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TNF Inhibitors or non-TNF Biologics - First Best Choice?

Jack Cush, MD

Prospective observational findings from the CORRONA registry of rheumatoid arthritis (RA) patients compared clinical outcomes between initial aggressive therapy using either a tumour necrosis factor inhibitor (TNFi) or a non-TNFi (biological disease-modifying antirheumatic drugs (bDMARDs) and tar

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RheumNow Podcast – Good Time Charlie…. (10.16.20)

Jack Cush, MD

Dr. Jack Cush sings the news and journal reports from the past week on RheumNow.com.

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EULAR Updated 2019 Recommendations for Psoriatic Arthritis Management

Jack Cush, MD

In June 2020, we failed to report on the ARD publication updating the 2019 update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA) - these are presented below.

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RheumNow Podcast – Lupus Delights (9.18.20)

Jack Cush, MD

Dr Jack Cush reviews the news and journal reports from the past week on RheumNow.com:

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ICYMI - 11 Pearls for Pregnancy Management in Rheumatoid Arthritis

Artie Kavanaugh, MD,  , Jack Cush, MD

Rheumatoid arthritis affects women in their child-bearing years and many will face the issue of pregnancy and RA management at some point. Here are11 considerations for those managing RA patients who wish to become pregnant.



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RheumNow Podcast – To Celiac Test or Not? (9.4.20)

Jack Cush, MD

Dr Jack Cush reviews the news, journal articles and takes a few Back Talk questions this week:

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Selective Biologic Responses in Seropositive RA

Jack Cush, MD

The Journal of Rheuatology reports a pooled analysis of patients from 16 observational RA registries that examined the association between seropositivity (RF or ACPA) with biologic DMARDs responses; they showed better clinical responses when seropositive RA patients receive abatacept (ABA) o

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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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Nonradiographic axial spondyloarthritis= meeting axSpA criteria without Xray sacroiliitis. Swiss study compared women & men w nr-axSpA. Women had a longer Dx delay, higher Dz activity & enthesitis, less B27+ & signif lower TNFi resp rate (OR 0.19) vs Men https://t.co/ykAHfimOd5

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Dr. John Cush RheumNow ( View Tweet)

The RheumNow Podcast is up - Bad Disease & Bad Outcomes. COVID consequences, TNFi Switching in SpA, psychosis in lupus? Watch it here> https://t.co/ced3cKg5eB or listent to podcast on iTunes> https://t.co/FHJv01AAbC or SoundCloud> https://t.co/e4nWr3wECz

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Dr. John Cush RheumNow ( View Tweet)

Study of 193 Axial SpA pts with TNF inhibitor switching shows, using stringent outcome measures (ASDAS-ID) shows odds of responding to 2nd TNFi best w/ secondary TNFi failure (OR 7.3) or adverse events (OR 9.1), compared to primary TNFi failure. https://t.co/kpDelzBYRe

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Dr. John Cush RheumNow ( View Tweet)

Incredible lecture on the highest of therapeutics for rheumatoid arthritis by @BrighamWomens Dr Michael Weinblatt. Love this screen shot of A to Z for therapies prior to the methotrexate era. Z=Zero therapy (do nothing). Incredible advances since then! https://t.co/AOIMBJiulo
Jeff Sparks jeffsparks ( View Tweet)
ASSERT looked at ankylosing spondylitis (AS) pts treated with infliximab (n = 16) or placebo (n = 7). Infliximab was shown to reduce depression & depressive symptoms by improving AS disease Sxs. There was no link between CRP inflammation & depression https://t.co/oC5rQP2Jec

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Dr. John Cush RheumNow ( View Tweet)

Retrospective cohort study of 213 IMID patients, 36.2% tested positive for COVID-19, who had no greater risk of hospitalized or ventilation and immunosuppressive use was not shown to worsened the course of disease (TNFi decreased risk of hospitalization) https://t.co/gmIXDJkLCt

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Dr. John Cush RheumNow ( View Tweet)

Discontinuing TNFi before wk 20 is feasible in RA and JIA pregnancy with well- controlled Dz. OTIS study of 490 women compared 25% who D/C TNFi before wk 20 vs 41% taking TNFi after wk 20. D/C TNF not assoc w/ clinical worsening in the 3rd trimester. https://t.co/DtHvQ2rbWY

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Dr. John Cush RheumNow ( View Tweet)

Systematic review of Paternal DMARD exposure prior to pregnancy shows no firm evidence of harm with TNFi, ABA, RTX, azathioprine, cyclosporine, HCQ, leflunomide, MTX or mycophenolate mofetil. Data from 84 papers, 611 male exposures, 5986 pregnancies https://t.co/VgEsrXhfdh

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Dr. John Cush RheumNow ( View Tweet)

RheumNow Podcast is Up! Rheum Lives Matter. More about social change, HCQ, JAKs & skin, growing cartilage, FM exercise. Watch it here>https://t.co/LLvADsDJ5O or listen to the Podcast here>https://t.co/pCXzaJUS9s

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Dr. John Cush RheumNow ( View Tweet)

UK safety reminder that Baricitinib (Olumiant) has an increased risk of diverticulitis (incidence rate 0.16 per 100PY), esp. in those taking Steroids or NSAIDs. https://t.co/IfcV03e1p7

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Dr. John Cush RheumNow ( View Tweet)

Mayo case controlled study of 212 autoimmune pts - half w/ CNS inflamm dz and half without. TNF inhibitor use was associated with an increased risk of inflammatory CNS dz (adj OR, 3.01; 1.55-5.82; P = .001); most of these occurred in RA pts (aOR, 4.82) https://t.co/8TsYxDhUZx

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Dr. John Cush RheumNow ( View Tweet)

Responses to switching TNFi in SpA go down w/ the 2nd TNFi. 1st TNFi @ 3 mos ASAS CII 51%; 2nd TNFi 41%; BASDAI @6 mo, 1st 46%, 2nd TNFi 33%. Compared to primary failure, pts w/ 2nd failure (OR 7.3 ) or toxicity (OR 9.1) had better ASDAS-I https://t.co/jMCUfBtxmY https://t.co/PBkQNOwVRQ

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Dr. John Cush RheumNow ( View Tweet)
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