vs 4%).… https://t.co/AYKNazgio5 https://t.co/1yQgeMiwku
Dr. John Cush RheumNow ( View Tweet)
Sobi announced it has submitted to FDA a supplemental (sBLA) for Gamifant (emapalumab-Izsg) for use in adult & kids w/ hemophagocytic lymphohistiocytosis (HLH)/macrophage activation syndrome (MAS) in Still’s disease with an inadequate response glucocorticoids, or with recurrent… https://t.co/PLpcD5jzxH https://t.co/0LUe9bXaYS
Dr. John Cush RheumNow ( View Tweet)
Can you distinguish which PsA? Persistent inflammatory (PIPsA) vs non-inflammatory PsA (NIPsA)? NIPsA has normal ESR/CRP, w/ obesity, biomechanical pain, OA, fibromyalgia, secondary post-inflam damage or central pain mechanisms. https://t.co/9SRmpNfXCF https://t.co/wsH6poUO1m
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New insights into Moyamyoa a complex cerebrovascular disorder affecting children/young adults w/ carotid or CV vessel narrowing; leading to CVA, Sz, HA, TIA, Cognitive Sx. Genetic mutations add to succeptibility (RNF213, ACTA2, DIAPH1, HLA). DIfficult to Dx vs Atherosclerosis.… https://t.co/LqFcU0xO3J https://t.co/CileSRAZgU
Dr. John Cush RheumNow ( View Tweet)
With GLP-1 agonists, is there a risk of aspiration during gen. anesthesia. Most advise against elective surgery/anesthesia unless the GLP-1 is held for 1-2 weeks. Based on MOA of delayed gastric emptying - 7/8 studies show Incr residual gastric contents in GLP-1, but none… https://t.co/U690OmeqJm https://t.co/Q6kyv9fyVJ
Dr. John Cush RheumNow ( View Tweet)
Study of sarcopenia in 138 young adults with inflammatory arthritis (IA) found sarcopenia in ~47% of IA- Signif different between JIA, SpA, & RA. W/ multivariable analysis, predictors of sarcopenia included BMI (OR 0.84), BMD (OR 0.01), vit D (OR 0.96) & HAQ (OR 14.5)… https://t.co/JHKwF8icj1 https://t.co/ph3pVIYuXx
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Congratulations to Dr. Joseph Merola (Rheumatologists & Chair of Dermatology at UT Southwestern) on his appointment to the Board of Directors for the American Academy of Dermatology (AAD) https://t.co/TxjuZWeXoJ https://t.co/Mo7PwLWD5f
Dr. John Cush RheumNow ( View Tweet)