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Safety of COVID-19 Vaccines in Rheumatic Patients

d Jack Cush, MD

Since the introduction of COVID-19 vaccines in January 2021, rheumatologists have fully advocated the protective benefits of their use - yet many have rarely noted flares and reactive side effects worrisome to patients.  Now a multinational study shows that the use of COVID vaccination in rheumatic and musculoskeletal disease is safe, well-tolerated with very rare serious adverse events.

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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:Hydroxychloroquine related hyperpigmentation appears as blue/ black discoloration of skin or mucosa, occurs in 7-30%; Recent report says ~5%; Risk factors include steroids, bruising, anti-coagulants & trauma - theyr slow to resolve if you D/C https://t.co/IJDolwNyDx

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Best of 2021: Comparison of oral and parenteral MTX shows oral MTX in RA is non inferior to subcutaneous MTX treatment (in 640 RA pts) with regard to disease activity, but oral MTX had fewer adverse events than SC ( 41% vs 52%, p= 0.005). https://t.co/4RB7SxuGx7

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121 Sjögren’s pts dx w/ non-Hodgkin's lymphoma - 76% were MALT lymphoma (9% Diffuse Large B Cell, 7% Nodal Marginal Zone Lymphomas). MALT 10-yr survival was 79% MALT. Predictors were Cryoglobulinemia, focus score, ESSDAI at Dx https://t.co/EYsB06DU4s

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Best of 2021:Danish Cohort study of 5310 cutaneous LE/SLE pts between 1995-2014 (7-8 yrs F/U & 40.724 PYs) shows overall increased cancer risk for CLE (SIR 1.35)and SLE (1.45), esp a 3-4 fold increased risk for NHL, hematological, pancreatic & lung cancers https://t.co/Lgbe2hwtNj https://t.co/NzjM5LCuaX

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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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Are autonomous practices disappearing. With pandemic closures and big network buyouts of practices, less than 50% of practices are MD owned. This WSJ article (by the daughter of a Brooklyn Rheumatologist) explains why this is not good for patients. https://t.co/lVxBrhpHbh

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Clinic.... "is like a box of chocolates, you never know what you're gonna get" - Forest Gump

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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/4ZQ7KmMszT

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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/vaoTNLy6ts https://t.co/euv8u0ScGH

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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/sKaZBqClyA https://t.co/i32kbIuEaX

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Best of 2021: Jack of All Subspecialties https://t.co/Nskfl0Y9qw https://t.co/BmMaoj2tuO

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Best of 2021: Perspectives on CV safety: JAKi (Tofacitinib) and TNF inhibitors https://t.co/pNBLklf6tY https://t.co/siJV8uhQOf

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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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