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RheumNow Podcast – The Bad News That’s Fit to Print (8.21.20)

Jack Cush, MD

Dr Jack Cush reviews the news and journal reports from the past week on RheumNow: filgotinib rejection, delays in diagnosis, metformin benefits COVID, Abx and IBD, and UPA beats MTX.

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Increased Lupus Anticoagulant Activity in COVID-19 Infection

Jack Cush, MD

JAMA Network Open reports that after adjusting for inflammation, lupus anticoagulant (LA) is significantly increased (positive) in COVID-19 patients and that LA positivity was associated with incidence risk of thrombotic events.

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RheumNow Podcast - The SARS-CoV-2 Update (8-14-20)

Jack Cush, MD

Dr. Jack Cush updates the news and journal articles from the past week on RheumNow.com, with information on enthesitis, nr-Ax-SpA, UAB, Blockbuster Rheum Drugs and use of ACE inhibitors.

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Rheumatic Diseases, Drugs and COVID-19 Guidelines

Jack Cush, MD

Several recent publications have focused on the risk and outcomes of rheumatic disease (RDD) and autoimmune patients who become infected with SARs-CoV-2.

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Latest COVID-19 Numbers from CDC

Jack Cush, MD

Following are the latest CDC numbers for COVID-19 in the U.S., including total cases and deaths; the states with the highest number of COVID-19 deaths; and COVID-19 healthcare case numbers.

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DMARD Use Does Not Increase COVID Hospitalization

Jack Cush, MD

An observational study of patients with systemic autoimmune inflammatory rheumatic diseases (AIRD) who also had COVID-19 disease shows that AIRD increased the risk of hospitalization, but that the use of disease-modifying antirheumatic drugs (DMARDs) were not associated with hospitalization.

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To date, the FDA has currently authorized 218 tests under EUAs; these include 176 molecular tests, 39 antibody tests, and 3 antigen tests.

U.S. FDA US_FDA ( View Tweet)

Study of 2 Canadian centers finds amongst 2095 patients taking biologics for #Psoriasis, 23 (1.1%) stopped their biologic for "COVID-19 related concerns". 5/23 restarted biologic for PSO flares. This included TNFi, inhibitors of IL17, IL12/23, IL23 https://t.co/gjSX4P0LMK

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Dr. John Cush RheumNow ( View Tweet)

COVID-19 child case count now over 400,000 https://t.co/bRYvZ5AoYt https://t.co/JhEbvncUbr

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Dr. John Cush RheumNow ( View Tweet)
Preprint analyses of RCTs and 11 nonRCTs showed JAK-inhibitor use in COVID-19 reduced mortality (OR 0.12; 0.03-0.39) & ICU admission (OR 0.05; 0.01-0.26). Similarly Type I interferon Rx also significantly reduced mortality (OR, 0.19; 0.04-0.85, p=0.03) https://t.co/NqKCGzcfwF

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Dr. John Cush RheumNow ( View Tweet)

Diabetes is a risk factor for COVID mortality; yet Metformin dramatically lowers mortality in a preprint, unreviewed paper - retrospective EHR review of 25,326 subjects COVID tested at UAB; metformin signif reduced mortality risk in DM w/ COVID (OR 0.33) https://t.co/DvZ4b3al1Y

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Dr. John Cush RheumNow ( View Tweet)

NJ study of 764 ICU COVID-19 pts, 210 (27%) received tocilizumab. TCZ treated patients had a lower death rate (49% vs 61%) (HR 0·64, 95% CI 0·47–0·87; p=0·004). Similar results seen in those requiring mechanical vent. or CRP >15 mg/dL https://t.co/idZTDunG1a

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Dr. John Cush RheumNow ( View Tweet)

RheumNow Podcast - The SARS-CoV-2 Update (8-14-20) Dr. Jack Cush highlights the latest numbers on COVID-19 and its impact on Rheumatic Patients. Also, Top 4 best sellers, new take on NR-Ax-SpA & enthesitis https://t.co/IJAHGynSNd

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Dr. John Cush RheumNow ( View Tweet)

The RheumNow Podcast is up: The SARS-CoV-2 Update with info on enthesitis, nr-Ax-SpA, UAB, Blockbuster Rheum Drugs and use of ACE inhibitors. Watch it here> https://t.co/1WUZQJajgW or podcast listen here>> https://t.co/IJAHGynSNd

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Dr. John Cush RheumNow ( View Tweet)

Prevalence of SARS-CoV-2 Antibodies in Health Care Personnel in NYC - 46 117 were tested. Overall 13.7% were seropositive. For PCR-positive HCP, 93.5% were also seropositive; PCR-negative HCP 89.7% were also seronegative. https://t.co/ZjzQUK6jmW

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Dr. John Cush RheumNow ( View Tweet)

3 pts w/ myasthenia gravis occurring after the onset of coronavirus disease 2019 (COVID-19), all were AChR antibody–positive. MG Sxs begain within 5 to 7 days after fever onset. They postulate neurologic damage from COVID may have autoimmune mechanisms https://t.co/YSy0SYoSmL

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Dr. John Cush RheumNow ( View Tweet)

Ann Int Med reports that the use of ACE inhbitors or ARB use is not associated with more severe COVID-19 disease (High-certainty evidence), and these meds are not associated w/ pos. SARS-CoV-2 tests- based on observational studies w/ 23565 COVID-19 adults https://t.co/px0rMH1Pjz

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Dr. John Cush RheumNow ( View Tweet)

COVID Testing study of 3046 NY Hospital employees (56% Ab testing, 20% RT-PCR, 12% both); found (9.8%) who tested positive for antibodies; Thus SARS-CoV-2 infection among Hospital workers is lower than that reported for the general public. PPE WORKS!

Dr. John Cush RheumNow ( View Tweet)

Virtual Video Joint Exam Pearl #5: Its easier to see gouty Tophi and rheumatoid nodules than nail changes of PsA or subtle rashes. For Rashes and oral lesions its BEST to have the patient take multiple pix with the cell phone and send them in by EMR or Email.

Dr. John Cush RheumNow ( View Tweet)

Virtual Video Joint Exam Pearl #1: pain elicited by cervical lateral bending (in someone w/ otherwise normal Cx ROM) is highly correlated with Tender trigger points in the neck region (hence #FM)

Dr. John Cush RheumNow ( View Tweet)

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