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Rheumatoid Arthritis

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What Worries You, Masters You (7.1.2022)

Jul 01, 2022

Dr. Jack Cush reviews recent news, regulatory and guideline updates from the past week on RheumNow.com.  Studies on methotrexate use, COVID vaccination, Supplements and vitamins, and arthrocentesis despite anticoagulation are discussed.




  1. FDA approved Abbvies risakizumab-rzaa

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Novel Anti-TNF Shines in Rheumatoid Arthritis Trial

MedPage Today
Jun 30, 2022

A new way of inhibiting tumor necrosis factor (TNF) for treating rheumatoid arthritis showed strong results in a phase II/III clinical trial, researchers said.



About 75% to 80% of patients receiving an investigational agent called ozoralizumab achieved 20% reductions in symptoms by

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Study of new onset #RA & undiff arthritis pts starting Rx 2005-2010; mean F/U 104 mos, 11% died. Steroids (<7.5/d) given to 44% initially, ultimately 57% w/ 20% recv >7.5/d. Steroids did not increase mortality (HR 1.35 ; 0.74, 2.47) or hospitalization https://t.co/KNpobs1UwH https://t.co/sjddMBKOeE
Dr. John Cush @RheumNow( View Tweet )
Jun 27, 2022
It's time to exonerate methotrexate in causing or exacerbating fibrotic interstitial lung disease in #RA patients https://t.co/AuEIWn8Pc4 https://t.co/razVTF6fFX
Dr. John Cush @RheumNow( View Tweet )
Jun 27, 2022
Metanalysis of 7 studies shows that oral anticoagulants need not be discontinued for joint injections or aspiration. Only pts w/ hemorrhage after 5427 procedures, over 32-yrs. INR values of 3 bleeding cases was 1.9, 2.3, and 3.4. https://t.co/pCxDqzXGHQ https://t.co/ExZkXSliFo
Dr. John Cush @RheumNow( View Tweet )
Jun 26, 2022
Modest Benefits of Diet on Arthritis A EULAR taskforce reviewed the literature on the effects of diet and lifestyle behaviors in RMDs, and found little evidence suggesting dietary factors can substantially affect the outcomes in people with RMDs.https://t.co/D31l7dlq9v https://t.co/Kt80Yp74ro
Dr. John Cush @RheumNow( View Tweet )
Jun 26, 2022
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Two Week Methotrexate Hold with COVID-19 Vaccination

Jun 24, 2022

A cohort study of rheumatoid arthritis (RA) patients evaluated immunogenicity of COVID vaccination with and without holding methotrexate (MTX) for and 2-weeks and showed better immunogenicity, but more RA flares with the second MTX withdrawal. 

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Japanese claims data study looked at hospitalizable infections (SIE) in RA pts based on age: young (16-64 y), old (65-74y), very old (>75y) and showed age related increase in SIE - 3.2, 5.0, and 10.1 SIE/100PY, respectively. (#s unaffected by biologic use)https://t.co/deaGy3g0Ai https://t.co/2A5mB8n4FK
Dr. John Cush @RheumNow( View Tweet )
Jun 23, 2022
Military biobank of serial serum samples was used to identify biomarkers of imminent RA (vs reactive arthritis or healthy controls). Soluble programmed cell death receptor-1 (sPD-1) best predicted seropos. RA w/in 6mos of Dx. Specif >89%; sensitivity 48% https://t.co/djOGhLeCIi https://t.co/DzKqwteQku
Dr. John Cush @RheumNow( View Tweet )
Jun 23, 2022
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Burnout Threatens the Rheumatology Workforce Conundrum

Jun 21, 2022

There is a shortage of rheumatologists in Canada and the recent 2020 Canadian Rheumatology Association (CRA) Workforce and Wellness study shows that the shortage may be compounded by rheumatologist burnout, especially among young and female physicians. 

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CC Genotype and Thiopurine Toxicity

Jun 20, 2022

Annals of Internal Medicine reports that thiopurine toxcicity risk is associated with the "CC" genotype and that azathioprine discontinuation was associated with hematopoietic toxicity and lower thiopurine doses. 



Prior studies have shown that azathiprine (AZA) use is associated with

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#EULAR2022 has concluded but you can find all our coverage here https://t.co/s62OVJPQ86 https://t.co/QAvPQYCABj
Dr. John Cush @RheumNow( View Tweet )
Jun 18, 2022
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Two Week Twitter (6.17.2022)

Jun 17, 2022

Dr. Jack Cush does a 2-week review of RheumNow Tweets on news and journal citations worth noting, along with some opinions on Telehealth, manpower, monkeypox and the price of drugs.




  1. Although Rheumatology currently ranks 2nd or 3rd in specialty use of telemedicine - the vast

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Not All RA Drug Classes Are Created Equal

MedPage Today
Jun 16, 2022

Clear differences were apparent among the three major types of targeted medications for rheumatoid arthritis (RA) in a large European registry study.



For one, patients using inhibitors of the Janus-associated kinase (JAK) pathway were more likely to stop them because of adverse

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Balance and falls studied in 228 #RA pts (24-85 yrs) followed x 1yr; 20% had at least one fall; risks included Age (OR 1.04), HAQ (OR 1.62), low FICSIT-4 score (OR 2.38) & 1-leg standing (OR  2.14). 1-leg stand is a good screening tool https://t.co/u9v8unC0gA https://t.co/oD0sgFxiQm
Dr. John Cush @RheumNow( View Tweet )
Jun 16, 2022
Small study 34 biologic-naive RA pts starting abatacept. Remission achieved 47.1% of early and 23.5% established RA. Remission @ 6 mos predicted by Baseline LOWER IL-6 levels ≤ 8.4 pg/ml, (66.7%) and CD4+CD25+FoxP3+ cells ≥ 6% (83.3%) https://t.co/N93E9M4M15

Dr. John Cush @RheumNow( View Tweet )

Jun 16, 2022
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JAK/STAT pathway in pyoderma gangrenosum: a new therapeutic highway?

Pyoderma gangrenosum (PG) is rare, but often associated with different forms of arthritis, in particular rheumatoid arthritis and inflammatory bowel diseases. 

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There are 494K PCPs in the USA, While up to 1/3 will "refill" DMARDs, only 6-9% are confident or knowledgeable in "initiating" DMARD therapy in #RA. GIGANTIC NEED FOR PCP education in MSK & Rheum Dz https://t.co/VjgWWDt3nX https://t.co/dTRXxsrzG5

Dr. John Cush @RheumNow( View Tweet )

Jun 16, 2022
Study of interferon (IFN) gene signature (IGS) finds IGS elevated in half of early RA pts; high IGS portends higher DAS28, fewer EULAR good resp & higher IFN-α; the latter assoc w/ epigentic changes, more lymphoctye activation. IFN-α as a biomarker? https://t.co/BHC98OR30A https://t.co/SRE7KVaoha
Dr. John Cush @RheumNow( View Tweet )
Jun 15, 2022
GLORIA Study Pred vs PBO in >65yrs RA x 2 years. 451 Pts & DAS28 4.5. 79% on DMARDs (14% biologics) Upside: Lower DAS28 -0.37 & less Xray progression -1.7 Sharp units Downside: 24% more AE (mild infxns), signif.small lowering of lumbar BMD -1% You Decidehttps://t.co/RRq0WcFsXz https://t.co/xLxjPPSMhh
Dr. John Cush @RheumNow( View Tweet )
Jun 13, 2022
CV risk factors not equal when considering magnitude of risk What can we learn from Oral Surveillance? The Oral Surveillance trial has almost become a household word for rheumatologists.https://t.co/LHZTVZh4AK https://t.co/2SlxrG7UpQ
Dr. John Cush @RheumNow( View Tweet )
Jun 13, 2022
Can we stop RA before it happens? Rheumatologists have long hoped and wondered whether the right type of early intervention could prevent RA occurring in at-risk individuals. https://t.co/vU4tRr7UJh https://t.co/cikU9pwaiT
Dr. John Cush @RheumNow( View Tweet )
Jun 10, 2022
Watch: RA Potpourri on Day One EULAR 2022: Not An Ugly Ducklinghttps://t.co/Lp25lP6ZZY https://t.co/wd5GCbaCLR
Dr. John Cush @RheumNow( View Tweet )
Jun 10, 2022
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EULAR 2022 Top 10 Abstracts (6.10.2022)

Jun 10, 2022

Dr. Jack Cush reviews the top abstracts from EULAR 2022  As chosen by me with the  aid of the RheumNow EULAR faculty. “Top” is relative and subjective, but my criteria for inclusion are based on impact, water cooler talk potential, innovation and social media buzz.  Speaking of social media

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CV risk factors not equal when considering magnitude of risk

What can we learn from Oral Surveillance?



The Oral Surveillance trial has almost become a household word for rheumatologists.



To recap, it was an FDA-mandated, open-label, randomized controlled trial that had high CV risk patients with active RA, on background stable dose

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