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Treatment Options for Still's Disease

d Jack Cush, MD

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)

d Jack Cush, MD

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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Achilles,ankle,heel

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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JAMA patient (resource) handout on Lumbar Spinal Stenosis! https://t.co/fl5K5Ve6fY https://t.co/aLHs6sKE1o

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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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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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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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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

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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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Sign up for Tuesday Night Rheumatology at 7pm! https://t.co/MLI4MW7eRW https://t.co/xGln5QN8kp

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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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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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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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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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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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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)
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