B Cell Depleters (2.21.2025)
Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.
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Risk Prediction Modeling in MDA5 Dermatomyositis
Patients with Melanoma differentiation-associated gene 5 (MDA5) positive dermatomyositis (DM) are complicated and prone to interstitial lung disease, poor prognosis, and a high
Survey on Corticosteroid (CS) use in PFAPA syndrome included 144 MDs (67% pedi-Rheums); 92% use CS in PFAPA flares. 42% expected a response w/in 12 hrs. 31% use CS ‘routinely. Med literature cites Prednisone as most preferred CS (48%). Response to CS ~ 95% https://t.co/V1wkhNaNAP https://t.co/YILAlKrUcQ
Dr. John Cush @RheumNow( View Tweet )
Eric Dein @ericdeinmd
Active Morphea: - MTX +/- steroids. If not effective, MMF/RTX/ABA - Topicals for circumscribed - Phototherapy Most pts achieve remission in active in 1 year Inactive morphea - Can address with PT, pain rx, psychological support, plastic surgery fat… https://t.co/OMGt8feO0z https://t.co/yWAgY2Z4Ng
Dr. John Cush @RheumNow( View Tweet )
Valentine RNL 2025 Review (2.14.2025)
Dr. Jack Cush reviews highlights from RheumNow Live 2025 held in Dallas, TX on Feb. 8-9, 2025.
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Obinutuzumab Efficacy in Active Lupus Nephritis
A phase 3, randomized controlled trial of an anti-CD20 monoclonal antibody, obinutuzumab, was shown to be effective and safe in patients with active lupus nephritis.
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Break a leg! Or a #hip
#AVN risk occurs even at 1 month of high / moderate dose #glucocorticoids
Shown by Michelle Petri @RheumNow #RNL2025
Risk in SLE is likely
👇
#disease #activity
And
#steroids
#SLE #systemic #lupus #erythematosus #steroids https://t.co/4EsQw9tY1u
Janet Pope @Janetbirdope( View Tweet )
Even a #SLE expert who wants all #lupus Pts on
No #chronic #prednisone
Realizes you can’t get everyone off #glucocorticoids
18% May be on chronic #steroids
But she keeps trying to taper
Michelle Petri
#RNL2025 @RheumNow https://t.co/SNP6Eep731
Janet Pope @Janetbirdope( View Tweet )
M. Petri on Steroids in SLE👇
-Organ damage is higher in AA vs Caucasians-driven by CS
-CV risk increase is dose dependent:
>10 mg =2x risk
>20mg =5x risk
-Increase prednisone by 10mg =30% increased risk for organ damage! 🤯
-20mg/day >1m increases risk for… https://t.co/fZVjS7JQBL
Adela Castro @AdelaCastro222( View Tweet )
Michele Petri @RheumNow #RNL2025
1 mg of prednisone -> 3% increased risk of damage
Taper quickly, withdrawal slowly
Make sure background therapy is on - monitor therapy with HCQ levels, early use of additional Rx https://t.co/pjFNcg99ed
Eric Dein @ericdeinmd( View Tweet )
Drug Naming Games (2.7.2025)
Dr. Jack Cush reviews the news, regulatory and journal reports from the past week on RheumNow.com.
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AGA Guideline: Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals
The American Gastroenterology Association has published its revised clinical practice guidelines for the prevention and treatment of hepatitis B virus (HBV) reactivation in at-risk patients, particularly those with immune-mediated disease, receiving immunomodulatory therapy and steroids.
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Lung Involvement in Still's Disease
A multicentre registry observational study assessed lung involvement in a cohort of Still’s disease patients, affirming pleuritis as most common and that parenchymal lung inflammatory disease is very uncommon in both children and adults.
A total of 90 Still's patients with lung
Steroids and Infection
https://t.co/J8OU6I9410 https://t.co/JwpSrS4ouI
Dr. John Cush @RheumNow( View Tweet )
ICYMI: VITAL Info on Autoimmune Disease (2.9.2024)
Dr. Jack Cush reviews the journal reports from the past week on RheumNow.com. Highlights are summarized by three songs: "Stairway to Heaven", "You're No Good", and "How Long (has this been going on)".
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A Modifiable Vascular Risk in SLE
MedPage Today
Atherosclerosis progression was more than twice as common in younger people with SLE than in healthy controls in a prospective study from Greece, but the rate difference narrowed substantially with sustained SLE remission and conventional cardiovascular risk factor management.
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Best of 2024: Upside/Downside of Steroids in Lupus Nephritis
A systematic review of randomized clinical trials of patients with biopsy-proven lupus nephritis demonstrates both the benefits and harms to early glucocorticoid regimens on lupus outcomes.
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Great table re:side effects of even low dose steroids in RA
Likely generalizes to other diseases ie PMR, SLE
P in prednisone stands for poison!
#ACR24 @RheumNow https://t.co/2bFy6dwl96 https://t.co/YDtjSX054I
Links:
Dr. John Cush @RheumNow( View Tweet )
TAPIR study of continuing vs stopping steroids in ANCA vasculitis in remission. Relapse at month 6 in 16% vs 4%. OR 4.22, but low rate in either group. If treated Rituximab, no difference! Merkel et al. @RheumNow #ACR24 Abstr#0774 #ACRbest https://t.co/F9DOBLrjVq https://t.co/BtphAuEopA
Dr. John Cush @RheumNow( View Tweet )
Best of 2024: Good Clinical Practice Recommendations on Glucocorticoid Withdrawal and Adrenal Insufficiency
Glucocorticoids are widely prescribed as anti-inflammatory and immunosuppressive agents. This results in at least 1% of the population using chronic glucocorticoid therapy being at risk for glucocorticoid-induced adrenal insufficiency. This risk is dependent on the dose, duration and potency of
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Best of 2024: Inadequate Zoster Vaccination in Immunocompromised Patients
A VA study of shows that recombinant zoster vaccine (RZV) vaccination in immunocompromised patients or those receiving immunosuppressive medications is insufficient, given these are high risk individuals.
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Bah Humbug Vitamin D (12.20.2024)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.
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Best of 2024: Determinants of Gout Flares
Approximately 12 million US adults in the US have gout. Two recent literature reports in JAMA and Arthritis Care & Research highlight contributors to gout flares.
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Review of IgA Vasculitis (Henoch–Schönlein Purpura) - the freq of glomerulonephritis is higher in adults than children and tends to present more severely. Rx w/ 1st line steroids, Other agents: Colchicine, dapsone, MTX (Minor dz), CsA, tacrolimus, MMF (steroid sparing)… https://t.co/tB5fll3RfN https://t.co/knc7KesyRj
Dr. John Cush @RheumNow( View Tweet )
ICYMI: Are Emulation Trials a Fantasy?
Are emulation ‘trials’ helpful, despite the biases that occur with observational data, or do they truly mimic the results of randomized controlled trials (RCTs)?
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How would you manage a patient with Overlap (anti-synthetase) syndrome, ILD, polyarthritis and myositis?
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