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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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Medicare study of 2.3 million shows high Telemedicine use was assoc w/ slight increase in visits (F2F & telemed), modestly lower use of 7 of 20 low-value screen tests for cervical CA, ECG, CMP, CBC, TFTs, & imaging for uncomplicated LBP (with less costs too)… https://t.co/lrG9NJ20B7 https://t.co/rLkGdBqWmr
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National Statistics analysis (2020-22)of 3.6 million US workers shows MDs & HCP had lower age/sex adjusted mortality rates vs non-HCPs. In nonHCPs, mortality is lower in females (HR 0.55), but in MD/HCP females its equal (HR 0.97; more CA +respt) & MD/HCP Black higher than whites… https://t.co/gmPJEN4xs0 https://t.co/7QpTZko8GP
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JAMA Case: A Woman With Painful Digital Ulcers - What would you order next?
- chest CT w/ myositis-specific autoAb panel
- dsDNA
- SCL-70 & Centromere Abs
- muscle biopsy https://t.co/9T8mNDdJTs https://t.co/pTphzcuZKF
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AI-assisted diagnosis for immunological disease
A novel machine learning framework – Mal-ID – can decipher an individual’s immune system’s record of past infections and diseases, according to a new study, providing a powerful tool with the potential for diagnosing autoimmune… https://t.co/gAViSbzreI https://t.co/IFXObUZe2s
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CRP and Hidradenitis Supprativa
A post hoc analysis of 2 phase 3 randomized clinical trials (PIONEER I and II) of adalimumab vs Placebo in patients with active Hidradenitis suppurativa (HS) demonstrated more severe HS that was associated with elevated CRP had a higher BMI.… https://t.co/VxFRjt3cRw https://t.co/rdNIvzMaP8
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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/wEnlo6vtAB https://t.co/4uJYC9HaS1
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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/9er7TkNXpK https://t.co/N6sal9URv3
Links:
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Three B-cell targeting anti-CD20 mAbs in clinical use:
- Rituximab (1997) for RA, GPA, CLL, NHL, Pemphigus Vulgaris
- Ofatumumab (2020) for relapsing MS
- Obinutuzumab (2013) for Follicular lymphoma & CLL
OFA & OBIN may be better than RTX in membranous GN pts w/ anti-RTX Abs… https://t.co/ZhUbXFXjSR https://t.co/vUHkS76PK7
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Optimal Management of Rheumatoid Arthritis Patients and Liver Disease
https://t.co/KpdY1MEM1w https://t.co/vETGMJgHf3
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JAMA Review on Dx & Rx of Monoclonal Gammopathy of Undetermined Significance. MGUS has NO Sxs or organ damage. MGUS & Dz associations (OP, Autoimmune) were likely overestimated; M protein testing should be done if malignancy or MGCS is suspected. Risk of progression to malignancy… https://t.co/Jikc5q3BJL https://t.co/hxhcD4bJ2X
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That's not my problem - or is it? Multimorbidity in RA
RA can look so easy on the television commercials where patients appear young, healthy, and vibrant on the advertised treatment.
https://t.co/4lSVKeRtyx https://t.co/Xa1UGbJigy
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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
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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
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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
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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
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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
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MD Survey: Who should manage patients with hidradentis supprativa?
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