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Study of 1141 consecutive gouty pts finds 10 (0.9%) with "Shrinking Toes" in those w/ tophaceous gout (usually MTP1,2) -

Dr. John Cush RheumNow

3 years 10 months ago
Study of 1141 consecutive gouty pts finds 10 (0.9%) with "Shrinking Toes" in those w/ tophaceous gout (usually MTP1,2) - toe shortening mainly due to lytic bone collapse during articular tophus dissolution (esp in severe gout w/ severe erosions) https://t.co/K0DzvAYoAg https://t.co/JhZWtSK7K4
When balancing all these disease domains, individual phenotypes, and comorbidities, sometimes treatment decisions can feel like tossing a coin. Fortunately, numerous guidelines have been published to help us do better than tossing a coin…or do they? 
In the wake of the 2016 AAOS Guidelines, rheumatologists dutifully reduced the dose HCQ take by patients with SLE to some number south of 5mg/kg per day. Though I believe the ophthalmologists correctly interpreted a 2014 paper in JAMA Ophthalmology that quoted a much-higher rate of HCQ associated retinopathy than had previously been appreciated, they and subsequent guidelines published in the field of rheumatology lacked a critical piece of
COPA, a rare syndrome w polyarthritis, ILD, pulmonary hemorrhage, w excessive STING signaling. #RWCS2022
@RWCSmtg http

Dr. John Cush RheumNow

3 years 10 months ago
COPA, a rare syndrome w polyarthritis, ILD, pulmonary hemorrhage, w excessive STING signaling. #RWCS2022 @RWCSmtg https://t.co/EUv8sMK8dx
Many have quoted and shown this image of Ankylosing Spondylitis in a young military recruit at age 25, 35, 45, 50 &

Dr. John Cush RheumNow

3 years 10 months ago
Many have quoted and shown this image of Ankylosing Spondylitis in a young military recruit at age 25, 35, 45, 50 & 51yrs. This may be the MOST used slide in rheum! It comes from the work of Toronto's Dr. Hugh Little, who sadly passed away at age 58 yrs. https… https://t.co/G28YlyhX3v
Retrospective study looked at 47 adults w/ dermatomyositis treated with tofacitinib. While clinically similar, those on

Dr. John Cush RheumNow

3 years 10 months ago
Retrospective study looked at 47 adults w/ dermatomyositis treated with tofacitinib. While clinically similar, those on TOFA were were younger (53vs 61), shorter Rx duration (24 vs 53 mos);there was signif CDASI improvement. #ACR22 https://t.co/nZ8NgS4cZb
Challenges in Lupus:
-Mortality greatest in 1st yr
-Dx Delays 6.4 yrs
-Long-term complications increased 50 fold
-Steroi

Dr. John Cush RheumNow

3 years 10 months ago
Challenges in Lupus: -Mortality greatest in 1st yr -Dx Delays 6.4 yrs -Long-term complications increased 50 fold -Steroids worsen long-term outcomes -Health care costs increased 3 to 5 years prior to Dx -Mean delay in drug starts after Dx =177 days https://t.co/NPxzluJJAV https://t.co/J2uLOfeijV
Adult-onset Still's presents an interesting and diagnostic challenge when encountered. Here are 5 tips to improve your diagnostic acumen for this febrile disorder.
The GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) treatment recommendations have been updated and the 2021 evidence-based guidance is rich in treatment recommendations based on the key disease "domains" - peripheral arthritis, axial disease, enthesitis, dactylitis, skin and nail psoriasis; with new PsA related domains uveitis and inflammatory bowel disease.
NEJM Clinical Images: 74-yoF with psoriatic arthritis has swelling of the fifth finger; found to have nontender, subcuta

Dr. John Cush RheumNow

3 years 10 months ago
NEJM Clinical Images: 74-yoF with psoriatic arthritis has swelling of the fifth finger; found to have nontender, subcutaneous nodules in the hypothenar region and over the fifth finger. https://t.co/ugfFGZ0CWh https://t.co/a5q1TWRqMM
Infection in lupus is suggested by very high CRP, PMN-lymph ratio (NLR) Plt-lymph ratio(PLR). Study of 104 hospitalized

Dr. John Cush RheumNow

3 years 10 months ago
Infection in lupus is suggested by very high CRP, PMN-lymph ratio (NLR) Plt-lymph ratio(PLR). Study of 104 hospitalized SLE found all very high w/ infx & Combined cutoffs of CRP >20 mg/L, NLR >3.5, PLR >151 had 87 sensitivity & 81% specificity for infx https://t.co/2ycSGhnHeK https://t.co/VZsGAK2hFs
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