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Dr. Jack Cush reviews the news, journal reports and lupus highlights from the past week on RheumNow.com. Triple positivity, the gut and CRPS, and hope for better outcomes with Vitamin D therapy.
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A randomized clinical trial with oral high-dose cholecalciferol ( vitamin D3) was shown to prevent or delay the onset of clinically isolated syndrome (CIS), typical for multiple sclerosis (MS).
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I think we're all somewhat familiar with PJP prophylaxis. This is the thing we do to stop the scary, opportunistic infection that affects people who are immunocompromised. I'm going to start by actually steelmanning the case for doing PJP prophylaxis before I explain why I think you probably shouldn't be doing too much of it.
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An open-label, single-centre, randomized controlled trial tested whether immunosuppressant (IS) withdrawal is noninferior to glucocorticoid (GC) withdrawal in systemic lupus erythematosus (SLE) patients and found that IS withdrawal is noninferior to GC withdrawal in SLE patients in long-term
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Current guidelines recommend limiting the use of glucocorticoids by coining the new concept of “bridging therapy”, that is, use GCs when the disease is active and get rid of them as soon as you can. This way of thinking is conceptually attractive, however, the formula for translation to real life settings is not included.
Dr. John Cush
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RA nodules respond to JAKi. Small case series of 7 established/refractory moderate-to-severe#RA pts w/ rheumatoid nodules who were treated w/ JAKi (tofacitinib, upadacitinib)-- 5/7 had complete resolution & 1 reduced nodules size (w/in 3-12 mos) on JAKi therapy. https://t.co/oQWHMBVQEi
Dr. John Cush
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Pitfalls in sacroiliitis imaging: Bone marrow edema may also be seen in young-middle-aged postpartum women, & athletes & kids (ongoing bone growth) & w/ advancing age (DJD) https://t.co/bwS047wlmI https://t.co/pqI3xTYtCz
Dr. John Cush
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single-centre study of 469 consecutive RA pts - 15 had VTE (3%). Strongest risk factor of VTE was the history of previous VTE (OR 44.7), recent hospitalisation (OR 6.82), diabetes (OR 11.23), and JAKi (OR 5.54) (Other studies show inflammation incr VTE risk) https://t.co/JfaBtfvujU
Dr. John Cush
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Hyperpigmentation in SLE
Young complex SLE patient develops blue-grey/slate colored hyperpigmentation on her arms and legs - From?
Features Dr. Jack Cush
https://t.co/yoKU7rJp8y https://t.co/Kh0tZLJ8SX
Dr. John Cush
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Metanalysis of ANCA-associated vasculitis with interstitial lung disease (8 studies, 654 pts shows the following significan mortality risk factors: age (HR 1.06), ever smoker (HR 1.61), UIP pattern (HR 2.07), acute exacerbation (HR 2.73) & microscopic polyangiitis (HR 4.03). https://t.co/z4zfDq9Wf9
Dr. John Cush
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Arterial or venous thrombotic events (AVTEs) are common w/ new forms of monogenic vasculitis (DADA2 & VEXAS), resulting from pathogenetic mechanisms of endothelial dysfunction, immune complex deposition and pro-inflammatory cytokines. Reviewed here. https://t.co/Nw9wNYssg3 https://t.co/1PoPWPWNec
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Prophylaxis Against PJP in SLE: I'll Pass with @EBRheum
https://t.co/tUGwziEYCg https://t.co/VqTa9jG8oj
Dr. John Cush
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Stable SLE - Should you Withdraw Immunosuppressant or Glucocorticoids?
An open-label, single-centre, randomized controlled trial tested whether immunosuppressant (IS) withdrawal is noninferior to glucocorticoid (GC) withdrawal in SLE patients and found that IS withdrawal is https://t.co/T8Fu83GScH
Dr. John Cush
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Glucocorticoids in SLE: how to start, how to follow, how to stop
More than 70 years after their first use in rheumatology by Philip Hench, glucocorticoids (GCs) continue to be one of the main weapons to fight systemic lupus erythematosus (SLE). No other available medication https://t.co/H6N0N3BhhU
Dr. John Cush
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single-centre study of 469 consecutive RA pts - 15 had VTE (3%). Strongest risk factor of VTE was the history of previous VTE (OR 44.7), recent hospitalisation (OR 6.82), diabetes (OR 11.23), and JAKi (OR 5.54) (Other studies show inflammation incr VTE risk) https://t.co/pBJDhXOgut
Dr. John Cush
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Retrospective Medicare Claims data study of RA pts w/ metastatic non-small cell lung cancer who recv Rx w/ immune checkpoint inhibitor; found that ICI- Rx RA had the same survival as non-RA pts, and sterid use was not associated with worse survival https://t.co/JLlCfrRwvN https://t.co/DNEM32yocL
Dr. John Cush
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FDA has approved nipocalimab (Imaavytm), a FcRn for use in generalized myasthenia gravis (gMG). It is approved for using in gMG patents who are anti-AChR and anti-MuSK antibody positive adults and pediatric gMG patients aged 12 and older. https://t.co/fYCWuTZ6Uz https://t.co/aSfydBS9xh
Dr. John Cush
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Very low & very high vitamin D (25/OH) levels assoc w/ adverse pregnancy outcomes - miscarriage (P = 0.0045) & preterm delivery (P = 0.0007). APO were lowest w/ 25(OH)D levels of 40 to 59 ng/mL. Monitor vit D and Rx during SLE pregnancies https://t.co/Z9jEgETqId https://t.co/fJRqD3v7UF
Dr. John Cush
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DANBIO registry study of 720 RA pts w/ a prior solid cancer (breast, colon. lung, endometrial, melanoma, bladder) in remission who received any biologic DMARD, TNFi or RTX found no incr risk of CA recurrence w/ any bDMARD, TNFi, RTX. Specifically, no incr in breast CA recurrence https://t.co/YJw8qXz1yM
Dr. John Cush
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Japan IORRA RA registry shows from 2011 to 2023, despite better Rx & control & less pred, Fractures went up in RA. From 2011 to 2023- DAS resmission 38 to 65%, bDMARD use 14 to 42%, GC use 38 to 22%, OP Rx 32 to 38%; But all FX incr 47 to 53/1000 Pys. https://t.co/cgz0Gkasai https://t.co/D2Uro7mEAT
