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Drug Safety

Malar,rash,SLE, Lupus

Low Dose IL-2 Therapy in SLE

Aug 17, 2022

A multicentre, proof-of-concept trial of suggests that low-dose IL-2 therapy may be effective in moderate-to-severe systemic lupus erythematosus (SLE). This is not surprising as IL-2 is needed to bolster insufficient regulatory T cell (Treg) activity, thought to be pivotal to the

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SCLE,DIL,PPI

Drug-Induced Lupus from Proton Pump Inhibitors

Aug 17, 2022

A wide range of therapies have been implicated in causing drug-induced lupus erythematosus (DIL); now it appears that proton pump inhibitors (PPIs) can be added to the list of causative drugs.



This was surmised from a study of Vigibase, a WHO funded pharmacovigilance database, that

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JUNIPERA Study - Secukinumab in Juvenile PsA & ERA

Aug 16, 2022

JUNIPERA study evaluated secukinumab (SEC) in children with enthesitis-related arthritis (ERA) and juvenile psoriatic arthritis (JPsA) and was found to be safe and effective in patients with active ERA and JPsA who previous failed to respond to conventional therapy.

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Hit Parade Review (8.12.2022)

Aug 12, 2022

We've got a lot to discuss this week: psoriasis; fatigue; sleep; sural nerve biopsies; uveitis and SpA; diet and RA; tofacitinib and the ORAL surveillance study; what not to take with mycophenolate - and more. In what order should these items be discussed? This week the run down is based on

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Fatigue is Under-Appreciated in Psoriatic Arthritis

Aug 09, 2022

Patient-reported fatigue is high in patients with psoriatic arthritis (PsA) and often goes under-recognized by physicians. Fatigue importantly impacts physical functioning, work productivity, and health related quality of life (HRQoL).

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GCA,Black

Increased Mortality in Giant Cell Arteritis

Aug 09, 2022

A population-based study from Ontario, Canada suggests an increased mortality risk in patients with giant cell arteritis (GCA), according to a recent report in Arthritis Care & Research.



A health administrative data study looked at 22,677 GCA patients (≥50 years of age)

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Do not take antacids or PPI with mycophenolate. Magnesium & aluminium hydroxide antacids (Maalox) will lower MMF Cmax 33% & AUC 17% if given simultaneously. PPI also lowers AUC by ~33% https://t.co/IoWISgL3SY https://t.co/JV1Yv5Pg9d https://t.co/b8UoQ4zMUV https://t.co/VwNgVQ5End
Dr. John Cush @RheumNow( View Tweet )
Aug 08, 2022
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More Bad Safety News for Xeljanz

MedPage Today
Aug 08, 2022

Another analysis of the mandatory postmarketing safety study for tofacitinib (Xeljanz) has confirmed what most observers expected: that rates of infection with the drug in rheumatoid arthritis are higher than with tumor necrosis factor (TNF) inhibitors.

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JAK Inhibitors in Difficult Still’s Disease

Aug 05, 2022

A small retrospective study suggests that patients with difficult to treat adult-onset Still's disease (AOSD) or sytemic juvenile idiopathic arthritis (sJIA) may respond well to JAK inhibitor (JAKi) agents - presumable by blocking pro-inflammatory cytokines, notably IL-6 and IFN.



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The Great Unknowns (8.5.2022)

Aug 05, 2022

Dr. Jack Cush reviews the news, FDA approvals, journal articles from the past week on RheumNow; plus viewer questions. This week great hopes for vitamin D, the great unknows of CSA and the great big mess that is the gout.




  1. 521 clinically suspect arthralgia (CSA) pts were

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Oral surveillance - tofacitinib vs TNFi in high risk pts: more infections, serious infection (SIEs) & non-serious infx with Tofa vs TNFi. SIE risk 17%-48% higher; SIE higher w/ high dose Tofa, esp in pts aged≥65. Usual risk factors - age, pred, comorbid. https://t.co/gjD8xqtfgp https://t.co/doMd4E9ClL
Dr. John Cush @RheumNow( View Tweet )
Aug 04, 2022
Supplemental Vitamin D Fails to Lower Fracture Risk NEJM has published study results showing that vitamin D3 supplementation does not significantly lower fracture risk (vs. placebo) when used in generally healthy adults.https://t.co/tY1VY3hpM2 https://t.co/22FcdnvAjL
Dr. John Cush @RheumNow( View Tweet )
Aug 04, 2022
ACR guidance

ACR Updated Guideline on Vaccinations for Rheumatic Patients

Aug 04, 2022

The ACR has posted a new ACR Clinical Practice Guideline Summary providing recommendations on the use of vaccinations for children and adults with rheumatic and musculoskeletal diseases (RMDs).



This guideline builds on past

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JAMA overview of Patient Reported Outcomes (PROs) - how generated, validated, used and limitations.https://t.co/572KxUO59s https://t.co/5c6xQfZqzu
Dr. John Cush @RheumNow( View Tweet )
Aug 03, 2022
CV,risk,MI,heart,cardiac

Gout Flares Up Cardiac Risks

Aug 03, 2022

A large case-control study showed that gout patients who experienced a cardiovascular (CV) event were more likely to have had a recent (< 120 days) gout flare compared to those without CV events.



This study sought to investigate the temporal association between gout flares and

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RA erosions bone ACR

The Approach to Difficult to Treat Rheumatoid Arthritis

Aug 03, 2022

Tan and Buch have reviewed the approach to difficult to treat rheumatoid arthritis (D2T-RA), with a new EULAR definiation of D2T-RA to foster an approach rationale and concideration of treatment options.



D2T-RA is defined by failure of at least two different mechanism of action

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Risk of incident & recurrent H.Zoster higher after tofacitinib - Korean claims analysis of 11,720 seropos. RA pts Rx w/ bDMARD or tofacitinib (2011-19). 14% got HZ. Compared to other biologics (ABA), Tofa incr HZ (HR 2.5) & recurrence (HR 3.69) https://t.co/lDuqdtkIjR https://t.co/zJ3ArS3gGs
Dr. John Cush @RheumNow( View Tweet )
Aug 02, 2022
hip,fracture3

Supplemental Vitamin D Fails to Lower Fracture Risk

Aug 02, 2022

NEJM has published study results showing that vitamin D3 supplementation does not significantly lower fracture risk (vs. placebo) when used in generally healthy adults.

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knee,pain3,target

Krill Oil Effective in Knee Osteoarthritis

Aug 02, 2022

Krill oil supplements in knee osteoarthritis (OA) was shown to be superior to placebo in reducing knee pain, stiffness and function while increasing the omega-3 index. Krill oil, rich in anti-inflammatory long-chain (LC) omega-3 ( ω–3) PUFAs and astaxanthin, is thought to be safe and now

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Upadacitinib in non-radiographic Axial Spondyloarthritis

Aug 01, 2022

The janus kinase inhibitor, upadacitinib, has been shown to significantly improve the signs and symptoms of non-radiographic axial spondyloarthritis (nr-AxSpA), extending the efficacy of UPA beyond classic ankylosing spondylitis.

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Choices

Not Still’s – Now What?

Jul 29, 2022

Your patient doesn't meet criteria for Still’s disease (AOSD or sJIA), now what should you do or consider?

What you do or consider next can be addressed according to the stage of current disease: A) Hospitalized Febrile Disease, or B) Outpatient “Still’s” Disease.

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Social Media Questions (7.29.2022)

Jul 29, 2022

Dr. Jack Cush reviews the news, journal reports and rheumatologist cases from the past week on RheumNow.com. This podcast is brought to you by StillsNow.com - be sure to sign up for our monthly StillsNow email and Monthly StillsNow Podcast.




  1. Study of 63 Thalassemia pts (50

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Lungs ILD

Approach to ILD in Myositis Syndromes

Jul 28, 2022

Mehta et al have published a full read review of managing interstitial lung disease (ILD) in patients with inflammatory myopathies, a heterogeneous group of syndromes connected by ILD and and increased morbidity and mortality risk.



They divide myositis-ILD into three main prognostic

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blood, level, numbers, data, calculation

Best Labs for Still’s Disease

Jul 27, 2022

There is no “test” (blood or other) that is solely diagnostic of Still’s disease, but labs can help make a diagnosis or manage disease, and affirm the safety of drugs in use. ​​​​​​​ 

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Have you checked out our new sister-site, Still's Now? A new site for Still's disease, autoinflammatory & febrile disorders.https://t.co/oWEugnOB6k https://t.co/5jwiP2Xqrz
Dr. John Cush @RheumNow( View Tweet )
Jul 26, 2022
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