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RheumNow Podcast – Like Father, Like Daughter (10.29.2021)

d Jack Cush, MD

Bad things happen when our patients go into the ICU and it's not always due to the disease. Good things happen when we rise from sitting. And guess what? Rheumatologists are setting cardiology straight about hydroxychloroquine and chloroquine. This, and a special recognition of parent-child rheumatologists, along with the news and articles from this week on RheumNow.

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Biologic Use and the Risk of Serious Infection in Psoriasis Patients

d Jack Cush, MD

National Health Data from France examined biologic use in patients with moderate to severe psoriasis, and found the risk of serious infections (SIE) to be increased with some biologics (infliximab and adalimumab), but not others (etanercept, ustekinumab IL-17 and IL-23 inhibitors or apremila

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BEAT-LUPUS: Sequential Belimumab After Rituximab in SLE

d Jack Cush, MD

The Annals of Internal Medicine reports that targeting B-cells in refractory systemic lupus erythematosus (SLE) with sequential belimumab after rituximab may significantly reduce dsDNA antibody titers and lessen the number of future severe flares.

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Rheumatoid Arthritis Thrombotic Risk Influenced by DMARD Choice

d Jack Cush, MD

RA patients have an increased risk of venous thromboembolism (VTE) related to disease activity and inflammation, yet a large real-world study of older RA patients shows methotrexate to be associated with a 2-fold increased VTE risk (compared to hydroxychloroquine).

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ACR Applauds Bipartisan Letter Urging Congressional Action to Avoid Looming “Medicare Cliff” https://t.co/KXNHRdubZk

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Dr. John Cush RheumNow ( View Tweet)

Nature has published a full read over of "Homing in on an oral link to inflammatory disease" how the microbiome may be a pathogenic link to diseases like RA. https://t.co/wwB9Eg9nsH

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Baricitinib long-term safety in #RA - 3770 pts (14744 PYs). Incid rates/100 pt-yrs: - Serious infx 2.6 - H. Zoster 3 - MACE 0.5 - In pts ≥50yr w/ ≥1 CV risk MACE = 0.77 for 1st 2 yrs, then 0.6 - Cancer SIR 1.07 w/ low SMR 0.74 - DVT/PE risk 0.5 & 0.4 https://t.co/amdzvXSZb4 https://t.co/3Si98fL6Z9

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MMWR reports those who have recv COVID-19 vaccine have lower risk non–COVID-19 mortality (vs unvaccinated). Adjusted rel risk of non–COVID-19 death for Pfizer-vaccine (2 doses RR 0.34), Moderna (0.31), Janssen (0.54). NO INCR MORTAL RISK IN VACCINATED https://t.co/X6X1w1aYoU

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"ECG monitoring is not part of the current standard practice when HCQ or CQ is prescribed for...rheumatologic or dermatologic conditions." -pub 10/26/21 ACR White Paper on Antimalarial Cardiac Toxicity https://t.co/uBqm5LBsob

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TheDaoIndex KDAO2011 ( View Tweet)

Health insurance data from Korea analyzed 17,854 SLE pts & saw incr risk hematologic & solid cancers; solid (126.9/10K PY;SIR 1.8), heme (11.2/10KPYs; SIR 1.7). Most common in SLE: breast, reproductive & thyroid then liver & colon cancers https://t.co/dRs7SUwUAY

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ACR publishes a "White paper on Antimalarial Cardiac Toxicity"- reviewing drug hx, indications, effects and rare risk of arrhythmias, conduction abnormalities, cardiomyopathy, QTc prolongation. torsade de pointes. No evidence for routine ECG monitoring https://t.co/2aemSKzk3T https://t.co/3stH4TntBT

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Dr. John Cush RheumNow ( View Tweet)
The Sacroiliac Joint - some call this a symphysis, but it is an "amphiarthrosis", or sliding joint, with minimal movement; Only the lower (distal) 1/3 of the joint is synovial lined -- this is where one should look for sacroiliitis. https://t.co/8uD13h2qHZ https://t.co/D3UERVXrgX https://t.co/3E3N1FnqDY

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FDA put a box warnings on breast implant packaging to include info that 1)Breast implants are not lifetime devices; 2) complication risk increases over time; 3) risk of anaplastic large cell lymphoma, 4) may be assoc w/ systemic Sxs https://t.co/VnpJg45PZY

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Rheumatoid Arthritis Thrombotic Risk Influenced by DMARD Choice https://t.co/gOLhO2aNOo https://t.co/FwKP3slExA

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Dr. John Cush RheumNow ( View Tweet)
QD Clinic - The Thyroid Lump QD Clinic is sponsored by https://t.co/V10S4oE43V's coverage of #ACR21 https://t.co/J5YkJmaNea https://t.co/UidG4dT1JJ

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Platelet-Rich Plasma Injections Fail in Ankle Osteoarthritis https://t.co/Fmf8f2C3Y4 https://t.co/9ZJe2jAYVw

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Dr. John Cush RheumNow ( View Tweet)
Sign up today to receive #ACR21 news and select topic emails throughout the conference. #RheumNow https://t.co/riyAnrRHhX https://t.co/MkoDsw34D0

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While psoriasis and Psoriatic arthritis patients have an increased risk of fractures, there is no increased risk of osteoporosis or osteopenia. Data from 12 studies an 199 million individuals https://t.co/G4Ya7CUWYX

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Systematic review of dsDNA studies (byfluorescence immunoassay) included 1977 total patients, 47% with SLE == over all dsDNA had >90% for specificity and a pooled specificity of 94.7% (95% CI 91.67%-96.67%) https://t.co/Nk8h9fDYpE

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Dr. John Cush RheumNow ( View Tweet)

Methotrexate is the most often-studied treatment and has best clinical outcomes in children and adults with localized scleroderma en coup de sabre. Metanalysis of 34 articles, only 4 RCTs, but 24 case reports. More research needed. https://t.co/fSEvDw2pge

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