Managing JDM with Calcinosis Save

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow and discusses a case of refractory juvenile dermatomyositis with calcinosis.

1. CDC report of fungal infx in US 2019 - coccidioidomycosis (20,061), histoplasmosis (1,124) & blastomycosis (240). Most Cocci cases (97%) AZ & CA; most Blasto (75%) in MN &WI; most Histo in IL (26%), but also MN, MI, WI, IN, LA, AR. https://bit.ly/3K39nKS

2. Medicare study of 10,868 Hospitalized lupus pts. Looking at age groups. 30 d rehospitalization higher in young adult LE (36%) - 40% higher than those without LE, 85% higher older LE. Rehospitalization higher with Longer hosp stay & higher comorbidity. https://bit.ly/3A5RbeZ

3. Urine-soluble CD163 as a biomarker in #SLE: usCD163 significantly higher w/ active lupus nephritis & correlates w/ UPCR, disease activity, anti-dsDNA Ab levels and a higher chronic kidney disease stage. https://t.co/Mxe53pCnEF

4. Drug-Induced Lupus from Proton Pump Inhibitors

5. MSK US in Gout? 71 gout pts on ULT followed x 1yr, 42% had at least one flare (median=2). Baseline US showing MSU deposits & inflammation significantly assoc w/ with # Flares (MSU score RR 1.17; power Doppler score RR 1.29) https://t.co/6IQo4JWtK0

6. Gout T2T: Rheumatology societies target urate <5 mg/dl (0.30 mmol/l) or <6 mg/dl (<0.36 mmol/l) - below point of urate saturation -->MSU crystal dissolution. Achieving target reduces flares & tophi; but these clinical benefits take time. https://t.co/qfFSpGCJZp

7. Study of 209 Early RA (<1yr) pts found 23 (11%) with Drug Free Remission (DFR) after 74 mos of F/U; DFR maintained x 48 mo (18–82). DFR was assoc w/ early persistence on Therapy (HR 3.84). Adhering to prescribed treatment may lead to DFR https://t.co/oO8wKOKfxE

8. Recurrence of axSpA in 1st-degree relatives (FDR) probands w/ 35-yrs F/U. From 363 AS probands & 806 FDR, 27.1% of B27(+) FDR developed axSpA; 18.2% from AS probands; 4% from nr-axSpA probands. Recurrence higher with B27+ probands https://t.co/1xczXdtrH3

9. Axial PsA frequency? Study of Derm identified PSO adults w/ chronic LBP, onset <45 yrs, not Rx w/ DMARDs--> 100 pts referred to Rheumatology; 14 pts dx w/ axPsA, 5 w/ peripheral PsA, & 3 w/ both axial & peripheral PsA https://t.co/oVxDcY17ZQ

10. Cochrane review of Stem cell transplantation in systemic sclerosis (3RCTs w/ 125 pts). Non‐myeloablative & myeloablative selective HSCT had moderate evidence for improved survival, skin thickness & function. But these had high Serious AE rates. https://t.co/d3CPsKiR88

11. Rituximab Efficacy in Systemic Sclerosis

12. Low Dose IL-2 Therapy in SLE   

13. Melatonin Use Growing, Inappropriate & Potentially Unsafe

14. Ask Cush Anything – JDM and Calcinosis Dr. Fawzi Mazen

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