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Oral Dysbiosis May Antedate Rheumatoid Arthritis

d Jack Cush, MD

A study of oral microbiome in anti-cyclic citrullinated peptide (anti-CCP) positive at-risk individuals without synovitis (CCP+at risk) shows dysbiotic subgingival microbiomes and increased abundance of P. gingivalis compared with controls.

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Systemic Steroids Reduce Mortality in COVID-19

d Jack Cush, MD

JAMA Internal Medicine reports an analysis of COVID-19 clinical trials showing that critically ill patients with COVID-19 treated with systemic corticosteroids have an overall lower mortality rate.

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2020 Nobel Prize in Medicine Goes to the Discovery of Hepatitis C

d Jack Cush, MD

The Nobel Assembly at Karolinska Institutet has awarded the 2020 Nobel Prize in Physiology or Medicine jointly to Harvey J. Alter, Michael Houghton and Charles M. Rice for the discovery of Hepatitis C virus. These three scientists made a decisive contribution to the fight against blood-borne hepatitis C, a major global health problem that causes cirrhosis and liver cancer in people around the world.

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RheumNow Podcast – Function Follows Form (10.2.20)

d Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com. Regulatory approvals, update on global rheumatology alliance, smoking and psoriasis, gabapentin let down and defining difficult RA.

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Defining Difficult Rheumatoid Arthritis

d Jack Cush, MD

‘Difficult-to-treat RA’ is an oft-used term that carries various clinical qualities and therapeutic disappointments. A EULAR Task Force was established to develop recommendations for the management of difficult-to-treat rheumatoid arthritis and as a first step, have put forth their definition of this rheumatoid arthritis (RA) subset.

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Low Risk of Latent TB with Secukinumab

d Jack Cush, MD

TB reactivation and latent tuberculosis infection (LTBI) are warned against with biologic agents, especially TNF inhibitors; yet clinical trial data now shows that the risk of LTBI with IL-17 inhibition via secukinumab is uncommon.

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Classic bony erosion of gout is a punched-out, lytic lesion w/ a sclerotic margin & overhanging edge -- called a G sign, rat-bite erosion or the Martel sign, named after famed U MI radiologist Dr. William Martel who 1st described this gouty erosion in 1968 https://t.co/WJJUnjnnfl

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European collaborative study of eosinophilic granulomatosis with polyangiitis (EGPA) Rx w/ RTX, mepolizumab or omalizumab (OMA). MEP > RTX > OMA. Mepolizumab was highly effective in GC‐dependent asthma. https://t.co/fi8pjnJO03

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Swedish population study of psoriasis pts Rx w/ secukinumab (848) or ustekinumab (1107) showed slightly more respiratory infx & UTI (HR 1.22), w/ no difference in hospital treated severe respiratory, UTI (HR 0.96) or candidiasis (HR 1.80) https://t.co/yIRubED6VX

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https://t.co/0bh6Mh2pKP
Adam Cifu adamcifu ( View Tweet)
"Prednisone >30 mg/day for > 4 weeks, patients should be on PJP prophylaxis." Image shows when to start/stop PJP prophylaxis Dr. Kevin Winthrop on Risks/Prevention of OI @UTSWRheum Grand Rounds @rheumnow https://t.co/nXuWYRxbgy
k dao KDAO2011 ( View Tweet)
Utilization study of 1031 tofacitinib vs 17,803 biologic DMARD Rx-patients shows 14% higher discontinuations w/ TOFA (HR 1.14), but pts who switched to tofacitinib from a bDMARD had longer persistence than pts switched to another bDMARD (HR 0.90) https://t.co/5cqloTTbjb

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Hellenic reigstry of 385 RA pts on DMARDs finds that, compared to remission or LDAS - those in persistent moderated disease activity had 50-80% more serious adverse events. https://t.co/3JA3VaMxeO

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Among 406 axial SpA patients in the DESIR Cohort smoking was associated with MRI‐SI joint after 5 years of axial SpA patients and only in blue‐collar job or low education levels; suggesting a possible role for mechanical stress axial SpA. https://t.co/fcDjesdF8K

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Danish comparison of 15K RA, 301K Diabetes adn 75K gen population; RA assoc w/ increased risk of CHF (HR 1.51), MI (HR 1.58), stroke (HR 1.22) vs gen. population; but RA had 20-40% lower CHF/MI/CVA than diabetes pts (who had highest 10 yr mortality). https://t.co/R20EUPAlML

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Dr. John Cush RheumNow ( View Tweet)

RheumNow Podcast is up! COVID effects on Rheum; drug approvals, Difficult RA, SLE complement & remission. Watch it here> https://t.co/490T6k1ytk or listen to the podcast on iTunes> https://t.co/FHJv01AAbC OR on souncloud> https://t.co/dAJ0827c3B

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Predictors of Remission in SLE? metanalysis of 17270 SLE pts; 42-88% achieved remission x 1 yr, & 21-70% for 5 yrs. Remission assoc w/ older age , lower Dz activity & No major organ involvement; positive serologies negatively associated w/ remission https://t.co/2aoGgnY6kw

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FDA Issues Final Guidance for Labeling Recommendations on Breast Implants, after review of data & commentary. Implants have been assoc w/anaplastic large cell lymphoma & breast implant illness (BII) w/ fatigue, “brain fog,” rash, myalgia, arthralgia. . https://t.co/HozSCRx4JH

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Latest data Global Rheumatology Alliance COVID Registry -2121 pts (40% RA, 17% SLE, 9% PsA), 64% on DMARDs, 33% biologics, 5% JAKi, 34% steroid,27% HCQ, with only 7.6 deaths and 39% hospitalized and 81% resolved infection. https://t.co/g0w4QZHmRl

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Swiss cohort of 666 axSpA, RA & PsA pts seen before, during & after COVID; consults dropped 52%, remote visits increased 129%, & non-compliance slightly increased during COVID (axSpA 20% vs 13% before, p=0.003); but no incr in flares(<15%) or Dz activity https://t.co/lWb7WCwGbN

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