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ANCA, vasculitis, test

ACR/Vasculitis Foundation 2021 Guidelines for ANCA–Associated Vasculitis

d Jack Cush, MD

Chung et al have published the 2021 treatment guielines for the management of antineutrophil cytoplasmic antibody–associated vasculitis, including granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis. These guidelines are put forth by the ACR and the Vasculitis Foundation as benchmark guidance to assist health care professionals in managing AAV.  

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Slow Steroid Tapering Succeeds in SLE

d MedPage Today

Gradual withdrawal of glucocorticoids was successful among patients with systemic lupus erythematosus (SLE) after 2 years of clinically quiescent disease, without an increased likelihood of flares, Canadian researchers reported.

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fetus,defect,baby,malformation

Potential Birth Defects with Hydroxychloroquine

d Jack Cush, MD

Hydroxychloroquine (HCQ) is one of the safest meds used in rheumatology, but there is new claims data suggesting a small increase in the risk of malformations associated with first-trimester HCQ use.

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back, LBP, spine, AS

Is Pre-Clinical Spondyloarthritis a Real Risk?

d Jack Cush, MD

A study of first-degree relatives (FDRs) of HLA-B27-positive axial spondyloarthritis (axSpA) patients shows clinical or imaging features of spondyloarthritis in up to 32% subjects, regardless of HLA-B27 status.

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Rare Myocarditis Risk following COVID-19 Vaccine

d CDC/MMWR

MMWR review of the risk of myocarditis and pericarditis reports a June 23, 2021 recommendation by the Advisory Committee on Immunization Practices that the benefits of COVID-19 vaccination clearly outweighed the risks of myocarditis after vaccination. 

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2020 saw record numbers of drug overdose deaths (93,331) a big increase (29.4%) over 2019, according to CDC & Natl Center Health Statistics (NCHS). Overdose deaths 69,710 primarily fentanyl, Rx pain meds and cocaine https://t.co/K9GlWAeALS

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Telehealth has declined but still much higher than pre-pandemic. CMS is proposing to extend Medicare coverage of certain telehealth services until the end of 2023. A -3.75% payment adjustment has been proposed & will be debated https://t.co/ETK74d9uGT

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Metanalysis shows that Ustekinumab (effective in IBD) may also control skin and joint extra-intestinal manifestations. Despite no effect on spondylitis, UST was effective at PSO, PsA, pyoderma gangrenosum, E nodosum stomatitis and uveitis https://t.co/NPxJdYUM7I

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Systematic review of muscle relaxants use in nonspecific low back pain shows uncertain, small, but not clinically important reductions in pain in the 1st 2weeks. Muscle relaxants are 3rd most common Rx for LBP (30 mill Rx in 2016)(49 trials >6505 pts) https://t.co/zN5rvBF1HO

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Norwegian pre-pregnancy registry studied 274 axial SpA and 317 RA women. Longer time to pregnancy (TTP) seen in 21% (32% TTP >12 mos). Longer TTP associated with older age, nulliparity, and longer disease duration. https://t.co/kT7fqnhTkw https://t.co/8qC1N2K7vI

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NHANES survey study shows adult psoriasis in the US was 3.0% (7.5 million adults). Psoriasis was most common in non-Hispanic White individuals, and the prevalence of psoriasis has not significantly changed since 2003 in the US. https://t.co/3yrlPu1GGi

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Rare Myocarditis Risk following COVID-19 Vaccine https://t.co/Q9QGhTTKvC https://t.co/dTOR9sZ3iP

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FDA & CDC joint statement: Those who are "fully vaccinated do not need a booster shot at this time". People who are not vaccinated remain at risk. Virtually all COVID-19 hospitalizations and deaths are among those who are unvaccinated. https://t.co/miqEJE4wgC

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Doximity Telemedicine report estimates 20% of US medical visits via telehealth; ~$29 billion of medical services in 2020. Top 10 telemedicine specialites: 1 Endocrinology 2 Rheumatology 3 GI 4 Renal 5 Cardiology 6 GU 7 Neuro 8 Geriatrics 9 Hem/Onc 10 Pulm https://t.co/a8WBEHmNzs

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6/24/21 FDA has granted emergency use authorization (EUA) for Actemra (tocilizumab) us in treating hospitalized COVID-19 (adults and kids) patients on steroids and who require, supplemental oxygen, mechanical ventilation, or ECMO https://t.co/YAVfbykcti

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Modest IL-6 mAb benefit w/ COVID. Metanalysis 27 RCTs & 10 930 hosp COVID pts shows 28D all-cause mortality lower w/ IL-6i (vs usual care.PBO) (OR 0.86), better w/ steroids (OR 0.78). Mortality 22% w/ IL-6i vs 25% usual care. https://t.co/rTLjGMMe2g https://t.co/nz1sbKlk2E

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How should anti-IL-6 mAb therapy be used in COVID-19 infection? 1. w/ corticosteroids 2. Early/severe pts: 3. Hospitalized on O2, but not ventilated https://t.co/S6DT0Fsjow https://t.co/oeM8EgZk8n

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Lit review shows there are few good studies patients on the management of hospitalised gout pts. No studies have tested strategies designed to prevent gout re-admissions/flares. Better prospective studies of ULT use by hosp gout is needed https://t.co/OVkMTepa5y

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HCQ prolongs SLE survival. Case–control study 6241 incident SLE pts compared 290 SLE dead to 502 alive controls. HCQ reduced all-cause mortality by 50% (aOR 0.50; .30–0.82) but HCQ stoppers had incr mortality (aOR 2.47) - sick stopper effect? https://t.co/JIeTJaDVPk

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185 Lupus pts undergoing renal transplant for ESKD saw good outcomes. Pt survival = 88%, 82%, 78% & 67% (@ 1,3,5,10 yrs). Graft survival was 93%, 89%, 87% & 89% (@ 1,3,5,10 yrs). Immunosuppressive use was protective & only 2 cases of recurrent LN seen https://t.co/xgFYskeX0a

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