ACR’s Run at Goliath (PCPs) (5.31.2024)
Dr. Jack Cush reviews the journal reports and articles from this past week on RheumNow.com. The ACR (and Cush) address their new website designed to educate PCPs and APPs - what do you think?
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@RheumNow The always erudite @LCalabreseDO is no slouch of a debating opponent, however. He acknowledges that the science has been imperfect, too much is wrapped up in it, and that fibromyalgia can teach a lot to long COVID. #EULAR2024 @RheumNow https://t.co/TzR4SMZh9f
Links:
David Liew @drdavidliew( View Tweet )
@RheumNow @LCalabreseDO @NIH and Len gives us some key recommendations for better practice for long COVID - for me, equally as applicable to fibromyalgia as to long COVID.
Fantastic discussion #EULAR2024 @RheumNow https://t.co/8PnjPEKcOu
David Liew @drdavidliew( View Tweet )
Fantastic long COVID debate: close friends Xavier Mariette & @LCalabreseDO head-to-head, debating whether long COVID is a specific disease or part of fibromyalgia.
Xavier argues it looks like any post-viral syndrome, & the immunological signal isn’t there. #EULAR2024 @RheumNow https://t.co/ajKjBSRo2n
Links:
David Liew @drdavidliew( View Tweet )
My friend the late, great @philipcrobinson and I wrote @TheLancetRheum about what we could learn from COVID about preventative medicine.
https://t.co/55j8rduvyn
It's worth us thinking how we can do better by our patients.
18/ #EULAR2024 https://t.co/zlDKYngsu0
Links:
David Liew @drdavidliew( View Tweet )
Anakinra in COVID showed mixed (often negative) results. But this Turkish retrospective observational study comparing standard of care to IV anakinra in severe COVID pts. IV ANAK had less thromboembolic event (5% vs 12.3%, p = 0.038), better survival https://t.co/4webWJKEfB https://t.co/85GnCd6N8O
Dr. John Cush @RheumNow( View Tweet )
National French study finds post COVID Vaccine the IR of PMR (179 cases; RR 7.1/mill) & GCA (54 cases; RR 2.1 /million) were reported 7-10d post vax. These #s are below population incidence rates (1-20/mill for GCA) https://t.co/XvaoWhqs2g https://t.co/BFDy2WKcLx
Dr. John Cush @RheumNow( View Tweet )
Machine learning analysis of retrosp EHR data (3/20-9/22) on 2+ million showed COVID (5.3%) outcomes in #IMID pts not linked to DMARD or IMID Dx; but rather to age, unvaccinated, & comorbidities (Afib, CAD, CHF, CKD, COPD, CA, liver Dz) https://t.co/aMmJD5P9cc https://t.co/Yy9FuCvol4
Dr. John Cush @RheumNow( View Tweet )
September 2023, CDC’s recommended the updated 2023–2024 booster COVID Vaccine (monovalent XBB.1.5). MMWR study shows only 18% of high risk (immunocompromised) recv'd it. Vax was 38% effective at preventing COVID hospitalization https://t.co/vf5jkMkPwj https://t.co/c55SuIuaDb
Dr. John Cush @RheumNow( View Tweet )
Post-COVID POTS? Neurology cohort study of 16 pts - 81%F, mean age 36. Common Sxs:
- Palpitations & Fatuge in 2/3
- in <1/3: migraines, IBS, Raynaud’s
- Variable tilt test but High autonomic Sxs
No insights on Rx... https://t.co/I7MLjHAUDb https://t.co/hWnfJ9WWPX
Dr. John Cush @RheumNow( View Tweet )
MMWR: Vaccination and Multisystem Inflammatory Syndrome in Children
MIS-C is a rare but serious condition typically occurring 2–6 weeks after SARS-CoV-2 infection and characterized by fever and multiorgan involvement.
https://t.co/PN2MPQxqSR https://t.co/eIzB4pjner
Dr. John Cush @RheumNow( View Tweet )
Ides of March (3.15.2024)
Dr. Jack Cush has advice for Caesar and the superstitious, and covers pregnancy, platelets, dialysis and vaccinations in Lupus.
Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory
MMWR: Vaccination and Multisystem Inflammatory Syndrome in Children
CDC
Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition typically occurring 2–6 weeks after SARS-CoV-2 infection and characterized by fever and multiorgan involvement. The current MMWR report shows that MIS-C case numbers have decreased by 98% since 2021.
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COVIDs Extended Risk for Rheumatic Disease
Annals of Internal Medicine reports a large, binational study finding SARS-CoV-2 infection was associated with an increased risk for AIRDs that extends up to 12 months after infection.
https://t.co/HjQ56hiiny https://t.co/vvC3iVqNyF
Dr. John Cush @RheumNow( View Tweet )
COVIDs Extended Risk for Rheumatic Disease
EurekAlert!
Annals of Internal Medicine reports a large, binational study finding SARS-CoV-2 infection was associated with an increased risk for autoimmune inflammatory rheumatic diseases (AIRDs) that extends up to 12 months after
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False positive COVID tests (+Rapid Ag; neg PCR) are rare, 1.7% of 11,297 tests; Persistent false positives seen in 13/191 and usually in women, with autoimmune dz (6/13; RA, SLE etc) & using the Quidel QuickVue rapid antigen test https://t.co/Pqkk7uBVcO https://t.co/m6ylQz00Ih
Dr. John Cush @RheumNow( View Tweet )
Best Treatments for COVID-Related MIS-C
https://t.co/6Ntdug1eam https://t.co/x6de0DQTZ9
Dr. John Cush @RheumNow( View Tweet )
Best Treatments for COVID-Related MIS-C
The RECOVERY trial focused on pediatric MIS-C patients treated with immunomodulators and anti-cytokine therapy demonstrated the benefits of first-line therapy with intravenous methylprednisolone or second-line tocilizumab in children refractory to initial treatment. Neither IV
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Hydroxychloroquine for COVID may have caused 16,990 deaths. Systematic review of 44 cohort studies showed HCQ use in COVID was associated with 11% increase in mortality in 6 countries (US 12,739, Spain 1,895, Italy 1,822, Belgium 240, France 199,Turkey 95 https://t.co/vmhvSx4XLO https://t.co/KRxqiiSFC3
Dr. John Cush @RheumNow( View Tweet )
Is MTX Safe in the Elderly? (12.1.2023)
Dr. Jack Cush reviews this past week's news and journal reports from RheumNow.com. 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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🔥 HOT OFF THE PRESS for #ACR23
Effectiveness of a fourth dose of #COVID19 mRNA #vaccine in patients with systemic autoimmune rheumatic diseases using DMARDs: an emulated target trial https://t.co/bvc75BP4aG @zach_wallace_md @jeffsparks https://t.co/CAlgjvUr9X
The Lancet Rheumatology @TheLancetRheum( View Tweet )
COVAD2 data:
⬆️proportion of SLE pts from lmHDI countries were on CS(73% vs 59% p=0.0002), antimalarials(81% vs 68% p=0.0002) & IS(66% vs 53%p=0.0009) vs pts from hvhHDI countries
Comorbids more in younger pts from lmHDI (prob from CS use)
#ACR23 ABST2269 @RheumNow @rheumarhyme https://t.co/4CLGFYG1d0
sheila ( View Tweet )
Kevin. Winthrop knocks it down on WHO is immunocompromised among rheumatic disease pts at Innovation Theater @CCalabreseDO #ACR23 @alhkim @AdamJBrownMD @ELittlejohnDO https://t.co/4hFtQgvaIf
Leonard Calabrese @LCalabreseDO( View Tweet )
Our collaborative study on nirmatrelvir-ritonavir (Paxlovid) virologic rebound is out in @AnnalsofIM @DrJLi @zach_wallace_md
-Paxlovid: 21% with rebound vs. 2% in untreated (OR 10)
https://t.co/RRDxerGdBy
Jeffrey Sparks MD MMSc @jeffsparks( View Tweet )
Is rituximab still a problem with COVID - esp if our patients have been vaccinated pre-ritux?
Antibody titres better when not getting regular ritux around boosters
Maybe boosters 9mo (or so) gap after ritux helps immunogenicity
@TroldborgAnne et al #ACR23 ABST2511 @RheumNow https://t.co/dE0uC6B9hx
David Liew @drdavidliew( View Tweet )
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