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Best of 2021: Jack of All Subspecialties

d Jack Cush, MD

It's great to be a rheumatologist, but boy, it's getting harder and harder. You have to be a jack of all trades. You have to be good at cardiovascular disease, osteoporosis, vaccination, inflammatory bowel disease - it just never ends. This and more, as Dr. Cush summarizes more than a dozen journal articles, news reports and questions + cases.

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Best of 2021: Perspectives on CV safety: JAKi (Tofacitinib) and TNF inhibitors

d Janet Pope, MD, MPH, FRCPC

Safety comparisons of JAKi (tofacitinib) vs. TNFi from Oral Surveillance showed that, in patients with active RA on MTX and aged >50 years with one or more CV risk factors, that there was numerically more MACE events, malignancies, and VTE especially in higher dose.

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Best of 2021: FDA Puts Boxed Warnings on JAK Inhibitors

d Jack Cush, MD

Based on the safety review of tofacitinib in Pfizer's Oral Surveillance (1133) study, the FDA has added serious boxed warnings to all three marketed JAK inhibitors (for inflammatory diseases) and formalized the recommendation that patients should be started on a TNF inhibitor (TNFi) before trying a JAK inhibitor. These recommendations apply to tofacitinib, baricitinib and upadacitinib.

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COVID vaccine vials

Best of 2021: Comparison of Three Coronavirus Vaccines

d Jack Cush, MD

On Feb. 27, the Food and Drug Administration announced it has issued an emergency use authorization for Johnson & Johnson’s one-dose Covid vaccine, making it the third COVID-19 vaccine to be commercially available.  We've compiled a comparison table and some key information relevant to your delivering patient guidance henceforth. 

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Best of 2021: A serious shortage of pediatric rheumatologists in the USA, where we need at least 1 ped rheum per 400,000 population. @RWCSmtg https://t.co/hUroLwclxz https://t.co/QHHNH99wJ0

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Best of 2021:Synovial Tissue Signature Guiding Targeted IL-6 Therapy in RA RNA sequencing-based stratification of rheumatoid arthritis synovial tissue showed stronger associations with clinical responses compared with histopathological classification. https://t.co/SD8ceTmbnm https://t.co/D98XBLj1YY

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Best of 2021: FDA Puts Boxed Warnings on JAK Inhibitors https://t.co/O5RnyWcDQl https://t.co/EAiU7DRmBU

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Best of 2021: Single center, 40 yr experience shows lupus psychosis to be rare. Among 709 SLE pts, 18 (2.5%) developed lupus psychosis. 2/3 remitted w/ antipsychotics & immunosuppressive Psychosis more likely w/ RNP and less likely w/ cardiolipin Abs. https://t.co/JXVU9uoO4j https://t.co/SBxsgNRMr8

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Best of 2021: High Risk Cancer Profiling with Inflammatory Myositis A recent metanalysis of studies suggest you may be able to use certain clinical factors to stratify cancer risk in patients with idiopathic inflammatory myopathies (IIMs). https://t.co/v4F3jmfnNK https://t.co/1lflsgMZtE

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Best of 2021: Abbvie has released data from KEEPsAKE-1 and KEEPsAKE-2 studies (1407 pts) showing Risankizumab (IL--23 inhibitor) is effective in Psoriatic arthritis; RIS Rx pts achieved ACR20 of 57% and 51% at week 24 (vs PBO 34% and 27%; p<0.001) https://t.co/0C07aTlEQY

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Best of 2021: Vagal Nerve Stimulation in Rheumatoid Arthritis Lancet Rheumatology has reported the results of a proof of concept trial, wherein vagal nerve stimulation was shown to ameliorate rheumatoid arthritis (RA) disease activity. https://t.co/cXCVN85HTG https://t.co/BePEkIn9l8

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Best of 2021: Alveolar Hemorrhage and Mortality in Lupus Metanalysis of patients with DA), show this to be a rare and life-threatening complication of SLE, that is more apt to affect older, severe lupus patients with active infection. https://t.co/QvXiWKLTlm https://t.co/IFAS1loBId

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Best of 2021: Avacopan - Is it Really a Win for ANCA-Associated Vasculitis? The NEJM has reported the results of a study showing that avacopan, a C5a receptor inhibitor, is as effective as steroids at treating patients with ANCA-AAV. https://t.co/cm9PX66zE7 https://t.co/e7S5C6eugK

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Best of 2021: Very high levels of IL-18 IL-18 (> 10 000 pg/ml) is associated with Macrophage Activation syndrome (with systemic JIA) as well as primary and secondary Hemophagocytic lymphohistiocytosis (HLH) https://t.co/FQPAHZTi4M https://t.co/UkNh2no123

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Danish Cohort study of 5310 cutaneous LE or SLE pts between 1995-2014 (7-8 yrs F/U and 40.724 PYs) shows an overall increased cancer risk for CLE (SIR 1.35)and SLE (1.45), esp a 3-4 fold increased risk for NHL, hematological, pancreatic and lung cancers https://t.co/MFPLG9ifGU

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One-Third Rheumatoid Risk from Lifestyle Analysis of the NHANES data suggests that 1/3 of the risk of developing RA in the USA is attributable smoking, obesity and alcohol intake. https://t.co/SAVzBGlAoP https://t.co/bIhmCkufmC

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Best of 2021: Israel provides COVID vaccine answers for rheumatic disease patients https://t.co/3mWEjdAnLL https://t.co/It5VjbQMoI

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Rheumatologist survey - How do you aspirate (or injx) a knee effusion - what is your needle approach?

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Best of 2021: Seronegativity in RA studied using sera and microarrays from 559 RA (283 ACPA-) found 9 autoAbs w/ >90% specificity for seroneg RA. anti-PTX3 & anti-DUSP11 had best performance w/ sensitivity 38% & specificity 88% https://t.co/jFAnpQzmve

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Best of 2021: Cutaneous manifestations of ANCA-assoc vasculitis studied in 1184 GPA, MPA, EGPA pts and found to assoc w/ more severe disease. Common were petechiae/purpura (15%); allergic Sxs such as pruritus, urticaria, were more common in EGPA

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