NHANES, Numbers, & Risk (7.18.2025)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com along with interesting case questions from "Ask Cush Anything".
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Molecular profiling of RA synovium predicts biologic responses
Machine learning analysis of pre-treatment synovial tissue biopsy from RA patients starting either ETN, TCZ and RTX revealed high accuracy prediction of 16 week outcomes unique to each biologic. https://t.co/4d6NEY6JN6
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MTX lowers risk of serious infxn (SI) - UK Observational study of 17 472 newly Dx RA (2018–2023); 10K on MTX, 4,540 other csDMARDs; 13680 corticosteroids (GC). 1307 SI (3/100 PY) w/ reduced adj HR 0.72 (95% CI: 0.63–0.82). 311 SI-related mortality (IR 0.69;0.61–0.77) https://t.co/YhJV3vyAmB
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Variability of Guidelines on the Perioperative Use of DMARDs in Rheumatic Diseases Patients
More effective treatments in patients with rheumatic diseases have resulted in less need for major surgery, yet a substantial number of RMD patients will undergo surgery often in the https://t.co/gjJOjZhSHU
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Molecular profiling of RA synovium predicts biologic responses
Machine learning analysis of pre-treatment synovial tissue biopsy from rheumatoid arthritis (RA) patients starting either etanercept (ETN), tocilizumab (TCZ) and rituximab (RTX)
1 in 5 Patients are Unaware of their Arthritis Diagnosis
Current CDC numbers suggest that arthritis (any type) affects an estimated 67.1 million (27.9% ) adults in the USA. Interestingly, 1 in 5 do not know their arthritis subtype (21.6%, 14.4 million).
This most recent analysis of the prevalence and distribution of arthritis subtypes
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Sulfasalazine as a preventative against Pneumocystis (PJP). 594 RA pts & 848 Rx episodes - 181 on SSZ, 667 controls. W/ 850 Pt-Yrs F/U, 21developed PCP, 3 died of PCP. SSZ significantly lowered PJP risk (p = 0.003, rate ratio = 0.05; 95% CI 0.00–0.34). https://t.co/PAgBaJGldR https://t.co/VV3MvVEGal
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NHANES study (1999–2018) of 38,272 participants looked at the neutrophil-to-albumin ratio (NPAR), & elevated NPAR significantly assoc w/ an increased risk of RA (ORtertile3vs1 = 1.27), esp if NPAR > 13.6. NPAR superior to SI), SIRI, PLR, MLR, & NLR. https://t.co/asLc6ghz7w https://t.co/2dAhIvekGA
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Variability of Guidelines on the Perioperative Use of DMARDs in Rheumatic Diseases Patients
More effective treatments in patients with rheumatic diseases have resulted in less need for major surgery, yet a substantial number of RMD patients will undergo surgery often in the setting of DMARDs use. A scoping review looked at numerous clinical practice guidelines/recommendations for the
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NHANES study (2007 to 2020) of 19,904 participants (≥ 20 years), including 1,477 RA pts. Prevalence of kidney stones was higher in RA (17% vs. 8%, p < 0.001) (OR = 1.77) https://t.co/0NZKQdQWR8 https://t.co/BRZ1RTNh5W
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Interstitial Lung Disease and Lung Cancer Risk
A large prospective cohort study found that interstitial lung disease (ILD) is associated with an increased risk of lung cancer.
This cohort study of 5,425,976 used a a sibling-controlled design to account for genetic factors. Data was taken from the Swedish Total Population Register
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RA study shows rapid remission (DAS28-CRP < 2.6 <12 wks) occurred in 28% of 865 pts & assoc. w/ better respsonses at week 26. Also rapid remission had signif. 5 yr benefits (SJC, TJC, Fatigue, HAQ, pain, & most PRO outcomes. https://t.co/2tvxS8oXP2 https://t.co/YAFGAri3Uj
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MRI-detected erosions in clinically suspect arthralgia pts do not portend future Xray erosive disease or progression. Study of 405 CSA pts; 47% had MRI erosions that incr odds of Xray erosion [OR 5.2] but 96% of MRI-detected erosion had no assoc. Xray erosion. https://t.co/PXkEC3LO6n
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Can you predict disease from serum biomarkers? Comparison of 5 controls, 36 individuals at risk, 74, RA, & 97 PsA pts finds RA w/ higher levels of sICAM-1, MMP1, MMP3, PP, c-Peptide, CRP SAA. Also CRP, SAA, GLP-1, GIP-1, Leptin, PP precede disease onset https://t.co/zqWxsbTSlC https://t.co/Kgv2ZAuzIR
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Rheums! Question or case for Jack Cush? Record it here and we may feature it on an upcoming podcast.
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Hmmm Really? (7.11.2025)
Dr. Jack Cush reviews the news and journal reports from this past week - some obvious, other new thoughts and some - hmmm, reallly?
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Early DMARD Initiation Benefits in Psoriatic Arthritis
Mease et al has published the results of a cohort study showing early initiation of disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis (PsA) resulted in better outcomes compared to late https://t.co/EdbnpBmnPe
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1 yr study of falls studied in 100 RA & 80 PsA pts. 33% of RA & 46% of PsA reported falls, w/ a higher frequency in PsA Pts (p=0.02). Falls associated w/ disease duration and HAQ score. As falls are assoc w/ high morbidity & mortality risk, pts should be questioned about FALLS https://t.co/tP7zmGCZcw
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MRI-detected erosions in clinically suspect arthralgia pts do not portend future Xray erosive disease or progression. Study of 405 CSA pts; 47% had MRI erosions that incr odds of Xray erosion [OR 5.2] but 96% of MRI-detected erosion had no assoc. Xray erosion. https://t.co/hvxJRv1r0R
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Case–control study RA pts > 65yrs in US. SEER (cancer) database (2014–2019). Overall cancer risk not associated with use of JAKi (adjOR 1.04), TNFi (0.98) or other bDMARDs (0.98). But, JAKi use was assoc w/ incr risk of lung CA (OR 1.40), esp in Males (2.12) & >2 yrs JAKi. Lower https://t.co/u2psafyN1I
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Granzyme expression is upregulated in RA, esp early RA. Blood & synovium from early arthritis & TNFi nonresponders (R4RA RCT) gene expression five granzymes, perforin, & serglycin determined by bulk RNA-sequencing data. GZM A, B, H, K, M, PRF-1, SRGN was higher in lymphoid https://t.co/v1rdFZHuuh
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#RA linked to 40% incr risk of serious dental Infx. National Inpatient Sample (2016-2022) retrospective study of ~15 million adult inpatient records, 10.7K (0.07%) had oral Infx Hosp. Risk factors included RA (1.9%; OR 1.4, male (1.79), Black (1.23), smoking (1.33) https://t.co/pr4Uf6ywJ7
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1,494 Ehrlangen RA pts - machine learning used baseline variables to predict remission at 6 mos. Best/most predictive results w/ AdaBoost modelingdemonstrated strongest accuracy of 85.71% (based on DAS28, Age, VAS and swollen joints. https://t.co/h9UgUKUFo4
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❓️Is early intensive therapy with combination csDMARDs or TNFi superior to standard step care for the treatment of moderate to severe #psoriatic_arthritis?
🅰️ Yes
🔅Check out the SPEED RCT presented by @DrLauraCoates at #EULAR2025
OP0089
@RheumNow
#Strategy
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Sex differences in biologic response in PsA.
DISCOVER-2 post hoc analysis showed:
•Radiographic progression at Week
♂️: 2.22 units
♀️: 1.10 units
•Early ACR-like response (cDAPSA LDA at 8wks) linked to less damage in men (0.39 vs 2.24)
Women less likely to progress https://t.co/hvRxKTMJT5
Dr. John Cush @RheumNow( View Tweet )
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