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Gout

RCT of #upadacitinib in #GCA It works to steroid spare 15 mg > 7.5 mg in outcomes Both >>placebo Ethically PBO had slower #prednisone taper Similar to #TCZ data What to choose in GCA IL6i? IL17i? JAKi? @eular_org # LBA0001 @Janetbirdope https://t.co/DGOltriVYF
Dr. John Cush @RheumNow( View Tweet )
POS0277: proof of concept: Prophlx with canakinumab x 1 dose rather than steroids/colch/NSAIDS when starting pegloticase with MTX in pts with active, refractory gout: 11 pts: #gout flares 0 (compared 54% in MIRROR-C), infusion rxn 0, no safety signal @rheumnow https://t.co/4qFnQTOuq0
TheDaoIndex @KDAO2011( View Tweet )
Great 1st #EULAR2024 scientific session: “Asymptomatic” Hyperuricemia — innocent bystander vs. menacing foe. Data re: effects on joints, kidneys, & heart have not supported clear clinical consequences w/ exception of kidney crystal deposition. TIGER Study results eagerly awaited. https://t.co/IPQU3Ww0NA
Tuhina Neogi, MD, PhD @Tuhina_Neogi( View Tweet )
Flavinoids (herbs, cherries, berries) have clinical efficacy in #Gout. Review of the mechanisms of flavonoids in gout includes: - Cox-2 inhibition - Lowers xanthine oxidase activity (mediated thru inflammasome, NOD/TLR4, NFKB, OAT1 & OAT3 transporters https://t.co/UC55GGZBCJ https://t.co/L6nE3BMIj1
Dr. John Cush @RheumNow( View Tweet )

Is Cannabis Safe? (6.7.2024)

Dr. Jack Cush reviews FDA approval, news and journal articles -- and it’s the week before EULAR 2024 in Vienna!!

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Role of Diet in Gout Risk Diet has long been influential in gout care and risks. A large cohort study has shown that plant-based diets may reduce the risk of developing gout. https://t.co/cqP7G4KeWi https://t.co/zxiOeACb5u
Dr. John Cush @RheumNow( View Tweet )
Canadian study of 44,438 older adults (age 76) w/ gout found only 52% reached serum uric acid (SUA) target w/in 12-mos, improving from 45% (2010) to 61% (2019). ULT adherence was 55%, also improved annually. Only 3.5% Rx by Rheumatologist! https://t.co/vAc8myxiRm https://t.co/gcMz379iPH
Dr. John Cush @RheumNow( View Tweet )

Role of Diet in Gout Risk

Diet has long been influential in gout care and risks. A large cohort study has shown that plant-based diets may reduce the risk of developing gout.

This prospective study assessed the risk of developing incident gout based on consumption of healthy and unhealthy plant-based diets.

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Colchicine prophylaxis w/ allopurinol (“start-low go-slow” 100mg escalation strategy), is best used in pts w/ gout flare in month prior to allopurinol. Longer prophylaxis may be required w/ ongoing flares in 1st 6mos of allopurinol if T2T not achieved https://t.co/yupiq26BJA https://t.co/KDF394SC30
Dr. John Cush @RheumNow( View Tweet )
Save the date! We are covering #EULAR24! We'll be sharing recaps, videos, and more. https://t.co/NMWtHB94Pi https://t.co/ok43pnagFg
Dr. John Cush @RheumNow( View Tweet )
Metformin Lowers Gout Risk in Pre-Diabetes A large, propensity score-matched cohort study shows that metformin use in patients with pre-diabetes significantly lowers the risk of future gout. https://t.co/IQ1Z7rhhp1 https://t.co/vYKBKsWh0y
Dr. John Cush @RheumNow( View Tweet )

Metformin Lowers Gout Risk in Pre-Diabetes

A large, propensity score-matched cohort study shows that metformin use in patients with pre-diabetes significantly lowers the risk of future gout. 

Metformin is widely used for diabetes and pre-diabetes. Importantly, its use has been linked with a

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Do you have a rheumatology question or case for Dr. Cush? Record it here and we may feature it on an upcoming podcast. Tell us your name and where you practice rheumatology. https://t.co/qvVEUoNYi5 https://t.co/duw6jg5xpp
Dr. John Cush @RheumNow( View Tweet )
Save the date! We’ll be covering #EULAR24! https://t.co/HGjP2SFyOp
Dr. John Cush @RheumNow( View Tweet )

"Don't You Know Who I am?" (5.17.2024)

Dr. Jack Cush reviews the news and journal reports from the past 2 weeks. This week's question: can we prevent gout, ILD or psoriasis?

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Single center EHR study of 5 064 pts w/ pre-diabetes compared those starting metformin (1154) vs 13 877 non-users w/ ~4 yrs F/U. Incidence of future gout was lower w/ metformin use (7.1 vs 9.5/1000PYs; HR 0.68); with no change in SUA or CRP https://t.co/CXdcEdWXhW https://t.co/j0ktehf9Sm
Dr. John Cush @RheumNow( View Tweet )
MGH study compared 1148 acute CPPD vs 3730 controls (mean 73 yrs) found 2 fold more fractures (mostly wrist); 11.7 vs 5.5/1000 PYs (HR 1.8) in pseudogout pts (also had more steroids & OP) https://t.co/HhCV6fYubF https://t.co/3bcbvSzzPo
Dr. John Cush @RheumNow( View Tweet )
RISE study of 700 Pegloticase users (14 mos F/U) found 18% on immunosuppressive (MTX, MMF, LEF), these had signif less PEG D/C (HR 0.52-0.69). Immunosuppressives not assoc w/ more lab abnormalities https://t.co/4ytot7HOMh https://t.co/0wrjvnZur3
Dr. John Cush @RheumNow( View Tweet )
Is Colchicine Rx a problem? Retrospective study of UK Clinical Practice registry, 13945 gout initiated allopurinol with colchicine (64yrs; 78% male). 26% on 1+ meds interacting w/ colchicine. Diarrhea & MI more freq w/ comorbidities & more severe CKD https://t.co/ZkhpzaTjjI https://t.co/e3BO813b30
Dr. John Cush @RheumNow( View Tweet )

Rheum Chapter Notes (4.26.2024)

Dr. Jack Cush reviews this past week’s news and journal articles from RheumNow.com.

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SGLT2 Inhibitors Lowers Gout Risks in Type 2 Diabetes A population-based cohort has demonstrated tha SGLT2i use in gout patients is superior to sulfonylurea therapy in lowering the risk of incident gout and recurrent flares among patients withT2D. https://t.co/QZ7bt39zEW https://t.co/Wlo9SF0hPF
Dr. John Cush @RheumNow( View Tweet )

Canary in a Coal Mine (4.19.2024)

Dr. Jack Cush reviews regulatory reports, news and novel journal articles - this week focusing on Sjogren's, ILD, Gout and Uveitis.

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SGLT2 Inhibitors Lowers Gout Risks in Type 2 Diabetes

A population-based cohort has demonstrated that sodium-glucose cotransporter-2 inhibitors (SGLT2i) use in gout patients is superior to sulfonylurea therapy in lowering the risk of incident gout and recurrent flares among patients with type 2 diabetes (T2D). 

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Of 375 #Gout pts D/C pegloticase after a median of 8 infusions (taken 112days (max 1,240d). Only 73% had SUA < 6 during pegloticase. After D/C 84% went on ULT (63% allopurinol; 34% febuxostat; after mean 92d); after ≥ 30 days), 51% achieved SUA < 6 https://t.co/unkvt1whrs https://t.co/DgVpBgKXcm
Dr. John Cush @RheumNow( View Tweet )

Burnout or Retire (4.12.2024)

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. Is it time to worry about burnout and those who are leaving healthcare?

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