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RheumNow Podcast – Rheumatologist Smoke-Enders (10.22.2021)

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Jack Cush, MD

Oct 22, 2021

Today I have a few questions: Is tramadol really a weak narcotic? Should we really still be doing placebo-controlled trials? What are we going to do about our patients who are smokers? This and more, in this week's review of the news and journal articles.

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Smoking Impairs Methotrexate Efficacy

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Jack Cush, MD

Oct 21, 2021

The Journal of Rheumatology reports that current smoking significantly reduces the clinical efficacy of methotrexate (MTX)-based therapy, as studied in an early rheumatoid arthritis (RA) cohort.

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Heart Failure in RA: Inflammation Matters

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MedPage Today

Oct 19, 2021

Patients with rheumatoid arthritis (RA) who had high levels of inflammation at baseline were at increased risk for later heart failure, a large cohort study found.

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Is It OK to Continue TNF Inhibitors with COVID-19 Infection?

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Jack Cush, MD

Oct 19, 2021

Registry level data of patients with immune-mediated inflammatory diseases (IMIDs) diagnosed with COVID-19 should continue their TNF inhibitor (TNFi) therapy as such patients were less likely to experience adverse COVID-19 outcomes (compared to other immunomodulatory treatments).

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Risk of Herpes zoster from upadacitinib RCTs: UPA > ADA > ADA+MTX > MTX. 5306 RA pts, HZ/100 Pt-Yrs was 0.8 MTX mono; 1.1 ADA+MTX; 3.0 UPA 15 mg and 5.3 UPA 30 mg. 71% of UP HZ cases involved a single dermatome. Higher risk w/ prior HZ & Asians https://t.co/0QUvXmFrJ3

Links:

https://bit.ly/3vlDLJj

Dr. John Cush RheumNow ( View Tweet)

Oct 18, 2021

ICYMI: Hepatitis B Reactivation with Rituximab and Abatacept A serologic study of rheumatoid arthritis patients shows that HBV reactivation is seen with rituximab, and less so with abatacept, especially in patients without HBsAb positivity. https://t.co/l1qCrWCyZd #RheumNow https://t.co/EUoWt9xGdB

Links:

https://bit.ly/3aBItc0

Dr. John Cush RheumNow ( View Tweet)

Oct 16, 2021

ICYMI: Triple DMARD Rx - MSH vs MLH (Lef). 136 active #RA pts given OL MTX/SSZ/HCQ vs MTX/HCQ/LEF. Equal efficacy (EULAR-Good) was seen at wk 12 (54% vs 59%) and wk 24 (65% vs 62%) - hence LEF substitution was noninferior. https://t.co/F5CGj0w7Bh https://t.co/OuDMgNIKTA

Links:

https://bit.ly/3AAQtou

Dr. John Cush RheumNow ( View Tweet)

Oct 16, 2021

Are You a High or Low Glucocorticoid Prescriber?

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Jack Cush, MD

Oct 15, 2021

A recent analysis shows thta glucocorticoids (GCs), usually recommended for short-term use in rheumatoid arthritis (RA), are variably used by rheumatologists, and that provider preference is a strong predictors of long-term glucocorticoid use.

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CXCL13 predicts worse Xray status in early #RA. Study of 158 pts, followed 11-years. Baseline CXCL13 correlated with Xray progression (ΔTSS) at 11 years. CXCL13 was superior to CRP, DAS28CRP, SJC28, CCP predicting 11-yr Xray damage https://t.co/1WAdZoYQ1P

Links:

https://bit.ly/3FGcgyG

Dr. John Cush RheumNow ( View Tweet)

Oct 15, 2021

Among 2359 RA & PsA pts (3169 TNFi courses 1778/1391), serious infection (SIE) rates were higher in RA 4.17/100PY vs PsA 2.16/100PY. PsA had 41% lower SIE risk (HR 0.59, p=0.004) - Registry data from the NOR-DMARD study https://t.co/llH07TFHOI

Links:

https://bit.ly/3BXgEr3

Dr. John Cush RheumNow ( View Tweet)

Oct 15, 2021

Retrospective study hospitalized new-onset systemic JIA (2008-19):52 children’s hospitals & 534 sJiAshows 29% rx w/ biologics & 58% steroids. Over time Biologic use increased & MTX decreased. Biologic correlated w/ Hi hospital volume, ICU stay, later years https://t.co/blbOps9zVQ

Links:

https://bit.ly/3aBhOfA

Dr. John Cush RheumNow ( View Tweet)

Oct 15, 2021

RheumNow Podcast – Quackademia (10.15.2021)

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Jack Cush, MD

Oct 14, 2021

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

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2021 Update to EULAR Points on Immunomodulatory Use in COVID-19

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Jack Cush, MD

Oct 14, 2021

EULAR has updated its recommendations (points to consider - PtC) for rheumatologists managing patients during COVID-19; now with 2 overarching principles and 12 PtC.

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Still’s Disease Following COVID-19 Vaccination

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Jack Cush, MD

Oct 14, 2021

Both systemic onset juvenile idiopathic arthritis (sJIA) and adult-onset Still’s disease are acquired autoinflammatory disorders of uncertain etiology. Yet recent reports of AOSD onset and flare following COVID-19 vaccinations may have important mechanistic implications.

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Comparative study of 46 AOSD, 9 MAS & 31 adult HLH pts, shows that serum IL-18 was signif higher in AOSD than HLH (closely correlates w/ ferritin, sIL-2R). IL-18, sIL-2R, ‘arthralgia or arthritis’ independently distinguished AOSD from HLH https://t.co/ZW6e78nEkh

Links:

https://bit.ly/2YMxgDv

Dr. John Cush RheumNow ( View Tweet)

Oct 14, 2021

Smoking worsens adult-onset Still’s disease. 185 AOSD pts, found 45 smokers who had higher risk of pericarditis (36 vs 16%), pleuritis (33 vs 14%), abd pain (18% vs 6%), higher systemic score (6.4 vs 5.4 ), More MAS (29% vs 6%), lung disease (18% vs 13%) https://t.co/ZKKhw1EbnD

Links:

https://bit.ly/3j4buBR

Dr. John Cush RheumNow ( View Tweet)

Oct 14, 2021

NICE issued a positive final appraisal recommending upadacitinib in previously treated moderate active rheumatoid arthritis (RA). This will expand UPA use to nearly 27,000 RA patients in the UK. Final pub date is Nov 10, 2021 https://t.co/A8OuzNlrAz

Links:

https://bit.ly/3oYD87f

Dr. John Cush RheumNow ( View Tweet)

Oct 14, 2021

Catastrophic Still's dz occurs early; compares 20 AOSD w/ organ failure vs 40 AOSD without. CAT-AOSD had shorter Dz duration, earlier Rx need; risks: younger; splenomegaly, liver, cardiac,lung involvement; ferritin level, no arthralgia https://t.co/8WIMd0JxZr

Links:

https://bit.ly/3vgNGji

Dr. John Cush RheumNow ( View Tweet)

Oct 14, 2021

Costs of #JIA are substantial, total costs up to 44,832 USD annually. Direct costs up to $32,446 USD, accounting for 55-98 % of total. $$$ mostly related to meds; cost go up 3 fold after biologic initiation. (JIA Indirect costs are underrepresented) https://t.co/rukJPWqD0y

Links:

https://bit.ly/3BQyqMc

Dr. John Cush RheumNow ( View Tweet)

Oct 14, 2021

Start #MTX & escalate 5mg q2wk (usual) or 5mg q4wk (fast): open RCT 178 #RA pts - equal EULAR resp (28 v 23%), DAS28-CRP (-1.3 v -1.3) - same at wk8 & 24. No diff in MTX polygluts., cell #s, LFTs, D/C - but more GI sx w/ fast wk8 (40 vs 27%) https://t.co/MbuFoA5HFp

Links:

https://bit.ly/3AuyfoA

Dr. John Cush RheumNow ( View Tweet)

Oct 13, 2021

Topics

All News

RheumNow Podcast – Rheumatologist Smoke-Enders (10.22.2021)

Save

Smoking Impairs Methotrexate Efficacy

Save

Heart Failure in RA: Inflammation Matters

Save

Is It OK to Continue TNF Inhibitors with COVID-19 Infection?

Save

Are You a High or Low Glucocorticoid Prescriber?

Save

RheumNow Podcast – Quackademia (10.15.2021)

Save

2021 Update to EULAR Points on Immunomodulatory Use in COVID-19

Save

Still’s Disease Following COVID-19 Vaccination

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