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RA-ILD represents the most severe extra-articular manifestation of rheumatoid arthritis, affecting an estimated 1% of the adult population in the US and Northern Europe.
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Dr. John Cush
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FDA has issued a drug safety warning for avacopan (Tavneos), dentifying 76 cases of drug-induced liver injury, including 7 cases of rare vanishing bile duct syndrome (VBDS). There were 8 deaths https://t.co/WkBhs1rNpf https://t.co/ZXdHsAJUOQ
Dr. John Cush
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Myocarditis causes 17,000 deaths/Yr worldwide. Causes include A) iatrogenic/autoimmune: checkpoint inhibitors & gene therapy; B) High income countries: parvo B19, herpesvirus 6; C) low income: dengue, HIV, malaria and Trypanosoma cruzi (Chagas disease) https://t.co/en4OnhWPda https://t.co/urwkjlVeg6
Dr. John Cush
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Italian population study of 37996 RA (prevalence 0.54%) pts w/ and 12875 incident cases (incid rate 33.1/100K), there were 1288 deaths/8yrs (MR 21.3/1K), median age=83; SMR 1.28 (1.21 to 1.35), higher <45 yrs (2.15). Leading causes CV (37%), cancer (21%) & infxn (11%) https://t.co/wPx5iqW7Nl
Dr. John Cush
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phase 3 VALOR trial of 6-valent OspA-based Lyme dz vaccine (LB6V) vs placebo; 4 doses given @ Mos 0, 2, 5-9, & 12 mos later. LB6V reduced Lyme Dz risk by 73.2% @28d after 4th dose. But it was only 15.8% effective (falling short of prespecified 20%) because of fewer than expected https://t.co/TcX0GV05gY
Dr. John Cush
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Outcomes of 87 VEXAS pts in the AutoInflammatory Disease Alliance (AIDA) - 75% had recurrent fever episodes. Fever episodes assoc w/ mortality, organ involvement (CV, GI, Lung), but not with complete response to biologics. https://t.co/j9vzBJNMj0 https://t.co/YGsE7LH3ml
Dr. John Cush
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ILD found in 3% of #PsA pts. Metanalysis of 6 studies, 14,272 pts found ILD pooled prevalence was 3% in PsA; highers ((6%) in studies w/ CT, HRCT. Smoking was a signif. risk factor for ILD in PsA (OR 2.94, 95% CI: 1.22–7.12; I2 = 1.8%). https://t.co/9mY4Eiqc9d
Dr. John Cush
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Rheumatic Immune-related Adverse Effects with Checkpoint Inhibitor Therapy
A retrospective study of patients who developed rheumatic immune-related adverse events (R-irAEs) after receiving immune checkpoint inhibitors (ICIs) at two oncology centers in Spain suggests that early https://t.co/hYf6GiR6TN
Dr. John Cush
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Rheumatic Immune-related Adverse Effects with Checkpoint Inhibitor Therapy
A retrospective study of patients who developed rheumatic immune-related adverse events (R-irAEs) after receiving immune checkpoint inhibitors (ICIs) at two oncology centers in Spain suggests that early https://t.co/jKCbIvfebm
Dr. John Cush
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Full read review & update on Rhabdomyolysis. 26K cases/Yr in USA. Muscle damage leading to weakness, myalgias, swelling, myoglobinuria, electrolyte probs, AKI. Causes: 1) exogenous toxins (46%); 2) trauma; 3) myopathies/metabolic muscle dz (10%), infxn. AKI in 46%, & death in https://t.co/E2LcLeMls0
Dr. John Cush
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RT @gibson_rheumPAC
Given rising resistance, effective first-line regimens and adequate duration (14 days) are critical. PPI-based quadruple regimens remain highly effective when patients can adhere.
#RNL26 https://t.co/bxqMbPFegt
Dr. John Cush
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RT @ericdeinMD
#RNL26
Prosthetic joint infection vs flare?
- PJI risk 50-80% higher in RA (OR 1.47-1.8)
- Immunosuppressants, intra-artic injections, RA activity, BMI incr risk
- Delay in diagnosis https://t.co/XTozafDQyf
Dr. John Cush
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RT @ericdeinMD
#RNL26
Inflammatory arthritis pts getting TKA:
- increased risk of RBC transfusion (OR 1.39), infection (1.64) and readmission (1.46)
- THA: also risk of mechanical complications (like dislocation) OR 1.3 https://t.co/ovW2C2EuXF
Dr. John Cush
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RT @gibson_rheumPAC
Helicobacter pylori Update: H. Pylori remains the most common chronic bacterial infection worldwide, acquired in childhood and lifelong if untreated. Its clinical impact spans far beyond dyspepsia—from ulcers to malignancy. #RNL26 tis
Dr. John Cush
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RT @richardPAconway
We have improved RA mortality in many areas but respiratory (mainly ILD) and infectious issues remain stubbornly elevated. #RNL26 https://t.co/ViucOIOOzY https://t.co/3kIqPMeKKX
Dr. John Cush
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RT @richardPAconway Disease activity is a strong risk factor for RA-ILD. Particularly for moderate/high disease activity but there appears to be a linear relationship (at least above a certain threshold) #RNL26 https://t.co/ot8ttdmu5G
Dr. John Cush
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RT @ericdeinmd
RA-ILD #RNL26
Jeff Sparks
MTX and ILD
- Rare MTX-induced pneumonitis. 7 cases in n=4786 (0.3% cases) vs <0.1 on PBO, rare diff from ILD
- No increase in incident ILD - meta-analysis of 7 studies show OR 0.49 https://t.co/k2XeAzBsYB
Dr. John Cush
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RT @richardPAconway
UIP is predominant radiologic pattern in RA-ILD. Contrast with our other diseases. But by no means exclusive - up to 50% of RA-ILD have a more inflammatory pattern. Important treatment implications! #RNL26 https://t.co/HmW1mz429i
Dr. John Cush
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RT @ericdeinmd
Mucosal Hypothesis RA #RNL26
Demoruelle
Mucosal origins of RA?
Key sites of immune-environment interaction initiate local inflamm, becomes systemic
Link of lung inflamm/immune dysregulation - ass w/ smoking, ILD
NETs in lung drive RA path?
Gut/oral microbes drive
Dr. John Cush
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Japanese nationwide survey of 1943 RMD pts taking Azathioprine (AZA) 34% had adverse events: hepatobiliary (149%), GI (10%), blood/lymphatic (9%), infections (5%), & skin (2.4%). AEs lead to 71% D/C AZA. Serious AEs (Gr ≥3) higher w/ older (OR 2.5), & SLE (OR 2.3) https://t.co/lVNYVQATfx
