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Heavy Metal Rheumatology (9.23.2022)

Sep 23, 2022

Below are this week’s highlights from RheumNow, as discussed by Dr. Jack Cush. Thanks to all of you for your kind comments and great reviews of our weekly podcast. Please let us know how we can improve by emailing me or recording your suggestion using the "Ask Cush Anything" link on our website

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Is PMR the Next Indication for Tocilizumab? About half of patients with steroid-dependent PMR were able to get off steroids altogether when they were started on tocilizumab (Actemra) infusions, a randomized phase III trial showed.
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CD19 CAR T Cell Therapy in SLE (9.16.2022)

Sep 16, 2022

The big news this week: the approval of deucravacitinib (a new class of drug?) for psoriasis; the 2022 ACR guidance on glucocorticoid-induced osteoporosis; a national poll of older adults over the age of 50 who claimed self-reported or doctor-diagnosed arthritis; and much more. Let's review

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2022 New ACR Guidance on Glucocorticoid-Induced Osteoporosis (GIOP)

Sep 14, 2022

The ACR has updated this guideline and includes recommendations on abaloparatide (PTHrP) and romosozumab, which are newly available since the ACR’s 2017 GIOP guideline.

It also addresses sequential therapy, which was not addressed in the past. Patients need to understand that when

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In a nutshell, reducing glucocorticoids in #SLE patients is associated with a number of important clinical benefits and may impact risk of other comorbidities such as BP and infection risk.

NICE Guidelines on Gout Diagnosis and Management

Aug 31, 2022

NICE (UK) has systematically reviewed current medical evidence and delivered a set of recommendations with consideration of cost effectiveness.

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Bullous Systemic Lupus Erythematosus

Aug 24, 2022

Bullous systemic lupus erythematosus (BSLE) is a rare blistering cutaneous manifestation of systemic lupus erythematosus (SLE).

As goes SLE, bullous disease typically affects women, especially those of African descent.

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Hit Parade Review (8.12.2022)

Aug 12, 2022

We've got a lot to discuss this week: psoriasis; fatigue; sleep; sural nerve biopsies; uveitis and SpA; diet and RA; tofacitinib and the ORAL surveillance study; what not to take with mycophenolate - and more. In what order should these items be discussed? This week the run down is based on

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Cytomegalovirus Increases Thromboembolism Risk in ANCA-associated Vasculitis

Aug 11, 2022

Infection may play an important role in the genesis of vasculitis and ANCA seropositivity; this report suggests that past cytomegalovirus infection may be a risk in the occurrence of venous thromboembolism (VTE) in patients with anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis. 

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Increased Mortality in Giant Cell Arteritis

Aug 09, 2022

A population-based study from Ontario, Canada suggests an increased mortality risk in patients with giant cell arteritis (GCA), according to a recent report in Arthritis Care & Research.

A health administrative data study looked at 22,677 GCA patients (≥50 years of age)

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The Great Unknowns (8.5.2022)

Aug 05, 2022

Dr. Jack Cush reviews the news, FDA approvals, journal articles from the past week on RheumNow; plus viewer questions. This week great hopes for vitamin D, the great unknows of CSA and the great big mess that is the gout.

  1. 521 clinically suspect arthralgia (CSA) pts were

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ACR Updated Guideline on Vaccinations for Rheumatic Patients

Aug 04, 2022

The ACR has posted a new ACR Clinical Practice Guideline Summary providing recommendations on the use of vaccinations for children and adults with rheumatic and musculoskeletal diseases (RMDs).

This guideline builds on past

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RA erosions bone ACR

The Approach to Difficult to Treat Rheumatoid Arthritis

Aug 03, 2022

Tan and Buch have reviewed the approach to difficult to treat rheumatoid arthritis (D2T-RA), with a new EULAR definiation of D2T-RA to foster an approach rationale and concideration of treatment options.

D2T-RA is defined by failure of at least two different mechanism of action

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Supplemental Vitamin D Fails to Lower Fracture Risk

Aug 02, 2022

NEJM has published study results showing that vitamin D3 supplementation does not significantly lower fracture risk (vs. placebo) when used in generally healthy adults.

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Not Still’s – Now What?

Jul 29, 2022

Your patient doesn't meet criteria for Still’s disease (AOSD or sJIA), now what should you do or consider?

What you do or consider next can be addressed according to the stage of current disease: A) Hospitalized Febrile Disease, or B) Outpatient “Still’s” Disease.

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Approach to ILD in Myositis Syndromes

Jul 28, 2022

Mehta et al have published a full read review of managing interstitial lung disease (ILD) in patients with inflammatory myopathies, a heterogeneous group of syndromes connected by ILD and and increased morbidity and mortality risk.

They divide myositis-ILD into three main prognostic

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syringe, pill, DMARD, Treatment, therapy

Treatment Options for Still's Disease

Jul 22, 2022

Are you treating “systemic” or “articular” (arthritis) Still’s disease? Most Still’s patients have a dominance of one or the other. With certainty, the right therapy for the right symptoms can be chosen. What about patients who have an incomplete or no response, or who become unresponsive to a

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Early, Aggressive and Seropositive (7.22.2022)

Jul 22, 2022

Dr. Jack Cush covers the news and journal reports from the past week on This week we have Insights NAFLD, overdose deaths, septic arthritis, refractory stills, & when MTX doesn’t work.

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Fever Pitch (7.15.2022)

Jul 15, 2022

Dr. Jack Cush reviews the new studies and drug approvals and new insights into febrile disorders from the past week on

  1. Ustekinumab (IL-12/23i) phase 2 study was successful in #SLE; but the phase 3 LOTUS study of 512 pts, UST was NOT superior to PBO (SRI-4 44% v

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Still’s Disease FAQs

Jul 14, 2022

What is the classic 'triad' of Still's disease? Does it affect males and females equally? What are typical lab findings? Which drugs are effective at treating Still's, and as importantly, which ones are not? What about complications? Read on for these and other FAQs regarding Still's disease.

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MRP8/14 as a Biomarker in Systemic Juvenile Idiopathic Arthritis

Jul 13, 2022

A large cohort study of children with febrile disorders has demonstrated the diagnostic utility of Myeloid-related protein 8/14 (MRP8/14) in diagnosing systemic JIA patients (SJIA) in clinical practice.

A cohort of 1110 febrile pediatric patients were divided into two cohorts: (cohort

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Rituximab Induction and Maintenance in Older ANCA–Associated Vasculitis Patients

Jul 13, 2022

A cohort study suggests that rituximab (RTX) use among patients 75 years and older with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) is efficacious but also has a high risk of serious adverse events, likely related to associated steroid use and the advanced age of

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Viscosupplementation Ineffective in Knee Osteoarthritis

Jul 13, 2022

The BMJ has published the results of a metanalysis showing strong conclusive evidence that viscosupplementation in knee osteoarthritis (kOA) has minimal effects on kOA pain, and also reveals strong evidence of an increased risk of serious adverse events. 

The review encompassed 169

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Steroid Injection for Chronic Achilles Tendinopathy

MedPage Today
Jul 12, 2022

Adding a corticosteroid shot to exercise therapy significantly improved symptoms of chronic Achilles tendinopathy, a 100-person randomized trial found.

At 6 months, mean improvement from baseline on the Victorian Institute of Sports Assessment-Achilles (VISA-A) scale was a significant

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ICYMI: 2021 Rheumatology Year in Review

Jul 08, 2022

For 2022, let's look our top 10 list of advances, game-changers, worries and those better medical practices that evolved during 2021.

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