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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Practice Metrics Use by Rheumatologists in RA. 54% of Rheums do "some" measure, Most used: HAQ 36%, RAPID3 27%, CDAI 18%, Vectra 13%. More than 35% do NOT measure
https://t.co/FOlyCSFF25 https://t.co/3S36tDlgcE
Dr. John Cush @RheumNow( View Tweet )
RA-ILD at Higher Risk for Serious Infection and Death
A prospective, multicenter study from Spain has demonstrated higher rates of mortality and serious infection in rheumatoid arthritis–associated interstitial lung disease (RA-ILD) patients.
https://t.co/cjmcNi0ZqL https://t.co/wUXNWNeyOa
Dr. John Cush @RheumNow( View Tweet )
Retrospective study of hand/feet Xrays in early/suspected #RA due to low prevalence of erosions (4.4%) seldom leading to change in Dx (2pts; 0.3%) or prognosis change (0.4%). Seronegative had less erosions; Longer Sxs not assoc w/ erosions https://t.co/YCj04ZlQJq https://t.co/fHf6EvGOyc
Dr. John Cush @RheumNow( View Tweet )
RA-ILD at Higher Risk for Serious Infection and Death
A prospective, multicenter study from Spain has demonstrated higher rates of mortality and serious infection in rheumatoid arthritis–associated interstitial lung disease (RA-ILD) patients.
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ICYMI: Top 5 Clinical Pearls in RA Management
https://t.co/zWRXzHTtIo https://t.co/rbitB9oWQG
Dr. John Cush @RheumNow( View Tweet )
Canadian OBRI study in 692 RA pts shows pts treated w/ triple DMARD (MSH) stayed on Rx longer (15 mos) compared to MTX+LEF (9.6 mos); not significant but MTX/SSZ/HCQ had signif lower DAS28 @ 6 mos (3.4 vs 3.9) & at 12 mos (3.2 vs 3.5, p=0.0005) https://t.co/ieHeXvgj3n https://t.co/MEMA1nrUpy
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Dr. John Cush @RheumNow( View Tweet )
Korean National Insurance claims study (2010-18) of NSAID use and CV events found among 19,775 RA pts (F/U 98290 PYs); there were 1663 cases of CV evens. Increasing NSAID doses incr incident CVD(adjHR 1.10); including CVA (aHR 1.09). CHF (aHR 1.12) https://t.co/mdRKYMQq1s https://t.co/36i2KT4j5A
Dr. John Cush @RheumNow( View Tweet )
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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In RA, previously affected Jts more likely to flare ("joint-specific memory") ?mediated by synovial resident memory T cells, predominantly CD8+ T cells, with a restricted TCR repertoire, responding to specific Ags by releasing chemokines & cytokines https://t.co/VfFZ03yZYL https://t.co/npX3TGDe5A
Dr. John Cush @RheumNow( View Tweet )
World Congress on OP, OA & MSK Disorders
EurekAlert!
Bone and musculoskeletal disease researchers and physicians from around the world will meet today in London, UK for the opening of the largest scientific event in the field, the World Congress on Osteoporosis, Osteoarthritis and
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Canadian OBRI study in 692 RA pts shows pts treated w/ triple DMARD (MSH) stayed on Rx longer (15 mos) compared to MTX+LEF (9.6 mos); not significant but MTX/SSZ/HCQ had signif lower DAS28 @ 6 mos (3.4 vs 3.9) & at 12 mos (3.2 vs 3.5, p=0.0005) https://t.co/tuIigaswDK https://t.co/DAh3lgRufA
Links:
Dr. John Cush @RheumNow( View Tweet )
Expert Review
Rheumatoid Arthritis: The Continuum of Disease and Strategies for Prediction, Early Intervention, and Prevention
📰 https://t.co/JfkO8WpELc
#rheumatoidarthritis #prediction #prevention https://t.co/3xqHalhjCV
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The Journal of Rheumatology @jrheum( View Tweet )
Staph. aureus bacteremia (SAB) is assoc w/ poor outcomes & Osteoarticular infection. Danish study of 18 274 SAB pt (367 w RA). 90d SAB risk in RA was 23% vs 12.5% in non-RA (HR 1.93). Higher w/ Jt implants (29%) & TNFi use (42%). 90d Mortality was 35% https://t.co/hjaPnTbE0E https://t.co/7t7omiUVYf
Dr. John Cush @RheumNow( View Tweet )
13 Risk Factors for RA-associated Interstitial Lung Disease (ILD)
ILD is the most widespread and fatal pulmonary complication of rheumatoid arthritis (RA). A recent metanalysis shows the pooled prevalence of RA-ILD was approximately 18.7%.
https://t.co/x1YFv0ZlL9 https://t.co/XGeilz2tus
Dr. John Cush @RheumNow( View Tweet )
Pearl: Three "S" Rule (Smoking, Seropositivity, Sex/Male): if present the risk of RA-UIP (ILD) goes up nearly 13 fold (ACR23 Abstract 1269) https://t.co/2YFosInpGs https://t.co/rOVN79JJRz
Dr. John Cush @RheumNow( View Tweet )
How do you communicate risk/benefit to patients? @RADoctor's recent publication highlighted by Dr. H. Gabalawy at #RNL2024
-Increase awareness
-Include numbers for context
- Make it easy for patients to understand those numbers
-Use absolute risks
- Avoid 1 in X format
Dr. John Cush @RheumNow( View Tweet )
Aging in RA: "(RA is due to a poorly functioning immune system which increases a patients risk of CVD, infection, and cancer. The aging immune system additionally affects this process.
Dr. John Cush @RheumNow( View Tweet )
"#RNL2024
Brittany Weber on Cardio-Rheumatology:
""Everything has changed"" on inflammation and CVD
- Canakinumab 150 mg v PBO HR 0.85, p =0.02
- Colchicine v PBO HR 0.69, P<0.001
2023: FDA approval for colchicine as 1st anti-inflammatory for reducing CV events
Dr. John Cush @RheumNow( View Tweet )
1/600 Falls May Die (4.5.2024)
Dr. Jack Cush reviews the news and Journal reports from this past week on RheumNow.com - including problems w/ falls, pain and treatment of Dupuytren’s contractures.
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ICYMI: Top 5 Clinical Pearls in RA Management
RheumNow Live 2024 provided a wealth of clinical insights, particularly in the realm of rheumatoid arthritis (RA) management. Here are the top five clinical pearls from the event's opening session, "Success in Rheumatoid Arthritis."
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#RNL2024
ASCVD Risk Calculators underestimate risk in patients of RA
Inflammatory disease was added as a "risk enhancer" in 2019 update
"A low ASCVD and/or absence of symptoms may be not be reassuring" https://t.co/Cz1LRda9xx
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Dr. John Cush @RheumNow( View Tweet )
soluble Fms‐like tyrosine kinase‐1 (sFlt-1)/placental growth factor (PlGF) ratio, biomarkers of placental function and adverse pregnancy outcomes. Study of 158 RA pts, 1/2 on TNFi during Preg. TNFi assoc w/ incr birthweight; no effx on sFlt‐1 & PlGF https://t.co/JFvDxrTAfr https://t.co/CRxSEbm2Ru
Dr. John Cush @RheumNow( View Tweet )
ICYMI: Eating for Rheumatoid Arthritis
The majority of practicing rheumatologists at RheumNow Live were unaware of the new ACR guidelines issued in 2022 regarding dietary and lifestyle recommendations for patients with Rheumatoid Arthritis (RA) (1).
https://t.co/0Z1lYzsxuI https://t.co/2atX1B4hQb
Dr. John Cush @RheumNow( View Tweet )
Metrics Used by Rheumatologists in RA
https://t.co/Lfzqdzehb7 https://t.co/uc5WTIdbTY
Dr. John Cush @RheumNow( View Tweet )
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