Labs/Biomarkers

"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 )
Sjogren,board

Interferon-α as an Immunologic Driver of Sjögren's Disease

Jack Cush, MD

Using data from a Sjogren's registry, researchers have shown that IFNα drives Sjögren's disease, and
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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 )
Allopurinol - severe allergic reactions are estimated at 0.4%-2%, rising to 8–18% in patients with chronic kidney disease. Being HLA-B*58:01 (+) dramatically increases risk (OR 117). For more gout content, follow our Gout: More than Flares campaign at https://t.co/lQoiFjubZJ, https://t.co/fTuc4lYvJz

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Dr. John Cush @RheumNow( View Tweet )
Chondrocalcinosis

Expert Perspective on Calcium Pyrophosphate Deposition Disease

Jack Cush, MD

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

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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

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Dr. John Cush @RheumNow( View Tweet )
Less than 10% of gout patients have crystal-proven gout. For more gout content, follow our Gout: More than Flares campaign at https://t.co/lQoiFjubZJ,

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Dr. John Cush @RheumNow( View Tweet )

While not a validated Dx tool for gout, AI retinal scanning of digital fundus photography was tested on 107730 pts & showed high ROC - f NIDDM 0.833, Gout 0.832, OP 0.787, HTN 0.740, hyperlipidemia 0.736 & thyroid Dz 0.699 https://t.co/1yrlR04z4g https://t.co/c04YtVVERY

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Dr. John Cush @RheumNow( View Tweet )
RHEUMATOLOGIST SURVEY ON GOUT - In what percentage of your new Gout patients, do you do arthrocentesis and crystal ID? Answer here: https://t.co/jpebQev4VU

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Dr. John Cush @RheumNow( View Tweet )

New research shows synovial lining enriched in macrophages expressing SPP1 (encoding osteopontin) in proximity to fibroblasts and fibrin deposits. SPP1+ macrophages degrade fibrin & promote fibroblast proliferation that deposit collagen & does the damage, joint remodeling. A new https://t.co/yFxwAYFPPb
Dr. John Cush @RheumNow( View Tweet )
uric.acid.test

Saliva and Uric Acid Testing

Jack Cush, MD

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.

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New research shows synovial lining enriched in macrophages expressing SPP1 (encoding osteopontin) in proximity to fibroblasts and fibrin deposits. SPP1+ macrophages degrade fibrin & promote fibroblast proliferation that deposit collagen & does the damage, joint remodeling. A new https://t.co/hrJoQXpAH8
Dr. John Cush @RheumNow( View Tweet )
JAMA HBV review - Worldwide, HBV affects ~254 million, causing 1.1 million deaths. In 2022, 14k new HBV infx in the US. HBsAg = ongoing infxn; HBsAb indicates immunity; HBcAg=ongoing or past infection. Do HBV DNA for virus-replication activity https://t.co/Yvdx09DrQ5 https://t.co/88VsTEgFev

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Dr. John Cush @RheumNow( View Tweet )
uric%20acid.crystals.gout_.JPG

Uric Acid: Is Lower Better?

Joshua Baker, MD, MSCE  Brian Coburn, MD, PhD

Lowering serum urate and urate crystals in the body is indispensable for long-term management of gout. The pathophysiology is simple and powerful: no urate crystals, no gout flares. However, this simplicity in goal belies a nuanced consideration in management: how low should serum

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RT @aurelierheumo A long release version of xanthine oxidase inhibitor in gout -442 pts 36 wks -HR091506 vs febuxostat -SUA <300 μmol/L: 63.8% vs 40.7% (Δ +22.9%, p<0.0001) -higher SUA reduction vs baseline -Similar overall TEAEs (~90%) A molecule to keep an eye on! #LB0008

Dr. John Cush @RheumNow( View Tweet )

ILD damage fibrosis path

EULAR26: ANCHOR-RA Study of RA-ILD

EurekAlert!

People with rheumatoid arthritis are at risk of developing interstitial lung disease (RA-ILD), which is associated with high mortality. ANCHOR-RA is a large, international cross-sectional prospective study that will enable the development of a multivariable model to help detect RA-ILD.5

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Giant-Cell_Vasculitis.jpg

EULAR26: Vasculitis updates: Glucorticoid use in AAV and GCA

EurekAlert!

EULAR recommends a combination of glucocorticoids with either rituximab or cyclophosphamide for remission induction in life-threatening or organ-threatening AAV, followed by gradual tapering of glucocorticoids.

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uricacid.jpg

ICYMI: Worldwide Trends in Hyperuricemia

Jack Cush, MD

A Lancet Rheumatology systematic review shows the prevalence of hyperuricaemia has risen markedly over the past two decades in both men and women, owing to population growth, aging, and increasing age-specific rates

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Eosinophil

ICYMI: EGPA Review

Jack Cush, MD

A current review of eosinophilic granulomatosis with polyangiitis (EGPA) provides current recommendations on diagnosis and management.

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Prospective study of 6 newly Dx RA pts starting MTX shows MTX causes a decline in T follicular helper (Tfh) cells and plasmablasts (@ wk 3 before clin response), selectively in responders but not nonresponders. MTX shifts cellular & gene expression towards a more physiological https://t.co/scmfAAE9XA
Dr. John Cush @RheumNow( View Tweet )
Is there a path to precision medicine in #RA? Theres a substantial unmet need. Immunoengineering is possible thru nanotechnological delivery vectors, cellular therapeutics, & biomaterial scaffolds, with compelling preclinical and early clinical support. https://t.co/gL56EOlt7p https://t.co/31IRNXckym

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Dr. John Cush @RheumNow( View Tweet )
RA.vascular.cholesterol.plaque.jpg

EULAR26: Updates in SLE and APS

EurekAlert!

Severe refractory systemic lupus erythematosus (srSLE) is a clinical state conceptualised as persistent high disease activity despite standard care with glucocorticoids and immunosuppressants.

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Therapeutic Updates

ILD Treatment and Guidelines

Hinze title card
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

Augurex Front End Image
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

ICYMI: Autoantibodies Anonymous

Artie Kavanaugh, MD
AutoAb.Token
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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Advanced Practice Rheum

Systemic Lupus Erythematosus

Jack Cush, MD
APR SLE VIDEO COVER
Dr. Cush reviews systemic lupus erythematosus.
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Autoantibodies Anonymous

Artie Kavanaugh, MD
AutoAb.Token
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
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