Efficacy of Subsequent b/tsDMARD Use in Rheumatoid Arthritis

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Analysis of rheumatoid arthritis (RA) data from the British Society for Rheumatology Biologics Register shows that, even after failing three or more biologic or targeted synthetic DMARDs (b/tsDMARDs), patients may continue to benefit from repeated trials of unused b/tsDMARDs. 

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RheumNow Podcast – What You Do For & What You Do To the Patient (4.8.2022)

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Dr. Jack Cush reviews the news and journal articles from the past week and discusses the use of fibroscan in RA, steroid hip injections in OA and famous quotes from a famous cardiologist.

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Ask Cush Anything! Have a rheumatology question or case for Dr. Cush? Submit it here and we may feature it on an upcoming podcast. https://t.co/KgPIeScthr https://t.co/nk4re9mlcH

Tocilizumab Works Best in Non-Mechanical Ventilated COVID-19 Patients

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JAMA has published a meta-analysis of 15 studies of hospitalized patients with COVID-19 treated with tocilizumab and corticosteroids, showing that a clinically meaningful mortality benefit from tocilizumab (and steroids) was best seen in those not requiring invasive mechanical ventilation (IMV).

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ACR Updates Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With COVID

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A Task Force from the ACR has provided an updated (version 3) guidance for the diagnosis and management of Multisystem Inflammatory Syndrome in Children (MIS-C), a COVID related condition characterized by fever, inflammation, and multiorgan dysfunction.

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Yesterdays RheumNow Live Vote survey of 170 Rheumatologists, showed that 74-80% of Rheums are reporting shortages of IV tocilizumab (Actemra) -- TCZ listed by FDA site as a drug in shortage largely due to demand, Genentech says there is supply https://t.co/YAvR4vbVHV

RheumNow Live Vote survey of 159 Rheumatologists shows, because of the Actemra Shortage, Rheums are either changing to subQ TCZ (45%), changing to other biologic or tsDMARD (33%) or waiting for resupply of TCZ (21%). https://t.co/zNeyRsYClD @CreakyJoints https://t.co/aGYO2fqw7J

UTSW Rheum Grand Rounds - Dr. Nigrovic shows the efficacy of long acting IL-1 inhibition (canakinumab) and IL-6 (tocilizumab) in systemic JIA patients @UTSWRheum https://t.co/XdG8pAq1c4

2021 Rheumatology Year in Review

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Our top 10 list of advances, game-changers, worries and those better medical practices that evolved during 2021.

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Clinical Practice Guidelines for Multisystem Inflammatory Syndrome in Children

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Multisystem inflammatory syndrome in children (MIS-C) is new and serious complication of COVID-19 that preferentially affects adolescents. A review of proposed management guidelines is compiled in this report, suggesting a unified approach to therapeutic management of MIS-C.

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Best of 2021:Synovial Tissue Signature Guiding Targeted IL-6 Therapy in RA RNA sequencing-based stratification of rheumatoid arthritis synovial tissue showed stronger associations with clinical responses compared with histopathological classification. https://t.co/SD8ceTmbnm https://t.co/D98XBLj1YY

Serious Adverse Events Associated with Tocilizumab in COVID-19 Patients

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Safety analysis of over 1000 adverse events associated with the use of tocilizumab in the treatment of COVID‐19 infection shows both rare expected and some unexpected AE.

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When to Stop Biologics in Systemic JIA?

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Systemic onset juvenile idiopathic arthritis (sJIA) is a dramatic onset inflammatory condition marked by spiking fevers, intermittent rash, polyarthritis and a host of other hyperinflammatory manifestations.

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Cytokine Inhibitor Lung Disease in Still's Linked to HLA-DRB1 Alleles

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Pulmonary complications in the setting of Still's disease (juvenile and adult) has seldom but consistently been reported, including reports of pneumonitis, pulmonary hypertension and a severe or fatal lung disease, often associated with hypersensitivity to anticytokine therapy. A multicenter study reports that drug hypersensitivity and pulmonary reactions in Still's patients receiving IL-1 or IL-6 inhibitors is strongly associated with HLA-DRB1*15 haplotypes.

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The Influence of Obesity on Choice of Biologic in Rheumatoid Arthritis

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In rheumatoid arthritis we have a wide range of options available to us when we progress to a biologic treatment option. We have little to differentiate between these agents based on the clinical trials.

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Top vasculitis takeaways from ACR 2021

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There were several hot topics at ACR21. Here I concentrate on top abstracts in vasculitis. 

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FDA Update: 3 trials showing Efficacy of Tocilizumab in COVID 19: 1. RECOVERY - lower mortality 2. EMPACTA - Less progression to mech vent or death 3. REMDACTA & COVACTA - did not meet primary endpoints (but not contradictory) FDA Metanalysis of all 4 trials #ACR21 EUA 6/21 https://t.co/9yHu87KGej

TCZ in GCA: one disadvantage is that you can't use CRP+/- ESR for flares Mavrilimumab in GCA: - CRP/ESR consistently go up with symptomatic flares - CRP/ESR up less (cf. placebo), in the absence of Sx flares More signal, less noise. phase 2 post-hoc #ACR21 ABST1401 @RheumNow https://t.co/c0lMJMcQv0

NORD-STAR Trial: outcomes in tx-naïve, early RA pts after 48w of csDMARDs+GC vs bDMARD (ABAtacept, CerToliZumab, or ToCiluZumab)+MTX ➡️ Superior CDAI remission rates w/ ABA+MTX & CZP+MTX but not TCZ+MTX vs csDMARD+GC ➡️Imaging progression low in all Abst#0825 #ACR21 @RheumNow https://t.co/QaFIF4WNEG