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The Cartel is Coming for Rheumatology
"What Do Blockbuster Drugs & The Black Market All Have in Common?" asked Dr. Madelaine Feldman at RheumNow Live 2025. They thrive, she explained, on market exclusivity "... until they don't." At first glance, the pharmaceutical marketplace may not appear like a crime drug ring, but Dr. Feldman of Tulane University described how sinister forces of market manipulation have negatively impacted patient care for years.
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Prevalence of Systemic sclerosis–associated interstitial lung disease (SSc-ILD) was 49.8% - Chinese study of 223 SSc (F/U 8.1 yrs). Among SSc-ILD, 64% had progressive disease w/ elevated CRP at Dx as predictor. Overall mortality rate = 24.2% (pneumonia) w/ predictors of age,… https://t.co/Lb98KziPOj
Dr. John Cush RheumNow ( View Tweet)
Full read review of association betw #RA & Chikungunya fever (viral infxn transmitted by Aedes mosquitoes). Theres no true link betw RA & CHIKV; but incidence of RA after CHIKV is 13.7% (based on 16 reports, 2879 pts, 449 RA postCHIKV) https://t.co/8fxIS846Nd https://t.co/YD1aLIVrrI
Dr. John Cush RheumNow ( View Tweet)
TheDaoIndex @KDAO2011
80% #hydradenitis suppurativa pts are smokers or former smokers, smoking can predate #HS by 4-5 years. Other associations: DM-2, Spa, obesity, SAPHO, PCOS eval for SCC (squ. cell CA) #RNL2025 https://t.co/XHrFseiAMK
Dr. John Cush RheumNow ( View Tweet)
Janet Pope @Janetbirdope
#Disease #activity in #axSpA
#ASDAS - a crude measure of activity in
#ankylosing #spondylitis
Is related to #radiographic #progression
👇
⬆️ CRP May be more predictive
#ClinicalPearl #RNL2025 https://t.co/34wrMuz9mO
Dr. John Cush RheumNow ( View Tweet)
Eric Dein @ericdeinmd
Active Morphea: - MTX +/- steroids. If not effective, MMF/RTX/ABA - Topicals for circumscribed - Phototherapy Most pts achieve remission in active in 1 year Inactive morphea - Can address with PT, pain rx, psychological support, plastic surgery fat… https://t.co/OMGt8feO0z https://t.co/yWAgY2Z4Ng
Dr. John Cush RheumNow ( View Tweet)
Eric Dein @ericdeinmd
How do you know if Morphea is active? -Erythema -Peripheral induration -New lesions in the past few month Non-active damage? - Dermal atrophy -SQ atrophy -Hyperpigmentation -Skin thickness center #RNL2025
Dr. John Cush RheumNow ( View Tweet)
Eric Dein @ericdeinmd
#RNL2025 Treatment of sclerosing skin conditions: Active inflammation? Sclerotic? Atrophic? Target based on activity, depth of involvement and other disease involvement
Dr. John Cush RheumNow ( View Tweet)
MD Survey: Who should manage patients with hidradentis supprativa?
Dr. John Cush RheumNow ( View Tweet)
Full read, comprehensive review of Hidradenitis Supprativa in Lancet Feb 1, 2025
Common assn; DM, IBD, Smoking, Obesity, metabolic syndr, NASH, SpA, RA
FDA approved Rx: Adalimumab, Secukinumab, Bimekizumab https://t.co/5Tb8on21E0 https://t.co/BLu6Zaejj5
Links:
Dr. John Cush RheumNow ( View Tweet)
Janet Pope @Janetbirdope
#ClinicalPearl Insights into #fibrosing #skin conditions Inflammatory Fibrotic Atrophy We treat the #inflammation but need to determine if lesions are active or not Bx May not discern #dx Heidi Jacobe #RNL2025 https://t.co/dG1k4fm4aO https://t.co/5TowCCDiTt
Links:
Dr. John Cush RheumNow ( View Tweet)
TheDaoIndex @KDAO2011
@drcharitydean on emerging public health threats including H5N1 & communicable dz. We need to be monitoring for human to human disease transmissions. There is a high level of concern by large business as they recognize this will affect the supply chain.… https://t.co/T3TZ7LtHQi https://t.co/Ar85A0EcW4
Dr. John Cush RheumNow ( View Tweet)
Eric Dein @ericdeinmd
B England
75% of RA pts have multi-morbidity
Pts develop multi-morbidity BEFORE the onset of RA
Should we have different goals: Prioritize LDA over remission in pts w multimorbidity
Collaborate w PCP: one size doesn't fit all, do something better than… https://t.co/RIe7BhSgvJ https://t.co/4dVdR088XF
Dr. John Cush RheumNow ( View Tweet)
TheDaoIndex @KDAO2011
A practical clinic-based approach to assessing CVD, CA screening, lung disease, infections for rheums by Dr Bryant England who offers us menus.. start by asking about symptoms. #RNL2025
https://t.co/AcQDJS870I https://t.co/UCyDOF2GRZ
Links:
Dr. John Cush RheumNow ( View Tweet)
Adela Castro @AdelaCastro222
Multimorbidity in Rheumatoid Arthritis:
-Affects >75% of pts
-Reduces quality of life and increases mortality
-Highly associated w/ D2T RA
-Requires multidisciplinary care teams (PCP, specialists, case management, PT)
-Management should start early… https://t.co/Sshm8CUWOA https://t.co/W9dojZT99T
Dr. John Cush RheumNow ( View Tweet)
Will AI put me out of a job?
The advent of artificial intelligence (AI) continue to amaze us in this changing world and in multiple areas of medicine. As an evolving science, rheumatology has also been introduced to AI where interesting applications seem to enhance patient… https://t.co/W0ysHzxiRg https://t.co/rPOcjC2lyR
Dr. John Cush RheumNow ( View Tweet)
Adela Castro @AdelaCastro222
Are your patients aging with RA, or are they diagnosed with Late Onset RA (LORA)? -LORA pts tend to present acutely -High inflammatory markers~PMR Like -Seronegative/Decreased titers of RF/CCP @UnaMakris #RNL2025 https://t.co/tLrGBV6P1i https://t.co/53HVvUmrG4
Links:
Dr. John Cush RheumNow ( View Tweet)
TheDaoIndex @KDAO2011
Late onset RA (LORA) aka RA diagnosed at an older age — pts have higher inflammatory markers, presents like PMR; they also have polypharmacy, comorbidities, frailty, etc that can complicate management @UnaMakris #RNL2025 @RheumNow #GeriRheum… https://t.co/E2WFwfCsWD https://t.co/tKF0OnUFQH
Dr. John Cush RheumNow ( View Tweet)
#Benralizumab vs #Mepolizumab
both work for #EGPA
Which to use? 🤷♀️
perhaps some advantage of more steroid sparing w
Benralizumab?
? JAKi ?long acting #IL5i
#RNL2025 @RheumNow https://t.co/UkthHpNRIq
Janet Pope Janetbirdope ( View Tweet)
Adela Castro @AdelaCastro222
How can AI be useful for RA pts and rheumatologists? -AI models have the potential for improving diagnosis, management and outcomes in RA pts. -Can also improve efficiency and clinic workflow. -Not so perfect as it sounds (hallucinations, limited… https://t.co/YA4A990p2v https://t.co/YnHtbP83Nm
Dr. John Cush RheumNow ( View Tweet)
