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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3 yr German laboratory study of 71,597 laboratory tests, found 238 positive tests for 13 myositis autoAbs in 209 patients. Pos. results due to Idiopathic inflammatory myopathy in 37(18%), other inflammatory rheum Dz 90 (43%) or NO Rheum Dx 82 (39%) https://t.co/KKg0X1AyU1 https://t.co/FfVfufaUm4
Dr. John Cush @RheumNow( View Tweet )
Full read overview of myositis associated - ILD (and treatments), including:
- Case examples
- Antisynthetase Syndrome
- Anti-MDA5 Amyopathic DM
- Interstitial Lung Disease in Myositis https://t.co/PhfuuBHOYf https://t.co/OC1GmWkYyO
Dr. John Cush @RheumNow( View Tweet )
Full read overview of myositis associated - ILD (and treatments), including:
- Case examples
- Antisynthetase Syndrome
- Anti-MDA5 Amyopathic DM
- Interstitial Lung Disease in Myositis https://t.co/zQpfstnGy8 https://t.co/XogyyxuVMk
Dr. John Cush @RheumNow( View Tweet )
No Risk of Interstitial Lung Disease with Methotrexate Use
JAMA reports a cohort study that investigated the association between methotrexate (MTX) use and Interstitial lung disease (ILD) in patients with dermatomyositis (DM).
https://t.co/qauRelAkG0 https://t.co/bhSLYrfzlv
Dr. John Cush @RheumNow( View Tweet )
#SARD #ILD
Who to screen for #rheumatic #diseases
For
ILD
#ACR guidelines
Screening May also depend on ILD prevalence
Not sure if frequency of screening and how to screen
@jeffsparks #ORA24 @ORAexec https://t.co/BcyyYLKvr6
Links:
Janet Pope @Janetbirdope( View Tweet )
202 adults w/ idiopathic inflammatory myositis (IIM) studied. Multiple myositis-specific Abs seen in 22% (2/3 w/ tRNA synthetase Abs (ARS+) & half MDA5+). Multiple MSA pts had better survival (HR 0.11), less RP-ILD, fever, rash; more muscle & dysphagia https://t.co/6PCMZJkuNn https://t.co/ElkJzPODaU
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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Methotrexate Does Not Increase ILD Risk in Dermatomyositis
A cohort analysis of dermatomyositis (DM) patients starting immunomodulators finds that methotrexate use was not associated with an increased risk of interstitial lung disease (ILD).
ILD affects ~23% of DM patients and the oft used MTX is has a low risk of pneumonitis and pulmonary
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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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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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ILD Onset in MDA-5 Dermatomyositis
Anti–melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM) is a rare, aggressive and progressive subtype of DM. Its' severity is dependent on the development of progressive interstitial lung disease (ILD), manifesting as either rapidly progressive ILD (RPILD
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GEM: Dysphagia in myositis pts is from skeletal muscle involvement, causing upper pharyngeal dysphagia, but may also manifest as dysphonia, nasal regurgitation, or aspiration (w/ risk of pneumonia). https://t.co/MOyfdCJywC
Dr. John Cush @RheumNow( View Tweet )
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.
Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory
Review article on inclusion body myositis, a progressive, debilitating myopathy w/ onset > 50 yrs. IBM typically has asmmetric, painless, weakness & atrophy of finger flexors or quadriceps w/ dysphagia. Most are wheelchair bound w/in 13-15 years https://t.co/LoWtmDqimu https://t.co/N3OUU7QMc1
Dr. John Cush @RheumNow( View Tweet )
Depression and RA (3.8.2024)
Dr. Jack Cush reviews the news, journal reports and regulatory approvals from the past week.
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85 pts w/ Myositis by MRI. Abnl MRI patterns correlated w/:
- Honeycomb & foggy w TIF1γ or Mi2+, MSA-neg DM/PM, SRP+, HMGCR+
- Honeycomb w Cancer (OR 6.8), Gottrons(OR 8)
- Foggy w weakness (OR 11.2)
- Dense dot w dysphagia (OR 6.3) & CA https://t.co/kZGuNLFglg https://t.co/lK93U5iY7q
Dr. John Cush @RheumNow( View Tweet )
Immunosuppression Increasing (2.23.2024)
Dr. Jack Cush reviews the news and journal reports from the past 2 weeks on RheumNow.com; but begins with a discussion of what constitutes "immunosuppression" and how it applies to our patients.
2021 NHIS Survey data suggests the prevalence of immunosuppression in the USA
CD19 CAR T-Cell Therapy in Autoimmune Disease
The NEJM has published the results of CD19 B cell depletion (by CAR-T cell therapy) in autoimmune disease patients, demonstrating it to be feasible, safe, and efficacious.
The rationale to CD19 CAR-T cell transfer is to reset aberrant autoimmunity via deep depletion of B cells with
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Favorable Survival w/ MDA-5 Ab+. 154 pts w/ MDA5+DM; 40 died (26%) Rx induction (mostly resp. failure). 114 survived, w/ 5-yr survival of 97% & relapse-free survival 77%. Survival improved w/ JAKi use (P=.03). 8% achieved complete drug-free remission. https://t.co/QkqM9IztEG https://t.co/yBCH85CpUN
Dr. John Cush @RheumNow( View Tweet )
Autoimmune disease and pregnancy
EurekAlert!
For many aspiring mothers with autoimmune disease, pregnancy can be daunting and full of unknowns. In some cases, those suffering from specific autoimmune conditions have chosen to forego pregnancy altogether due to concerns about their disease treatments and adverse pregnancy outcomes
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SeXXist Reason for More Women with Autoimmune Disease
EurekAlert!
Somewhere between 24 and 50 million Americans have an autoimmune disease, a condition in which the immune system attacks our own tissues. As many as 4 out of 5 of those people are women.
Rheumatoid arthritis, multiple sclerosis and scleroderma are examples of autoimmune disorders
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Cancer and Myositis #RNL2024 @RheumNow
@DrLisaCS on Cancer screening:
Risk stratify: dermatomyositis, NXP2, TIFy, <40yo, refractory, dysphagia, cutaneous necrosis at higher risk
Enhanced risk stratification for those at risks, versus "basic screening" for lower risks https://t.co/3yy9Fx1pk8
Eric Dein @ericdeinmd( View Tweet )
Dr Christopher-Stine @DrLisaCS Factors which should influence (some very strongly) your cancer screening approach in myositis @RheumNow #RNL2024 https://t.co/BoyJLrVDwo
Richard Conway @RichardPAConway( View Tweet )
anti-Sp4 Ab may be protective against cancer in myositis pts who are TIF1-g positive - Dr. L Christopher-Stine #RNL2024 @rheumnow https://t.co/n7Ikn3llGH
TheDaoIndex @KDAO2011( View Tweet )
Recent Blogs
Winning is everything – in football and in medicine. Rheumatologists have achieved many successes but still struggle to win against a handful of rheumatic foes. This retrospective examines past wins and losses and helps us to look ahead to a new season.
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