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Low Risk of COVID-19 Pneumonia in Rheumatic Patients

d Jack Cush, MD

A current letter in the Annals of Rheumatic Disease details the rheumatic disease patient cohort outcomes from the University of Siena, Italy showing only 2 cases of COVID-19 among 859 patients treated with tsDMARDs and bDMARDs.

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Again, Antimalarial Use Fails to Benefit COVID

d Jack Cush, MD

Today Lancet reported the results of another retrospective trial showing that hydroxychloroquine or chloroquine, alone or with a macrolide antibioitic, offered no additional benefits to COVID-19 patients, but was associated with higher rates of mortality and arrhythmia.

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RheumNow Podcast - Preaching to the Choir (5.22.20)

d Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.

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Outcomes of Critically-Ill COVID Patients in NYC

d Jack Cush, MD

Lancet has reported COVID outcomes from NewYork-Presbyterian hospitals in NYC during March 2020 showing high rates of hospitalization, ICU admission, mechanical ventilation and death. 

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No Certain Link between Biologics and Melanoma Risk

d Jack Cush, MD

A review of available data fails to show an increased risk of melanoma in IMID (inflammatory bowel disease, rheumatoid arthritis, and psoriasis) patients treated with systemic biologic therapies.  

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Anti-TNF and CNS Events: The Link Strengthens

d RheumNow

Patients with autoimmune diseases who were treated with tumor necrosis factor (TNF) inhibitors had an increased risk of developing inflammatory central nervous system (CNS) adverse events, a nested case-control study found.

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Aicardi-Goutières syndr - inherited early-onset disorders w/ CNS decline & autoimmunity; developmental decline, encephalopathy, weakness, spasticity, autoimmunity autoantibodies, Chilblains, gene defects inTREX1, RNASEH2A, RNASEH2B, RNASEH2C, SAMHD1 https://t.co/p1W5uHVXmQ

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Dr. John Cush RheumNow ( View Tweet)

14 pts refractory AOSD pts (Yamaguchi+) showed a good response to usual doses of tofacitinib. 7/14 complete remission, 6/14 partial remission & 1 relapse w/ pred reduction. May work by reducing reducing IL-6, IL-10, IFN-γ, IFN-α, GM-CSF, neutrophils. https://t.co/rUNoxJdDi5

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Dr. John Cush RheumNow ( View Tweet)

Case report in Annals Internal Med shows efficacy of tocilizumab in Cytokine Storm Syndrome; 51-yo renal transplant COVID+ pt developed multiorgan failure, cytopenias, CRP 262 mg/L, ferritin 52005 - failed MMF, DEX, tacrolimus- turned around w/ TCZ 8mg/kg https://t.co/MMNQGB9SA7

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Dr. John Cush RheumNow ( View Tweet)

Genetic study of 57 systemic JIA children finds presence of MEFV variant p.M694V/I was a risk factor for sJIA (OR: 7.13) https://t.co/TL6WisMQo8 Other studies have shown ~31% of Still's patients at lease 1 genetic variant for periodic fever syndromes. https://t.co/8ppovEw2kt

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Dr. John Cush RheumNow ( View Tweet)

Metformin reduces RA risk in Women - Population study of 2.3 million, found 113749 starting metformin (1998-2014); 558 developed new RA. Adherence (PDC 40–59%) predicted lower adjusted hazard ratio = 0.62, moreso in women on 2550+ qd https://t.co/z6AWWlBpa2

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Dr. John Cush RheumNow ( View Tweet)

Governor Cuomo cites NY study showing front line workers have lower rates of COVID positivity - Suggests that WEARING PPE's Works! (NY population 20% vs 14% transit workers & 12% healthcare workers & 10.5% NYPD and 17% FDNY/EMTs) https://t.co/pfC9rKHKVz

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Dr. John Cush RheumNow ( View Tweet)

Review of Rheumatic Sxs with Immune checkpoint inhibitors - Common are inflammatory arthritis, PMR & myositis. Non-MSK Sxs include sicca, vasculitides and sarcoidosis. SLE and scleroderma are extremely rare. Majority can be Rx w/ steroids. https://t.co/hku5L7hypo

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Dr. John Cush RheumNow ( View Tweet)

NEJM report shows that hospitalizations for acute MI are down ~-40% with the onset of the COVID Crisis (data from Kaiser N. California) - Will the shutdown/lockdown lead to other necessary services or hospital admissions? https://t.co/onpFhsDE9Z

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Dr. John Cush RheumNow ( View Tweet)

A patient service Video - How to Manage your Arthritis Medications (in the time of COVID) - View the video here: https://t.co/hWW0h8wCZn or listen to the podcast on iTunes or here>> https://t.co/8wV4V2pYY5 https://t.co/SldbyCBDeI

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Dr. John Cush RheumNow ( View Tweet)
JAK inhibr safety review - Meta-analysis shows a significant 57% increase in risk of H. zoster with JAKi (RR 1.57; 1.04-2.37). Data from 82 studies, 66,159 pts w/ RA, IBD, Pso, PsA, AS. Rates of SIE=2.81/100PY and HZ=2.67/100 PY. No increase in mortality https://t.co/Tyb0VDlJOT

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Dr. John Cush RheumNow ( View Tweet)

Specialties w/ highest percentage of women? OBGYN 58%, Peds 59%, Rheumatology 54%, Derm 49%, Endocrine 45%, Family medicine 43%, Psych 43%, Pathology 40%, IM 36%, ID 36%; yet men (375K) earn 31% more than women ($286K) as specialists https://t.co/oNTwm8vRFq

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Dr. John Cush RheumNow ( View Tweet)

Metanalysis of 9 clinical trials and 1014 patients fails to show added value of subacromial decompression surgery (for subacromial pain syndrome) over sham surgery or exercise but a small risk of harm from having surgery. https://t.co/ndJpGiLV3V

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Dr. John Cush RheumNow ( View Tweet)

RA is associated with increased risk of heart failure (HF). Vanderbilt Univ EHR study compared 9889 RA pts vs 9889 matched non-autoimmune pts - RA had 21% greater risk of HF. HF assoc w/ higher CRP, Artemin and MTX assoc w/ 25% lower risk (P=0.021) https://t.co/cm5qZXZAdO

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Dr. John Cush RheumNow ( View Tweet)

Review of 525 critically ill, rheumatic dz pts (25% vasculitis, 21%SLE, 19% RA, 9% PSS, 5% myositis). ICU adm for shock (41%), respiratory failure (32%), infx (39%) Dz flares (35%). Hospital mortality was 31% predicted by age, steroids, mech ventilation. https://t.co/xcw8xU9hPl

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Dr. John Cush RheumNow ( View Tweet)

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