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DLE discoid lupus

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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Increased Lupus Anticoagulant Activity in COVID-19 Infection

d Jack Cush, MD

JAMA Network Open reports that after adjusting for inflammation, lupus anticoagulant (LA) is significantly increased (positive) in COVID-19 patients and that LA positivity was associated with incidence risk of thrombotic events.

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Is Mortality Improving in Systemic Sclerosis?

d Jack Cush, MD

Systemic sclerosis (SSc) is a progressive autoimmune disorder that causes premature death, usually from lung, GI, or renal disease. While treatment efforts have been frustrating advances in care may have altered the risk of death according to population data showing that while SSc mortality increased from 1968 through 2000, it has declined since 2001.

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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)

Comparison of three different definitions of low disease activity in patients with systemic lupus erythematosus and their prognostic utilities https://t.co/UKEvGrLbfw #SLE #LLDAS LLDAS - less damage fewer flares better function

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Peter Nash drpnash ( View Tweet)

NJ study of 764 ICU COVID-19 pts, 210 (27%) received tocilizumab. TCZ treated patients had a lower death rate (49% vs 61%) (HR 0·64, 95% CI 0·47–0·87; p=0·004). Similar results seen in those requiring mechanical vent. or CRP >15 mg/dL https://t.co/idZTDunG1a

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Dr. John Cush RheumNow ( View Tweet)

NY Times article about a "guy and aching legs". 48 yrs old w/ myalgias, wt loss, SOB, sinusitis, high inflammatory markers, pulmonary infiltrates, microscopic hematuria, red & swollen ears; but no fever/chills. You're a rheumatologist, you know the Dx. https://t.co/fbrRMNA5u4 https://t.co/JFOcM0MBxB

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Dr. John Cush RheumNow ( View Tweet)

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