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RheumNow Podcast – #ACA: Ask Cush Anything (10.8.2021)

d Jack Cush, MD

Arthritis numbers are rising, and people are finally talking about osteoarthritis. Also, ACR 2021 is just a few weeks away - are you ready? Finally, I'll review cases and questions submitted by viewers in Ask Cush Anything (#ACA). This, and nearly a dozen news items and reports, are discussed in this week's podcast. Let's begin.

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antisynthetase,myositis,nail,erythema

Clinical Associations with Myositis Antibodies

d Jack Cush, MD

While myositis-specific autoantibodies (MSAs) and myositis-associated autoantibodies (MAAs) may have prognostic value through their clinical associations, many patients will not have them and overall, they are poorly predictive of a malignancy risk. 

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Prevalence of Arthritis Rising in the USA

d MMWR

The latest CDC estimates of the national prevalence of arthritis and arthritis-attributable activity limitations (AAAL) show a continued increase in absolute number: 58.5 million (23.7%) U.S. adults have arthritis, 25.7 million (43.9%) of whom have AAAL. 

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Erosive Hand Osteoarthritis Portends Worse OA

d Jack Cush, MD

An erosive hand osteoarthritis (EOA) study from the Osteoarthritis Initiative shows that EOA is more common in older women and is strongly linked to further progressive, articular structural damage.

This was a longitudinal cohort study of 3,365 individuals without prevalent erosive hand OA at baseline.

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DAPSA PsA measure

Pathways to a Psoriatic Arthritis Diagnosis

d Jack Cush, MD

Ogdie and colleagues have retrospectively analyzed a longitudinal cohort of psoriatic arthritis (PsA) patients, showing that only two-thirds of PsA are diagnosed by rheumatologists, PCPs and dermatologists, with significant differences in what preemptive symptoms were noted by different subspecialties.

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ICYMI: ASBMR meeting presented results of the ASTEROID trial in osteogenesis imperfecta; Setrusumab, investigational Mab inhibitor of sclerostin, failed to improve radial trabecular BMD (primary endpt), but did improve lumbar/hip/femoral BMD https://t.co/xSDIiffjb7 https://t.co/H4Cl8rH3Bq

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Dr. John Cush RheumNow ( View Tweet)
ACR 2021 is just a few weeks away - are you ready? I'll review cases and questions submitted by viewers in Ask Cush Anything (#ACA). This, and nearly a dozen news items and reports, are discussed in this week's podcast. https://t.co/Xb81eWEZ1q https://t.co/bJqkEyx2Mg

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Dr. John Cush RheumNow ( View Tweet)
Read more about Pathways to a Psoriatic Arthritis diagnosis on #RheumNow https://t.co/lIaddvq4q1 https://t.co/G6BOUMvyjc

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Dr. John Cush RheumNow ( View Tweet)
An erosive hand osteoarthritis (EOA) study from the Osteoarthritis Initiative shows that EOA is more common in older women and is strongly linked to further progressive, articular structural damage. https://t.co/XOVKNj423l https://t.co/gaPfj17IrB

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Dr. John Cush RheumNow ( View Tweet)
Epi-4 studies of 4,376 military service persons shows the prevalence of fibromyalgia = 2.9% predeployment, but was significantly higher in those with postemployment PTSD (10.8%) (not without PTSD-0.8%) but higher if in PTSD RCTs (40%) https://t.co/95tCsMtoyw https://t.co/DpMQqPVfhP

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Dr. John Cush RheumNow ( View Tweet)
Several studies have suggested that biologic Rx of Psoriasis may lower risk of later PsA. New study of nearly 2 million PSO (15k given biologic, 20K given oral Rx). The risk developing PsA higher w/ biologic (aHR 4.48) vs oral or phototherapy https://t.co/Na5EfWelkY https://t.co/6wOIm8P2gQ

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Dr. John Cush RheumNow ( View Tweet)
Upadacitinib RA program (5306 pts) the risk of H. zoster by Rx and dose (HZ/100PYs) MTX = 0.8/100PY ADA+MTX= 1.1/100PY UPA 15 mg= 3.0/100PY UPA 30 mg = 5.3/100PY Hence there is a 4-5X risk of HZ w/ JAKinhibitors https://t.co/wo9ih5PJ77 https://t.co/Zv9sSRBSHb

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Dr. John Cush RheumNow ( View Tweet)
Having both Cancer & Systemic sclerosis (SSc) is rare. Study of 1481 SSc pts saw cancer Dx w/in 2, (1.35), 3 (2.1%) & 5 yrs (3.5%;mostly breast, GYN, Heme CA). Higher 2 yr risk w/ topoisomerase I Ab (OR 3.43), U1-RNP (5.54), but not RNA polymerase III) https://t.co/dVuchv8Afv https://t.co/azGmJYifrj

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Dr. John Cush RheumNow ( View Tweet)
Study of 52 pts with Juvenile Systemic Sclerosis (JSSc) -10% were without skin dz (SSc sine scleroderma). 7 pts reviewed, all had cardiac dz (86 vs 16%; 3 cardiomyopathy, 3PAH), longer Dx delay (20 vs 8 mos), worse outcomes, (42 v 6%) https://t.co/7wGuX8QVBO https://t.co/XdTK7AlPrs

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Dr. John Cush RheumNow ( View Tweet)
MEDWATCH (FAERS) data on venous thromboembolic (VTE) risk with JAK inhibitors from 2010-2019 https://t.co/oKkTYcRsxL

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Dr. John Cush RheumNow ( View Tweet)

“Hiker’s feet” newly proposed cutaneous foot manifestations of dermatomyositis. Most pts had the antisynthetase syndrome (with anti-Jo-1) and almost all had mechanic’s hands. Such findings should prompt a search for ILD https://t.co/98EAQUHJbz https://t.co/mJ467Nfe8T

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Dr. John Cush RheumNow ( View Tweet)
Hip fractures represent a major global public health problem - data from ASBMR meeting suggests this is from an aging population and suboptimal OP treatment. Global study shows incr # hip fractures per year, but Post-fracture Rx only at 11-50% https://t.co/LlMDTrH93E https://t.co/ucrPzcnLZh

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Dr. John Cush RheumNow ( View Tweet)
2125 RA pts in RCTS w/ baricitinib entered a long term F/U study. baricitinib pts had less XRay damage over 5 yrs; 5 yr No Xray progression was 60% on baricitinib 4 mg; 66% baricitinib 4 mg+MTX; vs 41% on just MTX monotherapy. https://t.co/pLuQCDSf6g https://t.co/wFs3G0DrJ7

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SLE hospitalized with ARDS from COVID-19 have significantly higher risks of death and poor outcomes (RR=1.7), compared 319 SLE vs 251,800 nonSLE - SLE was more impactful than other comorbidities in such poor outcomes https://t.co/8VJjdOmTbi https://t.co/jYTg6k1QNq

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Dr. John Cush RheumNow ( View Tweet)
We are at that time of year when rheumatology fellowship programs across the nation are exploring potential candidates to train. We share tips for both the interviewer and candidates on the blog today. https://t.co/eWQs9CwqSm https://t.co/iHeuQpsoQx

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Dr. John Cush RheumNow ( View Tweet)
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