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Canakinumab Tapering in Still's Disease

d Jack Cush, MD

You can reduce - but not stop - canakinumab therapy in patients who are in complete clinical remission in children with systemic juvenile idiopathic arthritis.

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Are Women in Rheumatology Closing the Gap?

d Jack Cush, MD

"Fierce, Formidable and Phenomenal" was the tag line used to introduce Vice-Presidential candidate, Kamala Harris. Her introduction followed a review of the increasing role of women in voting, society and politics in America. Has the same been realized by women in academic medicine and rheumatology? 

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New Criteria for Discoid Lupus

d Jack Cush, MD

JAMA Dermatology has proposed an initial validation of classification criteria for discoid lupus erythematosus (DLE), primarily for research purposes, but with clinical applicatility.

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Filgotinib Decision Delayed by FDA

d Jack Cush, MD

On August 18th, Gilead and Galapagos received a complete response letter from the FDA, which will delay consideration of filgotinib for the treatment of moderate-to-severe RA.

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Upadacitinib is Superior to Methotrexate in Early RA

d Jack Cush, MD

In a head-to-head trial against methotrexate, JAK1 inhibition with upadacitinib was shown to be more effective in early, DMARD-naive RA patients. Here are the primary results.

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ACP/AAFP Guidelines on Managing Musculoskeletal Pain

d RheumNow

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line therapy in a new guideline for treating acute, non-low back pain from musculoskeletal injuries in outpatient settings.

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Mayo clinic: Theres a delay in diagnosing Seronegative RA - 1st joint swelling to diagnosis of RA was 187 days for seroneg vs 11 days for seropositive patients (P<.001). Seronegative RA less likely to achieve remission (28% vs 50% at 5 years) (P=.007) https://t.co/Hgewjmt1CL

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Dr. John Cush RheumNow ( View Tweet)

Study of 2 Canadian centers finds amongst 2095 patients taking biologics for #Psoriasis, 23 (1.1%) stopped their biologic for "COVID-19 related concerns". 5/23 restarted biologic for PSO flares. This included TNFi, inhibitors of IL17, IL12/23, IL23 https://t.co/gjSX4P0LMK

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Dr. John Cush RheumNow ( View Tweet)

COVID-19 child case count now over 400,000 https://t.co/bRYvZ5AoYt https://t.co/JhEbvncUbr

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Dr. John Cush RheumNow ( View Tweet)
Are there delays in Dx-ing RA? 2019 UK NHS study shows median delays from 1st Sx to seeing a rheumatologist was 27 weeks, with 20% seen w/in 1st 3 mos. Includes a patient delay (5.4 wks), GP delay (6.9 wks) & hospital delay (4.7 wks) https://t.co/vwNALZKkiR

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Dr. John Cush RheumNow ( View Tweet)

Study from 3 NYC lupus clinics compares flare rates in older SLE stopping HCQ (n 26) vs continuing HCQ (N 32) with no difference in lupus flare rates (19 vs 16%). Reasons for stopping HCQ: retinal toxicity 42%, pt preference 35%, adverse effects 15% https://t.co/7cVZbfJK68

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Dr. John Cush RheumNow ( View Tweet)

Filgotinib Decision Delayed by FDA. Instead of being the next approved RA drug, the FDA issued a complete response letter; citing concerns over sperm studies and the risk/benefit behind the 200 mg dose. Delay till 2021? 2022? https://t.co/6MHiGtOxCM

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Dr. John Cush RheumNow ( View Tweet)

Antibiotic use is associated with a higher rate of IBD (aOR 1.88; 1·79–1·98) based on a prospective case-control study from the Karolinska that compared 23,982 new IBD pts w/ 117,827 matched controls followed over 10 years. https://t.co/FbCVU5GEFo

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Dr. John Cush RheumNow ( View Tweet)

Forward study of 18,754 RA patients who experienced 1,801 CVD events and found CVD risk reduction with TNFi (HR 0.82 [95% CI 0.72-0.94]) and abatacept (HR 0.50 [95% CI 0.30-0.83]) compared to csDMARDs over & above MTX alone (use vs. non-use: HR 0.82) https://t.co/YVfKWjkvxU

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Dr. John Cush RheumNow ( View Tweet)

Gilead/Galapagos gets a setback for filgotinib, its JAK1 inhib, that was poised to be the next approved RA drug by FDA. Instead the FDA issued a complete response letter; citing concerns over sperm studies (MANTA, MANTA-RAy) & 200 mg dose. Delay till 2021? https://t.co/H0rLjOMXq8 https://t.co/Rk8PXblfPO

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Dr. John Cush RheumNow ( View Tweet)
Single center prospective study of 50 severe SLE pts (age 31 - 28 yrs) Rx with either mycophenolate or IV CTX. Ovarian dysfunction was short lived and subclinical w/ CTX. No premature ovarian failure seen w/ CTX. No ovarian dysfunction w/ MMF. https://t.co/qvc3i6TNB1

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Dr. John Cush RheumNow ( View Tweet)

Study 137 GCA pts (1993 -2015) - those w/ diabetes were less likely to have (+)Tem artery Bx & more likely to relapse. ARB Rx prior to diagnosis showed greater success discontinuing glucocorticoids. Statin therapy did not alter clinical outcomes of GCA.https://t.co/YUjSsDCArW

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Dr. John Cush RheumNow ( View Tweet)

Preprint analyses of RCTs and 11 nonRCTs showed JAK-inhibitor use in COVID-19 reduced mortality (OR 0.12; 0.03-0.39) & ICU admission (OR 0.05; 0.01-0.26). Similarly Type I interferon Rx also significantly reduced mortality (OR, 0.19; 0.04-0.85, p=0.03) https://t.co/NqKCGzcfwF

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Dr. John Cush RheumNow ( View Tweet)

Diabetes is a risk factor for COVID mortality; yet Metformin dramatically lowers mortality in a preprint, unreviewed paper - retrospective EHR review of 25,326 subjects COVID tested at UAB; metformin signif reduced mortality risk in DM w/ COVID (OR 0.33) https://t.co/DvZ4b3al1Y

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Dr. John Cush RheumNow ( View Tweet)

Highlight of this morning's telephone clinic: Instead of the usual goodbye, patient says 🗨️You do a good job! This means a lot to all of us trying our best to look after patients in this trying times😊 Thank you for your kindness!😀

Dr Ai Lyn Tan DrAiLynTan ( View Tweet)

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