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Anti-Rheumatic Rx

UKs MHRA issued a safety alert #MTX maybe associated w/ photosensitivity. Based on Coroners death (by secondary infx) report assoc w/ photosensitivity Rxn in a MTX Rx pt. Warning is because this is not a well-known side effect

Is MTX Safe in the Elderly? (12.1.2023)

Dec 01, 2023

Dr. Jack Cush reviews this past week's news and journal reports from Good news is that nearly 99% of adult rheumatology positions matched! But the challenge is that 45% of pediatric fellowship programs and 39% of pediatric rheum slots were unfilled in the 2024 NRMP match.

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Rheum Fellowship Slots Fill Up for 2024

Nov 30, 2023

While adult rheumatology programs continue to have high match rates, pediatric rheumatology programs remain less popular.The National Residency Matching Program announced yesterday that the 2024 rheumatology fellowship match filled 97.6% (124/127) of programs, and 98.9% (273/276) of rheumatology

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MTX Toxicity in Older CKD Patients

Nov 29, 2023

You know this; you've taught this; but here's a good study documenting a higher risk of methotrexate toxicity when used in the setting of older patients with chronic kidney disease.

Yesterday's JAMA published a higher 90-day risk of serious adverse events in older adults with CKD taking low-

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Why are older RA patients getting mistreated? Most rheums would say that every RA patient should be started on a DMARD. So I'm shocked that, in a US Medicare 20% sample dataset b/w 2008-17, less than 30% of new RA patients aged 66+ have a DMARD initiated.
Do We Stop or Continue Treatment? Remission had been a dream, an elusive concept. But then, with the introduction of biologics, conventional synthetic and targeted synthetic DMARDS, patients are able to live longer and with a better quality of life.
The SMART Study: Split Dose Oral Methotrexate Dr. Jack Cush discusses abstract 1583 presented at the 2023 ACR Convergence meeting in San Diego.

Here’s what will change my practice in Rheumatoid Arthritis

Here's what I learned at ACR23 that will change the way I practice in rheumatoid arthritis. 

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Withdraw DMARDS after remission?

The possibility of withdrawing DMARDs after patients achieve remission has been in our minds for a while. Yet when our patients ask whether it is a good idea to taper or stop their DMARD when they are doing well, most of us don’t have a black or white answer for them. The arrival on the

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Race to the top: how high will treatment response rates in RA reach?

Nov 27, 2023

We have become accustomed to the 60/40/20% rule for the outcome of ACR 20/50/70 respectively for biologics and targeted synthetic DMARDs. When a new agent is launched, we look out for the treatment response with much anticipation if it will be higher or lower than the benchmark we expect. 

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Plotting Future ACR Convergence Meetings (11.24.2023)

Nov 24, 2023

In this week's podcast, Dr. Jack Cush reviews the ACR Convergence 2023 meeting and proposes how to best learn at your next large medical meeting.

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TNFi and RA-ILD – The Pendulum Swings Again

TNF inhibitors revolutionised the treatment of rheumatoid arthritis. While highly effective for the joint manifestations of the disease, a note of caution was sounded regarding the potential for worsening of ILD with these agents. Within this framework, a study by England et al presented at

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Why are older RA patients getting mistreated?

Nov 21, 2023

Most rheumatologists, if asked, would say that every rheumatoid arthritis patient should be started on a DMARD of some sort - if not at diagnosis, then pretty soon after. So I am genuinely shocked that, in a large United States Medicare 20% sample dataset between 2008-17, less than 30% of new RA

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Early aggressive treatment in SLE: are we there yet?

Early treatment with DMARDs has revolutionised the outcomes of patients with rheumatic arthritis. However, this concept has not been fully extrapolated to other autoimmune rheumatic diseases such as systemic lupus erythematosus.

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Methotrexate: shall we split up? Methotrexate (MTX) is widely used in rheumatic diseases yet poses common tolerance issues, especially for the oral form; and bioavailability is known to be limited for doses over 15mg.

Rheumatology Roundup - ACR 2023

Nov 17, 2023

Drs. Jack Cush and Arthur Kavanaugh discuss highlights and key takeaways from ACR 23.

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As per #ACR23 ABST0433, what % of RA patients on US Medicare are on a DMARD within 1y of diagnosis? I'm not talking your choice of b/tsDMARD. I'm talking any cs/b/tsDMARD of any sort. Hear from @JihaRheum to skip to the answer: Truly stunning. @RheumNow

Here at Last: Treatment Options for VEXAS

We have known about the VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome for nearly 3 years, but there has been relatively little to say about how to treat it. To date there have been over twice as many publications about VEXAS (263 publications) as there have been

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#ACRbest Yrin Preview @ACRheum J Bathon Take home Symptomatic #Rx of ACPA+ people WITH #DMARD is too late to alter risk of #RA when drug is d/c AI to read joint erosions on X-ray May be ‘too little too late’ #Steroids in #RA increase #MACE even after d/c #ACR23 @RheumNow
Nov 15, 2023
Peng et al. 146 IgG4-RD in remission on immunomodulators+GC. 18 month follow-up. Withdraw IM+GC - 52% flare. Withdraw GC + continue IM 14.2% flare. Continue both 12.2% flare. Clear message that ongoing IM is the way Abstr#L16 #ACR23 #ACRbest @RheumNow
Nov 15, 2023
L16 #ACR23 @RheumNow W/d of Immunosuppr and Low-dose steroid in IgG4RD Gr1: W/d GC+IM, G2: IM alone, G3: Maintain Relapse rate: G1 52%, G2 14%, G3 12%
Nov 15, 2023
Withdrawing immunosuppression and steroids in IgG4-RD Maintaining immunosuppression with or without steroids associated with low relapse rate 52% of pts who withdrew steroids +immunosuppression relapsed @RheumNow #ACR23 Abs#L16
Nov 15, 2023
Withdrawal of Immunosuppressant and Low-dose Steroids in IgG4-RD Patients with Stable Disease 146 pts - 3 Grps 1: withdraw GC+IM 2:withdraw GC but maintain IM; 3: maintain GC+IM The maintenance of IMs, with or without low-dose GC, superior to withdraw #ACR23 @rheumnow #abstL16
#ACR23 Late-Breaking Abstr#L19 IA steroid can help osteoarthritis knee pain but effect & duration are variable. Phase 3 RCT: improvement in ADP & WOMAC pain favouring TLC5999 (liposomal modification of DEX) vs PBO at all timepoints inc. after repeated injection @RheumNow #ACRBest
Would intraarticular steroids for knee OA be better with a sustained release formulation? ph3, TLL599 (liposomal delivery dexamethasone) vs normal dex vs placebo some gains over normal dex well tolerated New options always welcome in OA! @ProfDavidHunter #ACR23 L19 @RheumNow