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Stills,continuum

AOSD: Young vs. Elderly Onset

d Bella Mehta, MBBS, MS

Adult onset still's disease (AOSD) is an autoinflammatory condition characterized by fevers, arthritis, and rash. It is considered an orphan disease because of its low prevalence - it is reported anywhere between 16 to 40 per ten million.

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An interesting biomarker in #sJIA- helps differentiate it from other diseases, including infections and other inflammatory diseases! - kids with fever! serum calprotectin (MRP8/14) particle enhanced immuno-turbidimeteic assay (sCAL Turbi). 650 pts @rheumnow #EULAR2023 abst#OP0034

Bella Mehta bella_mehta ( View Tweet)

Juvenile and Adult-onset Scleroderma Differ A retrospecitve cohort comparision of juvenile (jSSc) and adult-onset (aSSc) systemic sclerosis (SSc) are both rare but present differently. https://t.co/57OrgaUNqj https://t.co/Y2puN18ux0

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Dr. John Cush RheumNow ( View Tweet)
PSS.scleroderma.arthritis.contractures

Juvenile and Adult-onset Scleroderma Differ

d Jack Cush, MD

A retrospecitve cohort comparision of juvenile (jSSc) and adult-onset (aSSc) systemic sclerosis (SSc) are both rare but present differently.  

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Downs Syndrome (1/700) & autoimmune mechanisms - Downs has a 4-6 fold higher risk of JIA, type 1 diabetes, autoimmune thyroid disease and coeliac disease. https://t.co/wVUDRCS96I https://t.co/RosPAkRnPA

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Dr. John Cush RheumNow ( View Tweet)
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National Population Insights (4.28.2023)

d Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports and addresses 3 viewer case questions.

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Brazil study of 1,528 kid lupus (cSLE) shows low mortality (4.1%, n=63); 84%F, age 12 yrs w/ time to death=3.2yrs post-Dx. Cause?1) Sepsis (43%), 2) opportunistic infx(11%), & 3) Pulm hemorrhage (9.5%). Predictors: CNS lupus (HR 2.6) & CKD (HR 4.3) https://t.co/mocrJ2b8Mz https://t.co/TdJ7tFYr1r

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Dr. John Cush RheumNow ( View Tweet)
Finnish population study involving 4180 #JIA patients followed for 6+ years (betw mean ages of 8.3 to 14.8 years), finds that 13% of the JIA patients prescribed psychotropic drugs (vs 10% in controls; p<0.001). Antidepressant use most freq, esp in females https://t.co/PcFhGz291J https://t.co/Ss9NzgC8vp

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Dr. John Cush RheumNow ( View Tweet)
scale decision balance question

Female Force

d Susan Shenoi, MD, MS

In medicine, a field where burnout is becoming the norm, there is much promotion of the idea of work-life balance. In reality, the scales between work and life aren’t really balanced. Is the potential for change on the horizon?

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2023 NRMP Match: 365 applicants for Rheum; 97.8% (265 of 271 avail) of Adult Rheum fellow positions matched (only 4/127 programs did not fill their match). Pediatric Rheum 27/41 positions (62.8%)were filled (14/32 programs not filling). https://t.co/VECH6rMHBV https://t.co/MC1jhLCQBk

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Dr. John Cush RheumNow ( View Tweet)
@RheumNow's review of new drug approvals during 2022 at #RNL2023 https://t.co/IgndlG6lOI
Dr. Rachel Tate uptoTate ( View Tweet)
hospital-13-1518181.jpg

Higher Rehospitalization Rates in Younger SLE Patients

d Jack Cush, MD

A Medicare study shows that young adults with systemic lupus erythematosus (SLE) exhibit very high 30-day rehospitalization rates (36%) that are significantly higher than older SLE patients and age matched non-SLE patients.

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Without head-to-head trials, do we look to metanalyses? 13 trials of TNF inhibitors in JIA pts - Results at 12-14 weeks. While it ADA looks possibly better, that would be an over-interpretation and misuse of trial data that isnt truly comparable https://t.co/k6QcPZZj67 https://t.co/SwwND1VFfT

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Dr. John Cush RheumNow ( View Tweet)
51 Juvenile SLE (j-SLE) studied for neuropsychiatric Dz (j-NPSLE)- 39% presented with jNPSLE. While no clear biomarker/imaging of j-NPSLE identified, they found CSF neopterin (& IFN-α) levels signif higher w/ active j-NPSLE & CNS involvement (p=0.0008) https://t.co/QM8yJGrBJu https://t.co/4hj1eE2JIC

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Dr. John Cush RheumNow ( View Tweet)
dental,periodontal

Periodontal Mucosal Breaks Trigger RA Disease Activity

d Jack Cush, MD

Periodontal disease (PD) is more common in rheumatoid arthritis (RA), especially those with anti-citrullinated protein antibodies (ACPAs).  RA activity has been linked to the severity of PD and mucosal inflammation.

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Comparison of MIS-C dz in kids and adults>21 (MISC - A). By Dr Susan Shenoi @RWCSmtg #rwcs23 https://t.co/jvsMLARkCA
Dr. John Cush RheumNow ( View Tweet)
Serious Infection Risk in Pediatric Psoriasis with Ustekinumab, Etanercept, or MTX This comparative analysis looks at the risk of SIE requiring hospitalization in pediatric PSO patients treated with ustekinumab, etanercept, or MTX prior to 2016. https://t.co/kR14nrZzCo https://t.co/ccFJcO0eAj

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Dr. John Cush RheumNow ( View Tweet)
The FDA has added a new indication to the oral JAK inhibitor Cibinqo (abrocitinib) - now approved to treat atopic dermatitis in adolescents 12 to under 18 years old. (Approval is based on a phase 3 JADE TEEN trial. https://t.co/DsQj3BfPmZ https://t.co/0bpb2FAwpg

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Dr. John Cush RheumNow ( View Tweet)
Enthesitis-related arthritis compared in kids - 105 ERA (57 axial vs 48 peripheral). Axial ERA pts were older @onset (12 vs. 11yrs), longer Dx delay(10 vs. 5 mos), higher inflammatory markers, more Hip Dz (53% vs 27%), more biologic Rx (67% vs 21%) https://t.co/KTYn1kv3qO https://t.co/eWbvMSBLxm

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Dr. John Cush RheumNow ( View Tweet)
infx.pneumonia.jpg

Serious Infection Risk in Pediatric Psoriasis with Ustekinumab, Etanercept, or Methotrexate

d Jack Cush, MD

Etanercept was FDA approved for use in pediatric psoriasis (PsO) in 2016 and ustekinumab was similarly approved  in 2020.  This comparative analysis looks at the risk of serious infections (SIE) requiring hospitalization in pediatric PSO patients treated with ustekinumab, etanercept, or

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