Methotrexate Safety Tips (7.31.2026)
Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.
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Best proof of difference betw Seropos vs seroneg RA from TREAT-EARLIER 12 mos study 236 clinically suspect arthralgia pts w/ subclinical Jt inflammation Rx w/ MTX vs PBO. MTX prevented RA only the seroneg RA (9 v 35%); But no protection in seropos RA (58 vs 65%) https://t.co/A5aFUgMPQR
Dr. John Cush @RheumNow( View Tweet )
U Alberta Rheumatology study of GCAPS score in 62 new onset, suspected GCA referrals. GCA Dx in 39 pts excluded in 23. 50% had a High risk GCAPS (screening) score, 38% Intermediate & 13% had Low risk GCAPs. Intermediate or High risk GCAPS sensitivity 97%, specificity 30%, PPV 70% https://t.co/HxHL60VAuO
Dr. John Cush @RheumNow( View Tweet )
In a Cohort of 410 #SLE pts, there were 37 MALES who demonstrated a high prevalence of renal (IV/V lupus nephritis 49%) and a notable incidence of Plaquenil-related retinal toxicity. 62% on HCQ, but 22% D/C HCQ due to retinal toxicity or drug intolerance. https://t.co/FcIFxRoZ6O https://t.co/7OgexLYWge
Dr. John Cush @RheumNow( View Tweet )
Retrospective study, 41 pediatric Behcets Dz pts looked at Inflam. indices (NLR, SII, PIV, CRP/albumin) vs controls. BD systemic involvement in 68%, CNS dz in 10%, Vascular Dz in 12% & major organ dz 46%. Inflamm indices significantly higher in BD w/ systemic, CNS, & Vasc https://t.co/wHiBIaOWWU
Dr. John Cush @RheumNow( View Tweet )
6 mos. RCT of low-dose baricitinib (Bari) plus danazol for refractory ITP (n 216); Pts Rx w/ either Bari+DNZ vs DNZ alone. At 6-mos a durable response was seen in 45% of Bari+DNZ vs 20% in DNZ monotherapy (P < 0.001). AEs were equal (48% vs 45%), More studies needed on this https://t.co/YbF49ZNA0E
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Cerebral atrophy is common in SLE - assoc w/ age (OR 1.1), higher education (0.22), NPSLE (OR 4.6), cognitive impairment & lower dsDNA titers. 70 pts (mean age 40, Dz dur 12yrs). Cerebral atrophy 53% (mostly 76% mild). https://t.co/ewRmNj8zNA https://t.co/yT8TCXZREA
Dr. John Cush @RheumNow( View Tweet )
Gout: Diagnosis
The diagnosis of gout - labs, imaging and polarized microscopy, created by @MithuRheum for RheumNow.
https://t.co/s8gkANFJSB https://t.co/pkUeFLG5if
Links:
Dr. John Cush @RheumNow( View Tweet )
Interferon-α as an Immunologic Driver of Sjögren's Disease
Using data from a Sjogren's registry, researchers have shown that IFNα drives Sjögren's disease, and can be elevated a decade before diagnosis. This study assessed the role of type 1 interferon (IFNα) in its onset and https://t.co/Clj9u5COzQ
Dr. John Cush @RheumNow( View Tweet )
The Wider Implications of Dactylitis
Dactylitis, AKA the "sausage digit", is a hallmark of psoriatic arthritis (PsA), but as Possemato and colleagues point out, it is fundamentally a clinical sign, and not a diagnosis.
https://t.co/HRaIvMHMSV https://t.co/XOcHbFVMsS
Dr. John Cush @RheumNow( View Tweet )
Four Decades of Gout Management
During this month-long campaign on Gout, we have documented many significant changes in our approach to gout, as well as many unmet needs and deficiencies that merit our continued, primary attention. We are all familiar with the famous 1905 quote, “Those who cannot remember the past
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2 T2T RCTs of 383 gout pts starting allopurinol - 31% had tophi. At 12 mos achieving target uric acid (<0.36mmol/L) was same in pts with and without tophi (70.3 vs 73.6), as was the %gout flares in month 11 (71.4% vs 79.7%; p=0.21). Allopurinol T2T success not influenced by https://t.co/zr7K8Y2Bqz
Dr. John Cush @RheumNow( View Tweet )
New Avacopan Analysis Sent to FDA
MedPage Today
After data manipulation allegations, the FDA has been calling for the vasculitis drug to be pulled from the market since January.
Amgen has submitted a third-party review of avacopan's (Tavneos) pivotal trial data and other analyses to the FDA in a bid to keep the embattled drug for
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Interferon-α as an Immunologic Driver of Sjögren's Disease
Using data from a Sjogren's registry, researchers have shown that IFNα drives Sjögren's disease, and can be elevated a decade before diagnosis. This study assessed the role of type 1 interferon (IFNα) in its onset and https://t.co/0BDDvR5cUB
Dr. John Cush @RheumNow( View Tweet )
Uricase-Targeted Therapies in Gout
In most mammals, uricase catalyzes the oxidation of uric acid to allantoin, a highly soluble compound easily excreted by the kidneys. But humans lack functional uricase, leaving xanthine oxidase inhibitors (allopurinol/febuxostat) as first-line urate-lowering therapy (ULT). Uricase-based
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UTSW observational study of labs (n 14,199) changes w/ MTX use in 2,439 pts (13% RA, 11% PsO/PsA, 15% inflam arthritis) - found no difference in labs q3 vs q6 mos. No signif correlation betw monitoring intervals & changes in ALT, AST,WBC, HCT, MCV, PLT, FIB-4. Small https://t.co/gKwA7juexG
Dr. John Cush @RheumNow( View Tweet )
Fibrosis-4 (FIB-4) Index for Liver Fibrosis is calculated from age, AST, ALT, Plts. Study of 174 RA, PsA, PsO pts on MTX find 11% w/ fibrosis (by elastography). FIB-4 AUC for fibrosis =0.68 (weak). Fibrosis was signif assoc w/ FIB-4 >1.62, DM, obesity, advanced steatosis https://t.co/GYrhs2U1s3
Dr. John Cush @RheumNow( View Tweet )
"Leeuwenhoek (invented the microscope) examined uric acid (C5H4N4O3) crystals from gout patients and found them to resemble needles. He expounded on his observations in an 11 July 1679 letter responding to an earlier query from Mr. Lambert van Velthuysen (1622–1685), a physician, https://t.co/mY2wqYlRda
Dr. John Cush @RheumNow( View Tweet )
51 yoM w/ 2 yrs of FUO, unintentional 32-kg wt loss, LN, diffuse myalgias, but no GI Sxs or arthralgia. Neg MRIs, CT, PET scan, EGD, colonoscopy. Abnl labs: CRP 173 mg/L, ESR 46, anemia & ^ WBC. Cell-free DNA next-generation sequencing dx Tropheryma whipplei, & Whipple disease https://t.co/nJLa4l7Ers
Dr. John Cush @RheumNow( View Tweet )
Expert Perspective on Calcium Pyrophosphate Deposition Disease
A recent perspective by Tedeschi tackles many unresolved issues around CPPD diagnosis, classification, and management, including the lack of clinical trials or FDA approved treatments.
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Saliva and Uric Acid Testing
A recent report from China reaffirms the potential utility of salivary uric acid (UA) testing delivers smartphone-guided, enzyme-free gout screening at home for pennies per test.
https://t.co/VtvJuPNEWA https://t.co/pdBmy5JoQd
Dr. John Cush @RheumNow( View Tweet )
ARTIC trial enrolled 234 DMARD naive RA (<2yrs) pts; 15.4% (36) were seronegative (SNRA). @enrollment SNRA worse than SPRA(+) w/ higher SJC (17 vs 8, p<0.001), DAS28 (3.9 vs 3.4, p=0.03), US scores (55 vs 25, p<0.001), MD global (49 vs 39, p=0.006). No diff in Sharp score, https://t.co/xDxQKY8ZG2
Dr. John Cush @RheumNow( View Tweet )
Metanalysis of 31 studies (14,548 pts) looked at infection in idiopathic inflamm myopathy (IIMs). Infection prevalence was 24%, primarily Respiratory tract. PJP, aspergillosis, H zoster most prevalent pathogens. Risk factors: older age, male, DM, HTN,MDA5+ (OR 3.41), rapidly https://t.co/Go51MUOQlG
Dr. John Cush @RheumNow( View Tweet )
Congratulations to Dr. Chandra Mohan and Univ. of Houston for receiving a $4 million NIH grant for a 10-year longitudinal study to identify the earliest biological triggers of autoimmune disease https://t.co/6kMcv9PD5r https://t.co/CsY8QAxrXR
Dr. John Cush @RheumNow( View Tweet )
Therapeutic Updates
Watch our 11-video series on ILD Treatment and Guidelines including videos on assessing ILD, guidelines caveats and concerns, and more.
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Biomarkers in RA
Sponsored by Augurex
Rheumatologist Dr. Walter Maksymowych discusses the role of biomarkers in RA care, with a focus on 14-3-3eta as a modifiable marker for diagnosis and monitoring disease progression.
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Recent Blogs
At first, it seemed similar to many other such sessions – a circle of folding chairs, a group of colleagues whose visages exuded understanding and acceptance – but this was special. I started the meeting…. “Hi, my name is Artie.”
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At first, it seemed similar to many other such sessions – a circle of folding chairs, a group of colleagues whose visages exuded understanding and acceptance – but this was special. I started the meeting…. “Hi, my name is Artie.”
Read Post
Podcasts
EULAR 2021 - Day2d00:23:12
