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GI/Liver

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.





  1. Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory

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Endoscopy and Worry are indicated in the face of DYSPEPSIA and any of these: @BCryer https://t.co/6TabKhiLPO
Dr. John Cush @RheumNow( View Tweet )
Testing for H. Pylori. Serologic tests are OK but after Rx eradication, 25% of pts will remain positive for H. Pylori. @BCryer

Dr. John Cush @RheumNow( View Tweet )

Multiple Rx options to treat H. Pylori - Dr. Cryer recs regimens of 14ds; top line w/ bismuth is most recommended. (most effective is the one the patient will actualy take!) @BCryer https://t.co/f6836Ga1Fz
Dr. John Cush @RheumNow( View Tweet )
H. Pylori is usually acquired during childhood, remains dormant until activated years later. Is assoc w/ PUD and gastric cancer, not dyspepsia. Baylor Univ Grand Round By Dr. Byron Cryer @BCryer https://t.co/KXZfigVYX9
Dr. John Cush @RheumNow( View Tweet )
Is non-alcoholic fatty liver dz assoc w/ osteoarthritis? Study of 2633 pts - 317 (12.8%) w/ OA& 1140 NAFLD(41.5%); NAFLD was positively correlated with OA (OR = 1.72; 1.26–2.34). https://t.co/whWX2XIu3d https://t.co/sGXQYSFcH3
Dr. John Cush @RheumNow( View Tweet )
You are what you eat! So how does the Mediterranean diet affect the gut? *maintaining/shaping healthy gut microbiota *enhancing anti-inflammatory metabolite production *maintaining intestinal barrier integrity Dr. M. Guma #RNL2024 @RheumNow https://t.co/O9by7CahRW
Dr. Rachel Tate @uptoTate( View Tweet )
How does the Mediterranean diet affect inflammation? Dr. Guma noted the diet helps to: 1. maintain healthy microbiota 2. enhance production of anti-inflammatory metabolites 3. maintain intestinal barrier integrity. #RNL2024 @rheumnow https://t.co/d3ByStvXyR
TheDaoIndex @KDAO2011( View Tweet )
Dr. M Guma noted @ACRheum 2022 Guidelines on RA recommend the #MediterraneanDiet; studies have shown this diet reduces CV risk, RA disease activity #RNL2024 @RheumNow https://t.co/AdKWgME4nD
TheDaoIndex @KDAO2011( View Tweet )

2023 Rheumatology Year in Review

Dr. Jack Cush reviews highlights, advances and hot topics in rheumatology from 2023 and the RheumNow website.  



2023 was a year of growth and new horizons while returning to operational and practice standards (in care and education) established before the pandemic.  

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Best of 2023: LAVLI - A New Autoinflammatory Disorder

NIH researchers have have described a novel autoinflammatory disorder called "Lyn kinase-associated vasculopathy and liver fibrosis" (LAVLI), based on a mutation in the LYN gene (that encodes the Lyn kinase protein). They discovered that increased Lyn kinase activity promotes

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ICYMI: SpA Sleuths: The Case of Undiagnosed IBD

Abstract #0494 provides context to our continual search for better understanding of inflammatory bowel disease in patients with AS, nr-AxSpA, and PsA.

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ICYMI: Do Probiotics Improve Psoriatic Arthritis?

Psoriatic arthritis and the gut microbiome have become more intertwined, especially in the past few years. It was to my amazement that one of the first abstracts I came across was the effect of probiotic modulation on gut dysbiosis and disease activity in psoriatic arthritis patients. 

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JAKi and TYK2i: What to use and when?

You can see that the JAKi/TYK2i have both approved or potential seropositive and seronegative indications. There are also improvements in PsO for the class and studies in CTDs. So, it is difficult to know which to choose.

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OA and Microbiome! Ab#1581 @RheumNow #ACR23 Microbiome transplantation of mouse models - benefit if before or soon after OA induction (meniscal destabilization) ⭐️OA is inflammatory dis of innate immune sys, not "wear-and-tear" and gut biome may be a 🔑 https://t.co/eA8unUBnpC
Eric Dein ( View Tweet )
TM01 @ #ACR23: Daunting Case of Diarrhea 65 yo F w/ sero+RA + 2ndary SjS p/w 4 wks diarrhea -CT a/p: thickening of cecum, ascending colon -Colonoscopy path: ischemia -R colectomy: enterocoelic lymphocytic phlebitis, no underlying vasculitis. Dx: IgG4-RD, serum IgG4⬆️ @RheumNow https://t.co/jQ57U5EjPo
Meral K. El Ramahi, MD @MeralElRamahiMD( View Tweet )

Do Probiotics Improve Psoriatic Arthritis?

Psoriatic arthritis and the gut microbiome have become more intertwined, especially in the past few years. It was to my amazement that one of the first abstracts I came across was the effect of probiotic modulation on gut dysbiosis and disease activity in psoriatic arthritis patients. 

Read Article

SpA Sleuths: The Case of Undiagnosed IBD

Abstract #0494 provides context to our continual search for better understanding of inflammatory bowel disease in patients with AS, nr-AxSpA, and PsA.

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Love teaching about the PsA-AxSpa-IBD venn diagram of disease manifestations Interesting idea, using fecal calprotectin to trigger colonoscopy in pts w/PsA/axSpA ~40% w/pathologic finding, 4.4% dx w/IBD Jives w/my clinical experience @RheumNow #ACR23 Abstr0495 #ACRBest https://t.co/rIQpJnup9v
Mike Putman @EBRheum( View Tweet )
#obesity is a significant RF for #osteoarthritis Assoc'd with: 💠impairment of gut biota 💠microbial translocation Leads to innate immune activation #ACR23 @RheumNow @rheumarhyme https://t.co/iuEvBh3A1j
sheila ( View Tweet )
Do you check fecal calprotectin levels in your SpA pts? Maybe you should. #ACR23 Abs #0495 EISER study shows increased prevalence of undiagnosed IBD in SpA that may be detected in our clinics with fecal calprotectin levels prior to GI evaluation. https://t.co/d7BbrUd570 @rheumnow https://t.co/COcKdvjWnr
Dr. Rachel Tate ( View Tweet )
FDA Approves Infliximab Biosimilar for Subcutaneous Use Another infliximab biosimilar has been FDA approved, but this new version of Inflectra can be given subcutaneously for patients with inflammatory bowel disease. https://t.co/oTGm16k6Uo https://t.co/tSysmriP7q https://t.co/TIZc8rxwxM
Dr. John Cush @RheumNow( View Tweet )
Subcutaneous Remsima, an infliximab biosimilar, has been FDA. Celltrion has rebranded this as Zymfentra, for maintenance therapy in adults with moderately to severely active Ulcerative colitis and Crohn's disease following (after giving IV infliximab) https://t.co/3hb5Z7L9uw https://t.co/4gvSurl1nM
Dr. John Cush @RheumNow( View Tweet )

FDA Approves Infliximab Biosimilar for Subcutaneous Use

Another infliximab biosimilar has been FDA approved, but this new version of Inflectra can be given subcutaneously for patients with inflammatory bowel disease.



The Celltrion drug,

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Could Methotrexate Work in Hand Osteoarthritis?

Lancet reports the results of the METHODS study from Australia where hand osteoarthritis (HOA) patients benefitted from 6 months of methotrexate (MTX) - as long as there was MRI synovitis!



This multisite, double-blind, randomised, placebo-controlled trial, enreolled adults (aged 40–75

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