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Pediatric Rheum

Higher Rehospitalization Rates in Younger SLE Patients

Mar 08, 2023

A Medicare study shows that young adults with systemic lupus erythematosus (SLE) exhibit very high 30-day rehospitalization rates (36%) that are significantly higher than older SLE patients and age matched non-SLE patients.

This study was drawn from a 20% national Medicare sample from

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Without head-to-head trials, do we look to metanalyses? 13 trials of TNF inhibitors in JIA pts - Results at 12-14 weeks. While it ADA looks possibly better, that would be an over-interpretation and misuse of trial data that isnt truly comparable
51 Juvenile SLE (j-SLE) studied for neuropsychiatric Dz (j-NPSLE)- 39% presented with jNPSLE. While no clear biomarker/imaging of j-NPSLE identified, they found CSF neopterin (& IFN-α) levels signif higher w/ active j-NPSLE & CNS involvement (p=0.0008)

Periodontal Mucosal Breaks Trigger RA Disease Activity

Feb 23, 2023

Periodontal disease (PD) is more common in rheumatoid arthritis (RA), especially those with anti-citrullinated protein antibodies (ACPAs).  RA activity has been linked to the severity of PD and mucosal inflammation.

Researchers from Standfod have suggested a prominent role for PD in

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Comparison of MIS-C dz in kids and adults>21 (MISC - A). By Dr Susan Shenoi @RWCSmtg #rwcs23
Serious Infection Risk in Pediatric Psoriasis with Ustekinumab, Etanercept, or MTX This comparative analysis looks at the risk of SIE requiring hospitalization in pediatric PSO patients treated with ustekinumab, etanercept, or MTX prior to 2016.
The FDA has added a new indication to the oral JAK inhibitor Cibinqo (abrocitinib) - now approved to treat atopic dermatitis in adolescents 12 to under 18 years old. (Approval is based on a phase 3 JADE TEEN trial.
Enthesitis-related arthritis compared in kids - 105 ERA (57 axial vs 48 peripheral). Axial ERA pts were older @onset (12 vs. 11yrs), longer Dx delay(10 vs. 5 mos), higher inflammatory markers, more Hip Dz (53% vs 27%), more biologic Rx (67% vs 21%)

Serious Infection Risk in Pediatric Psoriasis with Ustekinumab, Etanercept, or Methotrexate

Feb 08, 2023

Etanercept was FDA approved for use in pediatric psoriasis (PsO) in 2016 and ustekinumab was similarly approved  in 2020.  This comparative analysis looks at the risk of serious infections (SIE) requiring hospitalization in pediatric PSO patients treated with ustekinumab, etanercept, or

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Burnout #10 (2.3.2023)

Feb 03, 2023

Dr. Jack Cush reviews the past week of news on

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Have you listened to last week's RheumNow podcast? Dr. Cush answers the question--is there such a thing as dry synovitis?
Study of 58 pediatric patients with Kikuchi-Fujimoto disease saw 15 (26%) with Macrophage Activation Syndr. KFD-MAS+ pts had signif. more skin rash (27%), Steroid Rx(80%), Dz recurrence (33%), lower cell counts (WBC, plt, lymphs) & higher LDH.
"Dry Synovitis" exist in juvenile arthritis pts? Study of 12 DS pts, says its different from Poly #JIA; onset 6.1 yrs, w/ polyarthritis, no palpable swelling, progressive LOM/contractures, neg ESR/CRP/RF/CCP, +MRI synovitis w/ osteochondral involvement.

Simon Says “Don’t Do This” (1.27.2022)

Jan 27, 2023

Dr. Jack Cush reviews this week’s journal articles, focuses on studies that should not have been done and responds to viewer questions in Ask Cush Anything.

  1. "Dry Synovitis" exist in juvenile arthritis pts? Study of 12 DS pts, says its different from Poly #JIA; onset 6.1 yrs

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New Guideline: Vaccinations OK With Few Tweaks for Rheum Patients

Jan 17, 2023

Nearly all available vaccines can be given to people with rheumatologic diseases, according to a new, detailed guideline from the American College of Rheumatology (ACR), though the timing for their administration and dosing of antirheumatic drugs may need adjustment in some cases.

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2022 Rheumatology Year in Review (1-6-2023)

Jan 06, 2023

Dr. Jack Cush reviews the best of 2022 in Rheumatology - highlights on new drug indications, breakthrough lupus therapies, new biosimilars and the multivitamin letdown.

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Should Kids w/ MIS-C get the COVID vaccine? Yes - study of 385 pt > 5 yrs w/ Hx of multisystem inflammatory syndrome showed no serious adverse events after COVID-19 vaccination. The safety profile of COVID-19 vax is same as gen population

Best of 2022: New Updated GRAPPA Psoriatic Arthritis Recommendations

Dec 26, 2022

The GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) treatment recommendations have been updated and the 2021 evidence-based guidance is rich in treatment recommendations based on the key disease "domains" - peripheral arthritis, axial disease, enthesitis,

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207 JIA pts to rheumatology studied. Initially 61% seen by Pediatrics but only 28% referred to rheumatologist. Mean time to Dx was 56 days, but longer for polyarticular & ERA/SPA (~114 d). Faster dx w/ Younger age & fever; longer w/ sm jts
Review of the Rheumatic causes of Pericarditis and their management. Causes: SLE, RA, MCTD, Myositis, EGPA, GPA, IgG4-rel Dz, FMF, TRAPS, CAPS, AOSD, JIA, Sarcoidosis, Kawasakis, GCA, Takayasu's
Systematic review comparing MIS-C and Kawasaki: 14 studies, 2928 pts; major differences- KD pts were younger; MIS-C had more Pulm, GI, Shock, more cardiac (LV, valvular pericarditis, myocarditis), but less coronary lesions & conjunctivitis

ACR22 Presents New Data on JIA Clinical Remission with Combo DMARDSs

Nov 09, 2022

New research being presented this week at ACR Convergence 2022, demonstrated that polyarticular juvenile idiopathic arthritis patients were more likely to achieve clinical remission with a combination of conventional and biologic DMARDs compared with other consensus treatment plans by the

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QD Clinic - 1st Line Anakinra New-onset systemic JIA - how will you treat? #ACR22

Transitioning JIA to Adult Care is Problematic

Oct 04, 2022

Juvenile idiopathic arthritis (JIA) may start in adolescence and extend into adulthood. This report of the Nordic experience shows that both pediatric and adulty rheumatologists need to develop "transition" practices; without such an approach considerable gaps in healthcare will befall these

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Causes of Death in Lupus

Oct 03, 2022

The California Lupus Surveillance Project has longitudinally followed included systemic lupus erythematosus (SLE) cases and shown that overall, the leading cause of death was cardiovascular disease (CVD), followed by rheumatic disease and hematologic/oncologic conditions.

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