Charity Dean #RNL2025 Dr. John Cush COVID-19: A sense of failure in the systems that couldn't contain pandemic... "Sparkly hope comes in" - technology revolution emerging. How do use AI revolution Prompted her transition from public health to Silicon Valley

@RhemNow #RNL2025 Treatment of sclerosing skin conditions: Active inflammation? Sclerotic? Atrophic? Target based on activity, depth of involvement and other disease involvement

Morphea subtype: - Circumscribed-oval, round, indurated - Generalized- >4 plaq, >3 cm, 2+ body sites. Note: Pansclerotic affects trunk but spares fingers - Linear- linear plaques at face, scalp, extremity. Predominant in peds - Mixed Any can be deep involvement Dr. John Cush #RNL2025

How do you know if Morphea is active? -Erythema -Peripheral induration -New lesions in the past few month Non-active damage? - Dermal atrophy -SQ atrophy -Hyperpigmentation -Skin thickness center #RNL2025 Dr. John Cush

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 transfer #RNL2025 Dr. John Cush

Do drugs stop structural damage in AxSpA? -NSAID use: In pts w nml CRP, no effect of NSAID on progression. In high CRP, conflicting res -TNFi studies v historical controls- but diff b/l Observational studies suggest benefit -SURPASS: SEC v ADA- non-sign mSASSS #RNL2025 Dr. John Cush

New for HS - Bimekizumab is 3rd FDA approved therapy based on BE HEARD 1&2 - Other approved ADA (2015, PIONEER 1&2), SEC (2023, SUNRISE/SUNSHINE) Clinical trials: IL23 failed, ILalpha failed Brodulamab (IL17a) clinically meaningful response TNF trials Dr. John Cush #ACR2025

Axial PsA: 1/3 of patients can have spondylitis without sacroiliitis Sacroiliitis less frequently bilateral in axPsA, sacroiliitis less severe - Consider screening spine for AxPsA even if no inflammation in SI joints Catherine Bakewell Dr. John Cush #ACR2025

Pregnancy is 🔥 inflammatory Hard to interpret MRI of SI joints in setting of pregnancy Ideally, don't score MRI during pregnancy or 1 year afterwards, would be affected by the pregnancy If needed for clinical eval, focus on structural lesions like erosions #RNL2025 Dr. John Cush

EGPA #RNL2025 Dr. John Cush Wechsler EGPA stages: Stage 1: initial allergic diathesis (rhinits) -> asthma 2: peripheral blood eosinophilia, eo infiltration in organs 3: terminal vasculitic stage: necrotizing vasculitis and granuloma Develops over yrs, can be months

EGPA #RNL2025 Dr. John Cush Wechsler: historical Rx- steroids, steroids, steroids. Recurred with w/d What else? Previously few trials -AZA non-severe EGPA: no signif benefit -Mepolizumab: IL-5i - better remission, less steroids -Benralizumab - MANDARA H2H non-infer v MEP

CTA or MRA for extracranial GCA? 2021 ACR-VF G/L: no pref 2023 EULAR LVV: U/s of axillary arteries & PET >MR or CT 2020 British Society: no pref given Rennie Rhee screening - CTA C/A/P: better res than MRA/PET, deeper arteries than u/s, less $, shorter time #RNL2025 Dr. John Cush

How do screen for extracranial disease in GCA? Who's gonna win the Big Game🏈? #RNL2025 Dr. John Cush

PET/CT - different in rheumatology than oncology! For Large vessel vasculitis: Wait 2 hours b/w FDG infusion and image acquisition for best results, affected by glucocorticoids Persistent vascular uptake seen during remission #RNL2025 Dr. John Cush Rennie Rhee

#Act4Arthritis #FlyEaglesFly American College of Rheumatology ACRheumDC Dr. John Cush Go birds

In this episode of Rheum for Everyone, Bharat Kumar, physician editor, talks about isolation & its impact on our patients with #rheum disease, & the rheumatologist’s role in combatting it. Watch → acr.tw/4hYelse

Excited to join this great team to make controversial decisions loved by everyone! #RheumMadness