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Infection

Stop Counting Bugs (10.4.2024)

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.This week’s rants include the microbiome, PsA treatment choices and fishing for P-values in research.

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Long Term Antibiotics Increase Risk of RA

JAMA has published a population-based retrospective cohort study showing a possible association between the long-term use of antibiotics and the risk of rheumatoid arthritis (RA).

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Pneumocystis Jirovecii Pneumonia Complicating Systemic Vasculitis A retrospecitive analysis of 62 patients with systemic vasculitis complicated by Pneumocystis jirovecii pneumonia (PJP) showed those with MPA had a higher mortality risk, possibly due to a higher prevalence of… https://t.co/vZHZbfqlbB https://t.co/bn2oTAPSnc
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Adult (133,216) vs Pediatric (955) pts on JAKi - analysis of FAERS shows both @ incr risk for infections & GI AEs. Pediatric pts had more blood and lymphatic disorders, while adults had more CNS and MSK/CTD disorders https://t.co/SKjzANYPSq https://t.co/S6JPYuvSlf
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Pneumocystis Jirovecii Pneumonia Complicating Systemic Vasculitis

A retrospecitive analysis of 62 patients with systemic vasculitis complicated by Pneumocystis jirovecii pneumonia (PJP) showed those with microscopic polyangiitis (MPA) had a higher mortality risk, possibly due to a higher prevalence of interstitial lung disease (ILD) in MPA.

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A low risk of Candida infections with ixekizumab (IXE); integrated analysis of 25; Candida infx rates - PsO:1.9/100 PY (N  6892); PsA 2.0/100 PY (N 1401); axSpA 1.2/100PY (N 932). Most occured only once, were mild/moderate & were oral or genital Candida https://t.co/ZkkPoSzPMW https://t.co/VysnaQ8rpi
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Study of 4821 pts (age 52 yrs) undergoig EGD - H. pylori infx seen in 2262, w/ long-lasting H Pylori (LLHp) infx in 1043 (21.6%). 6.3% dx w/ aCVD & 4.3% w/ RA. LLHp infection incr risk of aCVS (HR 1.57) & RA (HR 2.63) In RA, LLHp up risk for aCVD (7.89) https://t.co/FNOsEHKVIf https://t.co/dSeJuuuUMQ
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Is it possible that Helicobacter pylori (Gm neg) can exacerbate or cause RA? Infx of gastric epithelial cell line w/ H. pylori upregulated the expression of PAD4 and increased PAD4 activity, leading to Helicobacter pylori-induced citrullination? https://t.co/QeE3SmWLLp https://t.co/ZG2tYmdJNx
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Retrospective study of 58 pts w/ #SLE concurrent with PJP infx, showed that 39% died, with many of these having diabetes and invasive ventilation. A 4 fold incr Mortality seen risk factorsHyperglycemia/DM, decreased C3, & thrombocytopenia https://t.co/CqPpRXG8mN https://t.co/GyKbiU8GWY
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Antibiotics May Increase Inflammatory Arthritis Risk

A Danish registry study has shown that amongst those patients who develop inflammatory arthritis (IA), antibiotics use was more frequent when compared to the background population (BP). 

This isn't the first time this association between antibiotic usage and futher

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Retrospective study of 919 RTX-treated GPA pts shows TMP-SMX prophylaxis (given to 31%) assoc w/ reduced serious infections (adj HR 0.5) and less outpatient infections (aHR 0.8). All 13 pneumocystis infx (PJP) occured in those not Rx w/ TMP-SMX. https://t.co/bO6oAHv7Lr https://t.co/fPntW75hnY
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Metanalysis of 50 RCTs (3,231 pts w/ lupus nephritis (LN) related starting pred dose to rates of complete response (CR), serious infections, & death. PO pred 25 mg/D assoc w/ 20%, 3.2% & 0.2%, respectively. Pred 60 mg/day incr rates to 35%, 12% & 2.7% https://t.co/6FH9BWsmaz https://t.co/0cQPAIuvRw
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Tick-borne diseases have increased in the last decade in the US, including Lyme disease (~476 000/yr), babesiosis, human granulocytic anaplasmosis (HGA), Rocky Mountain spotted fever, monocytic ehrlichiosis (HME), alpha gal allergy (red meat allergy) https://t.co/tl8qPyjU3Z https://t.co/AP0wglsJXM
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Lead with Lupus (8.2.2024)

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com - leading with lupus because everyone wants to know about lupus!

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Decline in Physician Trust During the COVID-19 Pandemic

JAMA reports that following the COVID-19 pandemic US adults trust in physicians and hospitals decreased, and was associated with lower odds of COVID vaccination.

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Location, Location, Location (7.26.2024)

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Location matters; Geo-rheumatology?

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CDC warns of Listeria outbreak assoc w/ deli meats - in 12 US states (lead by NY, and MN, MO, IL, WI, PA, VA, GA, NJ, DE, MD, MA, NC), 28 cases, 28 hospitalized, 2 deaths. @risk are the pregnant, elderly, immunosuppressed. Cook deli meats >165F https://t.co/SWKMhIBQEi https://t.co/snLjBKn1UJ
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Biologics Prevent AA amyloidosis progression to ESRD

MedPage Today

One of the most serious complications of rheumat0logic and autoimmune diseases can be prevented with biologic drugs, a single-center chart review suggested, and some such products may be more effective than others.

Among 83 patients receiving biologic agents for their underlying

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Best Rheumatologists (7.19.2024)

This week on the RheumNow Podcast, Dr. Jack Cush reviews the news and journal reports of interesting, including irAE, pollution and Psoriasis, microwave therapy, scleroderma without scleroderma that only the best rheumatologists could discern.

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Intercurrent infections may be assoc w/ SLE flares. 203 Amsterdam SLE pts, incidence of major & minor infections were 5.3 & 64/100Pys. Intercurrent infections (major & minor) were assoc w/ SLE flares (HR 1.9); major infx lead to major SLE flares (HR 7.4) https://t.co/DSPgi9KrwT https://t.co/FI7ZYf3CPl
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ICYMI: Community-Acquired Pneumonia (CAP) https://t.co/geb8y2AK26 https://t.co/cB3y5vQoz1
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ICYMI: 2022 EULAR Recommendations on Screening & Prophylaxis for Opportunistic Infections https://t.co/eHn2o2pFFR https://t.co/8S1fzl4AaJ
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ICYMI: Can Mycophenolate be Stopped in Stable SLE?

In patients with clinically stable systemic lupus erythematosus (SLE) and lupus nephritis, the withdrawal of mycophenolate mofetil was not significantly inferior to mycophenolate maintenance, but MMF withdrawal had numerically more reactivations, while MMF maintenance had more infections.

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Has JAK POT Hit the Spot About Infection Risk? Dr. Yuz Yusof discusses abstract OP0092 presented at Eular 2024 in Vienna, Austria. https://t.co/vN2VZYGqbE https://t.co/MQ3QCJU4SW
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DMARDs and Herpes Zoster Vaccination: To Stop or Not To Stop Dr. Jonathan Kay discusses abstracts POS0620 and OP0020 presented at Eular 2024 in Vienna, Austria. https://t.co/gKJRygBeq0 https://t.co/2NTNYJLPNZ
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