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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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Treatment of pyoderma gangrenosum is clinically empiric. Full read ref w/ Graded Rx Recommendations: - 1st line: Steriods or Cyclosporin - Consider biologics: TNFi, IL-1, IL-12/23, IL-17, IL-23 - Others: MTX, MMF, AZA, Dap, colchic, thalidomide, IVIG https://t.co/uMJyfFzsRB https://t.co/vw4VqbjZWh
Dr. John Cush @RheumNow( View Tweet )
Jun 25, 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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JAK Janus

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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covid coronavirus virus

Spondyloarthritis and COVID-19

Jun 15, 2022

There are still questions surrounding COVID-19, and some common questions I receive from patients revolve around what to do with their current DMARDs or should they even start treatment during this pandemic. Two studies focused on this question. 

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450 axSpA pts followed 2868 Pt-yrs, 48% on TNFis. TNFi Rx pts had reduced CV risk (HR 0.30; 0.10–0.85), but no longer signif after adjustment for CRP, ESR (HR 0.37, 0.12–1.12, p = 0.077). Reduced CV risk, may not be specifically due to TNFi use https://t.co/mVHYn3PteL https://t.co/bgKWreBL8z
Dr. John Cush @RheumNow( View Tweet )
Jun 14, 2022
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ACR Applauds FTC Decision to Investigate PBM's

ACR Press Release
Jun 13, 2022

The American College of Rheumatology applauds the Federal Trade Commission’s decision to investigate the business practices of pharmacy benefit managers (PBMs), which continue to increase PBM profit margins while placing the burden of skyrocketing drug costs on America’s most vulnerable

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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.https://t.co/LHZTVZh4AK https://t.co/2SlxrG7UpQ
Dr. John Cush @RheumNow( View Tweet )
Jun 13, 2022
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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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Gender

Time to consider gender stratification in AxSpA diagnosis and management

Differences across genders in many aspects related to rheumatic diseases diagnosis, phenotyping, trajectories definition and prediction of response to treatment have been overlooked. Two abstracts have shed light on relevant gender-based differences in AxSpA assessment or treatment.

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#ClinicalPearl Oral Surveillance chance of having a MACE was highest....you guessed it, in those with past MACE events. Some CV risks have different risks ex HTN May have less risk vs high cholesterol @RheumNow @eular_org #EULAR2022 POS0237 https://t.co/kTn4rxMlej
Jun 05, 2022
Axial Spondyloarthritis

Update on Axial SpA at EULAR 2022

Jun 04, 2022

This year at EULAR 2022, there were important and interesting topics in Axial Spondyloarthritis (AxSpA). These are my picks of abstracts from the conference.

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Malignancy risk on b/tsDMARDs in patients with prior malignancy history

Jun 04, 2022

For autoimmune patients with a history of malignancy, the initiation of biologic or targeted synthetic disease modifying agents (bDMARD/tsDMARDs) may provoke concern. While data for biologic medications and malignancy risk has been largely reassuring, clinical trials have often excluded

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We’re in the #EULAR2022 highlights: basic/translational first. Wait, don’t go… because Temra cells are cool. Up in RA pts who are TNFi-IR, & may actually be more than a bystander. Understanding TNFi resistance is path to: predicting it knowing best what to do with it @RheumNow https://t.co/22Y6iinSbH
Jun 04, 2022
McInnes @IainBMcInnes1 et al. Bimekizumab (IL17A/Fi) in PsA. BE OPTIMAL 852 patient RCT vs PBO vs ADA. Looks same for joints, better for skin than ADA (not stat sig) @RheumNow #EULAR2022 LB0001 https://t.co/oKEHJE3tGn https://t.co/H7nPnbEWUB
Richard Conway @RichardPAConway( View Tweet )
Jun 04, 2022
What drives residual pain improvement in #JAKi treated pts? Dunno but #Baricitinib and #Sarilimab showed better pain decrease vs placebo and #Adalimumab. #OP0052 showed both #Tofacitinib & Adalimumab reduced pain more than placebo in PsA & RA if in remission @RheumNow @eular_org
Jun 03, 2022
Michielsens et al T2T tapering of TNFi in AxSpA and PsA. 72% tapered, 28% discontinued TNFi. Month 12 LDA 69% vs 73%.Month 12 dose 53% vs 91%. Flares 85% vs 78%. Needed more NSAID 54% vs 24% and steroid 30% vs 17%. @RheumNow #EULAR2022 OP0261 https://t.co/EDBPOgg4sX https://t.co/ckPqaTdm4B
Richard Conway @RichardPAConway( View Tweet )
Jun 03, 2022
VIGIBASE registry RA 39000+ pts JAKi and 231000+ pts TNFi *No increase in MACEs with JAKi 1.4% vs. 0.9% *JAKi Increase in DVT RR 3.99 and PE RR 3.5 adjusted on age and sex @RheumNow #OP0268 #EULAR2022 #Lupus https://t.co/hiAvKctgky
Aurelie Najm @AurelieRheumo( View Tweet )
Jun 03, 2022
Female PsA patients on TNFi have reduced treatment effectiveness, LDA (vs males). #EULAR2022 POS0077 @RheumNow https://t.co/EwDwxUarNb https://t.co/W5xgQlrnlF
Dr. Rachel Tate @uptoTate( View Tweet )
Jun 03, 2022
Ok to taper? In PsA and AxSpA pts on TNFi, a T2T w/ tapering strategy was non-inferior to a T2T w/o tapering. 69% of tapered group remained in LDA, 73% no-taper group in LDA after 12 months. Taper group did use more NSAIDs, cDMARDs, steroids @RheumNow #EULAR2022 ABST#OP0261

Robert B Chao, MD @doctorRBC( View Tweet )

Jun 03, 2022
Nyam et al. JAK-pot study. >90000 treatment courses. No difference in aHR for treatment stop due to adverse events in JAKi vs TNFi or non-TNF bDMARD. @RheumNow #EULAR2022 OP0266 https://t.co/3tgADvH1Bq https://t.co/2qLRzfMB9c
Richard Conway @RichardPAConway( View Tweet )
Jun 03, 2022
#EULAR2022 POS0213 Beware of paradoxical low lipids in RA! ⭐️ETN+MTX vs MTX T2T: Early ETN: increased in HLD, lesser LDL, differs from MTX. Correlates with clinical disease activity @RheumNow https://t.co/c6GXadVwYN
Jun 03, 2022
Szekanecz et al. ORAL Surveillance. Geographic differences in MACE largely driven by history CVD and high baseline risk in North America and ROW. @RheumNow #EULAR2022 POS0110 https://t.co/cR6a7N2KP5
Richard Conway @RichardPAConway( View Tweet )
Jun 03, 2022
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