DERM on RheumNow (July 2026) Save

Welcome to the Derm on RheumNow podcast for July 2026. I'm Jack Cush with RheumNow. This podcast is for dermatologists and those interested in the overlap between dermatology and rheumatology. As an FYI to my, dermatology colleagues, RheumNow started about twelve years ago when I wanted to have a website and an email sort of news publication service for rheumatologists written by rheumatologists and we publish about 25 pieces of news every week, either as long form articles or as tweets, and then we have podcasts and videos and other things as well for, our very large rheumatology audience, but in doing that, we cover a lot of subjects that we co manage, you know, lupus patients, dermatomyositis, scleroderma vasculitis, hydradenitis, etc, and hence why I've been doing this podcast. This, podcast this month, we've had a major educational campaign on gout, which I'll spare you, reports about, and so we have a few things that are probably worth, mentioning, as a review.

One report looked at the twenty year trends on six thousand five hundred patients with scleroderma, looking at the era from 2005 to twenty twenty five, and they showed that endothelin receptor antagonists and the use of prostanoids and prostacyclin therapies went from being scant in 2005 to being used in twenty eight percent of people in 2025. While calcium channel blocker use in, phosphodiesterase five inhibitors, has remained stable, our former reliance on cyclophosphamide has shifted to mycophenolate, predominant use of mycophenolate, rituximab, and entedinim, the latter being for the lung disease associated with this, and thankfully, steroids have dropped from, I think it's fifty percent down to eighteen percent. We shouldn't be using steroids in systemic sclerosis patients. I have, another systemic sclerosis board, a meta analysis of 31 studies, thirty two thousand patients looks at the risk of malignancy. With our disorders in rheumatology, we know that chronic inflammation imparts a malignancy risk, and in rheumatology, it's almost, it's funny how uniform it is.

It's a higher risk of lymphoma, maybe a higher risk of leukemia, a higher risk of skin cancer and lung cancer, and we have lower risks of some things, especially colon cancer and, oral cancers, and that may be because of our use of nonsteroidals and COX-two inhibitors that lower those risks. Anyway, in this study of thirty two thousand patients, again, a sixty six percent higher risk of cancer in systemic cirrhosis patients. The cancers that were most commonly seen were esophageal, liver, cervical, lung, and hematologic. The, where the, again, the SIRs, the standardized incidence ratios where you compare the risk of cancer and systemic sclerosis to the population risk, it's either, threefold higher SIR 3.3 to fourteenfold higher SIR 13.95. The time from the onset of systemic sclerosis to cancer, the mean was seven point four years.

So, it doesn't take forever, but there was a fairly good confidence interval there. So, I think you should be looking for this as we should be in rheumatology. Can you vaccinate patients with autoimmune diseases, against the, herpes zoster? As you know, the Zostavax, the live virus vaccine, has gone outlawed, no longer available in The United States and been replaced by the recombinant zoster vaccine called Shingrix. Here's a study in seventy six, systemic sclerosis patients who were immunosuppressed taking a DMARD of some sort, compared to three zero four controls, and they all received two doses of the recombinant vaccine.

The point of the paper was to say that the scleroderma patients have a lower rate of seroconversion, but it ain't that much lower. I mean, it's ninety three percent versus ninety nine percent in the controls. So, there's high rates of seroconversion. It's a little bit lower, but it wouldn't stop me from, doing it. I wouldn't be more certain to do it knowing that we have really high seroconversion rates and there's no need for, additional dosing, I think, to boost that up, But again, cell and that's those are looking at the humoral responses.

If you look at cell mediated responses, they were the same, and actually patients with systemic sclerosis had actually less overall adverse events, and then we're talking about the minor stuff, the constitutional achy arm, feeling nauseous, not doing well for a few days. A large UK database of, from primary care looked at the frequency of rain outs, between over twenty five year period, '98 to 2023, the prevalence was almost nine hundred cases per one hundred thousand. That's about one per one thousand in the population. Overall in 2023, this is in The UK, they had one hundred and fifty eight thousand patients with Raynaud's. This was more frequent in the elderly, more frequent in females, less in African Americans, less in those who lived in London.

Not sure why that was, but because there's certainly a lot of young people and African descent people living in London per se. Anyway, the incidence rate was forty six per one hundred thousand, and again, it's something we all take care of and need to have a plan for. Two last reports were, I think good guidelines kind of ideas. One is a report in Annals of Internal Medicine looked at, an application for screening dermatomyositis patients for cancer, and there's this, International Myositis Assessment and Clinical Studies Group, IMAX, that develop guidelines that are based on a likelihood and risk. So, there are some people with dermatomyositis that are at low risk, and some that are at higher risk, based on manifestations being older, for instance, or based on, the autoantibody associated with that such as, you know, NXP-two or MDA-five, for instance, and they basically impart a screening procedure, but not everybody needs to have PET scans, colonoscopies, mammographies, whatnot.

My advice always has been treat them as you would, they're going to be older, do age appropriate, health maintenance screening, but these guidelines in this paper says that in their four thirteen patients with a known diagnosis of dermatomyositis, the overall risk of a paraneoplastic, malignancy was six point five percent, but that when they use the guidelines in high risk people, that went up to eight point eight percent. Now that's a meaningful, number, if you can make an earlier diagnosis of malignancy, and so being familiar with these guidelines and screening people based on their a priori risk, when you did, you followed the guidelines for high risk people, it was eight point eight percent, when you followed the guidelines for low risk people, was only two point five percent, sort of justifying the use of these guidelines in screening patients with dermatomyositis. As I mentioned last month, we were at the ULAAR meeting, in London, looking at all the new research and we had a nice review article put up. It was called psoriatic arthritis ULAR twenty twenty six recap. You may want to, click on the link in the show notes and read that.

It's a pretty short read. We go over a synopsis where we kind of grouped up what we saw were trends at that meeting, including head to head trials. There were a number of head to head trials including B BOLD and Together PSA and Together PSO and the APEC study with guselkumab, there was a lot about obesity GLP-1s and diet in psoriatic arthritis that, you may be interested in and that you probably are already aware of, in fact, that anti inflammatory diet does work in psoriatic disease and that Medispa study, for instance, showed that it works in psoriatic arthritis. There was a number of reports reviewing, the diagnosis of subclinical psoriatic arthritis where you find imaging evidence of inflammation before they have much in the way of swollen joints or clinical manifestations, and then there were the same reports that you've seen in the past that we see occasionally, where if you take a psoriasis cohort and you treat them aggressively, can you prevent the onset of psoriatic arthritis? And that's been shown probably better with the IL-seventeen inhibitors than with the TNF inhibitors, and I think that's very interesting data and speaks well for what you do in managing psoriasis aggressively by yourself or sometimes even with a rheumatologist, and then there was a fair amount on pain management in PSA patients that you might find of some utility.

Anyway, check out this report. You can look, go to the website or the YouTube channel to click on these links, and learn more about these particular citations. We'll talk next month. Take care.