Great conversation with Laura Cappelli about IRAEs! Everything you ever wanted to know but were afraid to ask! #rheum #MedEd #Cancer

How many rheumatology patients have you discussed palliative care?

Glad there was a great session at #ACR2023 on this. I recapped it with Hopkins Bayview IM Residency Dr David Wu for Dr. John Cush

m.youtube.com/watch?v=4G87mV…

Very proud of Children's Hospital #pedsrheum fellow Dori Abel, MD for this beautifully written letter in@PhillyInquirer about the absolutely unconscionable rigamarole that is insurance prior authorization.
inquirer.com/opinion/commen…
American College of Rheumatology
American College of RheumatologyDC
CARRA

The low down on calcium & vit D supplementation:
🔅Persons on PPIs and H2 antagonists should take Ca CITRATE bec Ca carbonate needs gastric acid secretion
🔅Take note of values used for Vit D: 100IU will ⬆️ 25(OH) Vit D by 0.7-1ng/ml
𝓛𝓲𝓼𝓪 t. 🐳🗺🧭
#osteoporosis #onePRA2024

For #osteoporosis management, drugs are not enough because they do not reduce fall risk.
#Sarcopenia should also be addressed.
#OnePRA2024

#RheumMadness 2024 is here!

This year, we are getting practical with 16 teams vying to be named the most practically useful rheumatology article in this year's tournament.

👇Learn more on our website 👇
sites.duke.edu/rheummadness/

Or just read this 🧵 (1/7)

Dr. Danda’s loss is deeply mourned throughout the medical community. His work changed the lives of many patients with rheumatological conditions.
We at Myositis India extend our heartfelt condolences to his family, and strive to carry forward his legacy of service and healing.

Today is #RheumatoidAwarenessDay – take action & help raise awareness by educating lawmakers in your state on the importance of CSRO's issues.  Visit our Action Center to learn more and send a message to your elected officials today: votervoice.net/CSRO/Campaigns… #RheumDay

#RNL2024 Dr. John Cush
Mike Putman: Myths on AAV
*RTX (not necessarily) > than CYC for relapse
*PLEX (still) indicated for (some) AAV
*Pts on avacopan need (some) corticosteroids
*Avacopan >> to steroids at 52w (w/ inadequate treatment)
*Pt should get steroid taper fitting their disease

Which rheumatology word would you like to retire?
#RNL2024 Dr. John Cush

Does adding NSAID to TNFi help prevent radiographic progression?
Lianne
#RNL2024 Dr. John Cush
Adding Celecoxib to TNFi: numerically less progression, but not statistically significant

Vedolizumab-induced enthesitis
Lihi Eder #RNL2024 Dr. John Cush
11/90 (12.2%) of pts on VDZ for IBD w/ develop new-onset enthesitis
Is this true drug rxn or previously masked by prior meds (TNF)?
Usually unilateral +/- oligo, dactylitis
Most respond to NSAID or injxn, 27% change Rx

Enthesitis Lihi Eder
Dr. John Cush #RNL2024
- NSAID - 1st line in mild/isolated
- GC injxn but caution at Achilles
- MTX cond rec by GRAPPA (SEAM PsA)
- All bDMARD work vs PBO (TNFi, IL17, 12/23, 23, JAK, PDE4) - none superior
- IL17 v ADA: higher resol for IXE v ADA, but mixed data

#RNL2024 Dr. John Cush
Lihi Eder on enthesitis
- ~1/3 PsA, SpA
- Enthesitis precedes onset of PsA in PsO, high u/s score ass. w/ RFs (BMI, nail dyst)
- Exam: tenderness (non-specific), as swelling uncommon. U/s helpful, but non-specif
- Marker of severity, higher risk of damage

AS v nr-AxSpA for TNFi - no diff in response
Eric Ruderman Dr. John Cush #RNL2024
ADA: ASAS20 AS 58%, nr-AxSpA 52%, ASAS40 AS 39%, nr 36% (ATLAS, ABILITY-1)
ETN: ASAS 20 59%/52%, ASAS50/40 44%/33% in p3 AS study v EMBARK
CZP: RAPID-AxSpA - no diff bw AS & nr-AxSpA response in same trial

#RNL2024 Dr. John Cush
Eric Ruderman on AxSpA
SPEED study: roughly 1/2 AS have AxSpA, 1/2 have nr-AxSpA
Are they similar:
- Yes, but r-axSpA less F and more abnml CRP
= Low progression of nr-AxSpA to AS - only 26% progressed in mean 10.6 yrs

Cancer and Myositis #RNL2024 Dr. John Cush
LisaChristopherStine on Cancer screening:
Risk stratify: dermatomyositis, NXP2, TIFy, <40yo, refractory, dysphagia, cutaneous necrosis at higher risk
Enhanced risk stratification for those at risks, versus 'basic screening' for lower risks

Cancer and Myositis #RNL2024 Dr. John Cush
LisaChristopherStine
Dermatomyositis risks - TIF1y is highest risk, followed by NXP2
Protective features: childhood onset, ILD, arthralgias
Cancer and myositis often present w/in 1 yr before or after
Cancer is major cause of death

Kavanaugh on Medical Ethics
#RNL2024 Dr. John Cush
Bias in research for ++ outcomes leads to fudging/biased interpretations of results
Fabricated study results submitted to orthopedic journals:
- 97% acceptance for positive result, 80% for no-difference result. Bias towards +outcome

Kavanaugh on Medical Ethics
#RNL2024 Dr. John Cush
How do we informed consent?
- How to fully inform pts in complex research?
- Or paternalistic to not provide detailed info
- How deep to disc risk/ben?
- Easier to study in countries w/o good SoC
Prior hx: prisoners, Nazi, Tuskegee