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Fighting Hydroxychloroquine Misinformation

d Jack Cush, MD

JAMA Internal Medicine has posted an Editor's note on the use of hydroxychloroquine for COVID-19; noting the sequence of dysfunction since the president promoted its use on March 21, 2020, when he said “What do you have to lose? I’ll say it again: What do you have to lose? Take it.”.

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More Rheumatology Fellow Advice from the Mentors

d Jack Cush, MD

If you’re looking for some great advice to consider or rebuke, here is the generous guidance of nearly two dozen leaders in rheumatology who sincerely offer you their wisdom and best wishes.

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Uric Acid Targeting in Gout Management

d Jack Cush, MD

A study from 2 gout clinics implementing different treatment strategies has shown that a treatment strategy that aims to strictly achieve low uric acid (UA) results in a higher a rate of targetd serum UA lowering and less gout flares.

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RheumNow Podcast - Top 13 Rheumatology Centers (7-31-20)

d Jack Cush, MD

Dr. Jack Cush reviews the news and TOP 13 list of Best Rheumatology Hospitals.

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Virtual Video Joint Exam Pearl #5: Its easier to see gouty Tophi and rheumatoid nodules than nail changes of PsA or subtle rashes. For Rashes and oral lesions its BEST to have the patient take multiple pix with the cell phone and send them in by EMR or Email.

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Virtual Video Joint Exam Pearl #4: Professor Paul Emery was right! THe MCP squeeze (done by the patient) and MTP squeeze is fairly predictive of RA/inflammatory arthritis AND outperforms the "Finger" (distal hand) squeeze. Hence the MCP/MTP is my main squeeze!

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Virtual Video Joint Exam Pearl #3: Despite cam setups designed to do upper extremity exams, patients can easily move cams and limbs to examine spinal movt, gait, knee, ankle and foot problems with great accuracy.

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Virtual Video Joint Exam Pearl #2 : Despite being in my video on the Virtual joint exam; asking the patient to show you their fist (AKA fist bump the camera) to see potential MCP swelling has thus far been a largely useless maneuver...but it looks good on cam...

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Virtual Video Joint Exam Pearl #1: pain elicited by cervical lateral bending (in someone w/ otherwise normal Cx ROM) is highly correlated with Tender trigger points in the neck region (hence #FM)

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After a career of doing over 90,000 joint exams, Iv now done about 140 VIRTUAL Video joint exams and while I think Im pretty good at it....Im really a burgeoning amateur. Never the less here are my Virtual Joint Exam Pearls (thus far....)

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Retrospective study of 20 RA pts w/ resolved hepatitis B (HBcAb+; HBsAg neg). 16/20 were Rx w/ tocilizumab & 8/20 w/ tofacitinib (nearly all HBsAb+). 25% recv antiviral Rx w/in 2 yrs of TCZ or Tofa; 6 had mild LFT elevations & No one had HBV reactivation https://t.co/EeFXo7mLhQ

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A large Latin American SLE cohort was studied; 66 (5.6%) had familial SLE & 1110 (94.4%) sporadic SLE: Familial SLE was more often associated with discoid LE (OR 1.97) & CNS dz (OR 1.65), more MSK Dz. No group difference in Disease activity https://t.co/4Lak2q4QJn

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Systematic literature finds a connection between ankylosing spondylitis (AS) and dementia (RR 1.19 [95% CI 1.01‐1.41]). From a total of 6562 articles reviewed, only 4 met criteria - analysis included 156418 pts. Cause? inflammation, inactivity?

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The RheumNow Podcast is up - Top 13 Rheumatology Centers in the US; anakinra & colchicine in COVID, unload the loading dose, CB2 in Scleroderma. Watch it here>> https://t.co/5LIIi7Pwg1 or listen to the podcast here>> https://t.co/5LIIi7Pwg1

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Spanish registry of 3679 SLE pts finds 13.6% had polyautoimmunity (SLE plus another autoimmune Dz), Dx as thyroiditis (8%), Sjogrens (14%) secondary APS (14%). Incr odds in female, w/ ILD, Raynauds, SSA/SSB/RNP but LESS w/ antimalarial drugs [0.50] https://t.co/duTqepvmLR

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Based on a small number of studies (n = 5), there is little evidence to support the superiority (efficacy & safety) of Loading dose regimens when starting biologic (abatacept, certolizumab and secukinumab) therapy. https://t.co/0lNUzTFIOK

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Sandoz rituximab biosimilar(SDZ-RTX; Rixathon) compared with reference rituximab (Ref-RTX) and shown to have same efficacy outcomes (DAS28 Remission, ACR20/50/70, CDAi/SDAI, HAQ), B cell depletion levels, adverse events & low level antidrug Abs https://t.co/0XWQs23Xcv

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Fracture risk & prevalence of osteoporosis is elevated in patients with idiopathic inflammatory myopathies: cross-sectional comparison of 52 myositis and 43 RA pts. OP Prevalence higher in the myositis group (13.5% v 7%) but equal fracture risk (68 v 75%) https://t.co/XT6O9HoqdH

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Safety & efficacy of rituximab in Older RA (>65; n=97) vs younger (<65yrs; n=276) showed no difference in drug survival over 2 yrs (72% vs 74%)or SDAI activity. BUT.. there were more SIE (14.2 vs 6.6/100 PY) & pneumonia (10.7 vs 5.1/100 PY) in older pts https://t.co/dxqPg2fOlV

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FDA recommends health care professionals discuss naloxone with all patients when prescribing opioid pain relievers or medicines to treat opioid use disorder. Naloxone can be administered(+/- medical training) to help reduce opioid overdose deaths https://t.co/9B0hPhOm57

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