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DMARDs,biologics,RA

Cost-Effective Use of Biological and Targeted Synthetic DMARDs

Jack Cush, MD

An international task force of 13 European experts have developed evidence-based points to consider regarding the cost-effective use of biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in the treatment of inflammatory rheumatic diseases (including rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis).

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Big Time Vasculitis (3.10.2023)

Jack Cush, MD

Dr. Jack Cush Reviews the News and Journal articles from the past week on RheumNow. This weeks highlights includes insights on scleroderma, myositis, vasculitis and answers the question - does aggressive biologic treatment of psoriasis prevent future psoriatic arthritis?

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Does Biologic Treatment in Psoriasis Reduce the Risk of Psoriatic Arthritis?

Jack Cush, MD

Retrospective claims analysis shows that psoriasis patients treated with either an IL-12/23 inhibitor or an IL-23 inhibitor had a lower risk of developing incident psoriatic arthritis, compared to TNF inhibitors or IL-17 inhibitors.

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NSAIDs in Pregnancy (3.3.2023)

Jack Cush, MD

Dr. Jack Cush reviews the lastest journal articles, news, and FDA announcements from the past week on RheumNow.  This week, the importance of IFNa, Subclinical PsA and NSAID safety during Pregnancy.

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Psoriatic Arthritis: Depressing News on Second- and Later-Line Treatments

MedPage Today

Most patients with psoriatic arthritis (PsA) failed to achieve low disease activity after switching from one targeted therapy to another, real-world data from Scandinavian registries indicated.

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Skin,cancer,squamous,cell

Does Methotrexate Increase Skin Cancer Risk?

Jack Cush, MD

There are several reports suggesting a link between methotrexate (MTX) use and certain skin cancers, yet these are confounded by a higher risk of skin cancers with inflammatory conditions like rheumatoid arthritis of which MTX is the most common treatment.

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

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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Achilles,ankle,heel

GRAPPA Recommendations for Treating Enthesitis in Psoriatic Arthritis

Jack Cush, MD

GRAPPA has provided new, evidence based updates to the management of enthesitis in patients with psoriatic arthritis (PsA), affecting at least 30% of PsA patients and is associated with more severe disease, x-ray damage, and poorer outcomes. 

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Achilles,ankle,heel

ICYMI: GRAPPA Recommendations for Treating Enthesitis in Psoriatic Arthritis

Jack Cush, MD

GRAPPA has provided new, evidence based updates to the management of enthesitis in patients with psoriatic arthritis (PsA), affecting at least 30% of PsA patients and is associated with more severe disease, x-ray damage, and poorer outcomes. 

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29 pts w/PsA Sine Psoriasis: 16F/13M, mean age 45 yrs w/ PsA ~6.2 yrs. 54% had 1st-degree relatives with PsA. 66% had DIP arthritis, 39% polyarticular, 36% oligoarticular, 25% were axial. Nail findings seen in 89%, enthesitis 59%, dactylitis 62% https://t.co/FPAqosYr9C https://t.co/xr692rSZZ1

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2017 Prevalence of Psoriatic arthritis (PsA) in Sweden estimated to be 0.34% (range 0.32-0.50% across all sensitivity analyses); lower in males & w/ higher level of education. 0.24% have seen rheumatology care- 32% on b/ts-DMARDs, 41% csDMARDs https://t.co/Jh2WUYVJR2 https://t.co/ZdFVIq2iQ0

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ARTIS Swedish study of Cancer in RA or PSA pts (~15k pts) starting JAKi vs TNFi. With ~2 yrs F/U, the risk of Cancer (excluding NMSC) was similar betw JAKi and TNFi (HR 0.94; 0.65 to 1.38), but more incident NMSC w/ JAKi (HR 2.12; 1.15 to 3.89) at 2 yrs https://t.co/BiPWF1T0lZ https://t.co/nrmaCGBcce

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Study of 87 pts with isolated Nail Psoriasis noted that 11% went on to have #PsA (concurrently or within 3 years). NP findings were mainly onycholysis in79% and nail pitting in 70% https://t.co/2NynITxe6B https://t.co/qs4uYySjxp

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PsA: Depressing News on Second- and Later-Line Treatments Most patients with PsA failed to achieve low disease activity after switching from one targeted therapy to another, real-world data from Scandinavian registries indicated. https://t.co/7tSzoNLVoD https://t.co/3oUM4E38b1

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Dr. John Cush RheumNow ( View Tweet)
Prospective study of 490 mod-to-severe psoriasis compared prospectively by exam & US for PsA - 384 w/o arthritis (Silent PSO), 80 non-PSO & 106 w prodromal or active PsA (12.7%). US synovio-enthesitis in 1.8% of controls & 16.1% of silent PSO (p< 0.001) https://t.co/kUdIwLnfYL https://t.co/dgIaOXaJKR

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5 Nordic register study of new b/tsDMARD starts in in PsA - 5659 ADA (56% biologic-naïve) & 4767 other b/tsDMARD (21% naïve) starts. ADA more often 1st line; newer b/tsDMARDsin biologic-experienced. 2nd line retention: ADA 65%, ABA 45%, Otez 43%. https://t.co/XKLiana6vB https://t.co/PotwYlYXto

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Subanalysis of DISCOVER-1 RCT w/ IL-23 inhibitor guselkumab, showed similar response in TNFi-naive (n 118) & TNFi-experienced (263) Rx w/ guselkumab Q4W (76% & 68%) or Q8W (61% & 58%), yet skin responses (PASI90) were better in TNFi-naive Rx PsA pts. https://t.co/tsKuLZw7dQ

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GRAPPA Recommendations for Treating Enthesitis in PsA GRAPPA has provided new updates to the mgmt of enthesitis in patients with PsA, affecting at least 30% of PsA patients and is associated with more severe disease, x-ray damage, and poorer outcomes. https://t.co/AC6KHGMeo0

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Univ of Toronto’s PsA Study looked at surgery amongst 1574 pts: 185 pts (~12%) had 379 MSK surgeries related to PsA. Signif higher rates of surgery were seen w/ #damaged joints (HR 1.03), TJC/SJC (HR 1.04), nail Dz (2.08), ^ ESR (2.37), B27+ (2.22) https://t.co/XdUJ0guwUh

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New Guideline: Vaccinations OK With Few Tweaks for Rheum Patients Nearly all available vaccines can be given to people with rheumatologic diseases, according to a new, detailed guideline from the ACR. https://t.co/514mIylgzj https://t.co/9Zq9pGcujV

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