Podcasts about dmards

On this episode, we evaluate current guidelines and evidence-based treatment strategies for managing rheumatoid arthritis. We compare and contrast the efficacy, safety profiles, and appropriate use of disease-modifying antirheumatic drugs (DMARDs), biologics, and other therapies as well as discuss patient-specific treatment strategies considering factors such as disease severity, comorbidities, and patient preferences.  Cole and I are happy to share that our listeners can claim ACPE-accredited continuing education for listening to this podcast episode! We have continued to partner with freeCE.com to provide listeners with the opportunity to claim 1-hour of continuing education credit for select episodes. For existing Unlimited (Gold) freeCE members, this CE option is included in your membership benefits at no additional cost! A password, which will be given at some point during this episode, is required to access the post-activity test. To earn credit for this episode, visit the following link below to go to freeCE's website: https://www.freece.com/ If you're not currently a freeCE member, we definitely suggest you explore all the benefits of their Unlimited Membership on their website and earn CE for listening to this podcast. Thanks for listening! If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable PowerPoint slides for each lecture. If you purchase an annual membership, you'll also get a free digital copy of High-Powered Medicine 3rd edition by Dr. Alex Poppen, PharmD. HPM is a book/website database of summaries for over 150 landmark clinical trials.You can visit our Patreon page at the website below:  www.patreon.com/corconsultrx We want to give a big thanks to Dr. Alex Poppen, PharmD and High-Powered Medicine for sponsoring the podcast..  You can get a copy of HPM at the links below:  Purchase a subscription or PDF copy - https://highpoweredmedicine.com/ Purchase the paperback and hardcover - Barnes and Noble website We want to say thank you to our sponsor, Pyrls. Try out their drug information app today. Visit the website below for a free trial: www.pyrls.com/corconsultrx We also want to thank our sponsor Freed AI. Freed is an AI scribe that listens, prepares your SOAP notes, and writes patient instructions. Charting is done before your patient walks out of the room. You can try 10 notes for free and after that it only costs $99/month. Visit the website below for more information: https://www.getfreed.ai/  If you have any questions for Cole or me, reach out to us via e-mail: Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com

QD clinics - lessons from the Clinic brought to you by RheumNow Live 2025 QD 269 CREST or More? https://youtu.be/GSBfr2S9iL4 Is this CREST or Diffuse PSS? Features Dr. Jack Cush.  QD270 Acute Neck & Back Pain https://youtu.be/qWTGvqL9-wY Acute onset febrile, polyarthritis, neck and low back pain Features Dr. Jack Cush.  QD271 - Treating Overlap with ILD https://youtu.be/eR7O-oy_O_g Polyarthritis, ILD, Dermatomyositis - how to treat? Features Dr. Jack Cush.  QD272 - Natural RA https://youtu.be/Ie1u-_KqxVE PsO/PsA patient avoiding DMARDs and Biologics, and wants Natural therapies Features Dr. Jack Cush.  QD Clinics - lessons from the clinic, sponsored by RNL2025 in Dallas, TX; Feb 8 & 9, 2025  Register at RheumNow.live

A New ACR Best Things I Saw Today in PsA Do TNFis and JAKis Prevent Cancer!? Hold or continue JAKi and IL-17 when receiving COVID boosters? JAK-pot! How fast do DMARDs work? JAKi Studies at ACR Poly-treatment of Polymyalgia Rheumatica? RA Roundup: Is LDA Inappropriate? What about Statins for JAKs? RA: One JAK to Rule Them All? SELECT-GCA: Efficacy and Safety of Upadacitinib "SELECT-GCA: Upadacitinib in Giant Cell Arteritis" SELECTing the right patients: upadacitinib in GCA So really, are JAKs Safe? Summary of JAKi Studies The Case for JAKi in PMR The Real Value of JAKi is Beyond RA When, What and How Long to Treat GCA & PMR Worried about CV Risk and JAKi? What about the Steroids?

JAK-pot! How fast do DMARDs work?:Dr. Mike Putman and Dr. Kim Lauper Paraoxonase-1: Possible Biomarker for Progression to RA:Dr. Jonathan Kay Potential Impact of Weight Loss Drugs in Rheumatic Diseases:Dr. Arthur Kavanaugh PREDICT-SpA: Evaluating the influence of gender on disease assessment tools:Dr. Sheila Reyes SELECT-GCA: Upadacitinib in Giant Cell Arteritis:Dr. Mike Putman Too Many CAR-Ts for Horses?:Dr. Pope Transplant-free Survival Predictors in Idiopathic Inflammatory Myopathies-ILD:Dr. Gaby Martinez

On this episode we discuss the diagnosis and management of axial spondyloarthritis.  We begin by defining axial spondyloarthritis (radiographic axial sponyloarthropathy AKA ankylosing spondylitis vs non-radiographic axial sponyloarthropathy) and describe its clinical presentations, etiologies, and pathophysiology. We then compare and contrast the efficacy, safety profiles, and appropriate use of medications including NSAIDs, non-biologic DMARDs, biologics, and JAK inhibitors.  Cole and I are happy to share that our listeners can claim ACPE-accredited continuing education for listening to this podcast episode! We have continued to partner with freeCE.com to provide listeners with the opportunity to claim 1-hour of continuing education credit for select episodes. For existing Unlimited (Gold) freeCE members, this CE option is included in your membership benefits at no additional cost! A password, which will be given at some point during this episode, is required to access the post-activity test. To earn credit for this episode, visit the following link below to go to freeCE's website: https://www.freece.com/ If you're not currently a freeCE member, we definitely suggest you explore all the benefits of their Unlimited Membership on their website and earn CE for listening to this podcast. Thanks for listening! If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable PowerPoint slides for each lecture. If you purchase an annual membership, you'll also get a free digital copy of High-Powered Medicine 3rd edition by Dr. Alex Poppen, PharmD. HPM is a book/website database of summaries for over 150 landmark clinical trials.You can visit our Patreon page at the website below:  www.patreon.com/corconsultrx We want to give a big thanks to Dr. Alex Poppen, PharmD and High-Powered Medicine for sponsoring the podcast..  You can get a copy of HPM at the links below:  Purchase a subscription or PDF copy - https://highpoweredmedicine.com/ Purchase the paperback and hardcover - Barnes and Noble website We want to say thank you to our sponsor, Pyrls. Try out their drug information app today. Visit the website below for a free trial: www.pyrls.com/corconsultrx We also want to thank our sponsor Freed AI. Freed is an AI scribe that listens, prepares your SOAP notes, and writes patient instructions. Charting is done before your patient walks out of the room. You can try 10 notes for free and after that it only costs $99/month. Visit the website below for more information: https://www.getfreed.ai/  If you have any questions for Cole or me, reach out to us via e-mail: Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com

In this insightful episode, host Dr. Sebastian Herrera delves into the critical topic of comorbidities and related conditions in psoriatic disease, alongside experts Professor Kurt de Vlam MD, PhD, Head of Clinic Rheumatology at the University Hospitals Leuven in Belgium and Dr. Alexis Ogdie, MD, MSCE, Associate Professor of Medicine and Epidemiology at the University of Pennsylvania in the United States.What's inside this episode?Understanding Comorbidities vs. Related Conditions: Discover the distinctions between these two critical aspects and why it's important to differentiate them in psoriatic disease management.Expert Insights: Hear about the influence of comorbidities on treatment choices and patient outcomes.Impact on Treatment: Learn how related conditions and comorbidities affect therapeutic decisions, including the selection of DMARDs.Patient Care: Explore the importance of a comprehensive approach to treating psoriatic disease, addressing both the primary condition and associated health issues.Key Points & Highlights:Definitions and Importance: Clear definitions of comorbidities and related conditions, and their significance in the clinical setting.Treatment Influences: How the presence of comorbidities can alter the choice of therapies and the necessity of personalized treatment plans.Common Comorbidities: Discussion on obesity, cardiovascular disease, depression, and more, and their implications for patient care.Future Directions: The need for ongoing research and proactive management strategies to improve patient outcomes.Why listen?Educational Insight: Gain a deeper understanding of how comorbidities and related conditions impact psoriatic disease.Expert Opinions: Benefit from the knowledge and experience of leading specialists in the field.Comprehensive Care: Learn about the holistic approach to managing psoriatic disease, ensuring better quality of life for patients.Stay Connected:For more intriguing insights and episodes, visit our website. Don't forget to subscribe to Inside GRAPPA for more episodes like this. Share with your colleagues and friends who might benefit from this episode! Hosted on Acast. See acast.com/privacy for more information.

In Escape Rooms müssen die Spieler*innen gemeinsam Rätsel lösen um aus einem geschlossenen Raum zu entkommen. Dr. Myriam Reisch und Dr. David Kickinger (Abteilung für Rheumatologie und Immunologie, MedUni Graz) entwickeln seit einigen Jahren medizinische Escape Rooms: Auf der Jagd nach dem letzten Cortison im Krankenhaus etwa lernen die Teilnehmer*innen ganz nebenbei das Erheben des Gelenkstatus, den Umgang mit Impfungen und DMARDs, den Ultraschall von Gefäßveränderungen im Rahmen einer Vaskulitis etc. Nach 60 Minuten haben die Spieler*innen das Erblinden der (fiktiven) Patientin verhindert und erlebt, dass jeder Mitspieler einen wichtigen Beitrag zur Lösung leistet. Außerdem hatten sie Spaß. Schließlich kann man nicht jeden Tag, wenn es Lieferengpässe bei Medikamenten gibt, ins Zimmer der Klinikleiterin einbrechen…

Do we need more IL-17 and JAK Inhibitors in Spondyloarthritis? Dr. Eric Ruderman shares his perspectives on the following abstracts being presented at Eular 2024 in Vienna, Austria: OP0195 Sonelokimab IL 17 A/F nanobody inhibitor LB0005 Izokibep IL17A nanobody inhibitor POS0803 Vunakizumab, another IL17A inhibitor OP0138 TAK-279 phase 2B selective TYK2 inhibitor Zasocitinib Giant Cell Arteritis and Polymyalgia Rheumatica Update Dr. Janet Pope discusses abstracts LBA0001, OP0233, OP0261 and POS0280 at Eular 2024 in Vienna, Austria. JAK Inhibitors for New Indications Dr. Janet Pope discusses new indications for JAK inhibitors, reporting from Eular 2024 in Vienna, Austria. Pain in RA: Different Drugs for Different Mechanisms Dr. Aurelie Najm reports from Eular 2024 in Vienna, Austria, about abstracts OP0072 and OP0086. Top 3 Messages About JAK Inhibitor Safety Dr. Janet Pope discusses a debate she participated in at Eular 2024 in Vienna, Austria, and her top three messages regarding JAKi safety. DMARDs and Herpes Zoster Vaccination: To Stop or Not To Stop Dr. Jonathan Kay discusses abstracts POS0620 and OP0020 presented at Eular 2024 in Vienna, Austria. Has JAK POT Hit the Spot About Infection Risk? Dr. Yuz Yusof discusses abstract OP0092 presented at Eular 2024 in Vienna, Austria. Select your GCA Therapy Dr. David Liew discusses LBA0001 presented at Eular 2024 in Vienna, Austria.  

Mechanistic Promise in RA Doesn't Always Mean Actual Gain Dr. David Liew reports on abstracts OP0007 and OP0069 at Eular 2024 in Vienna, Austria. The Role of Psychosocial Determinants in the Management of Rheumatoid Arthritis Dr. Mrinalini Dey reports from Eular 2024 in Vienna, Austria about an abstract she will present during the meeting, POS0309. A Step Closer to Identifying Phenotypes of RA ILD Dr. Mrinalini Dey discusses abstract OP0202 presented at Eular 2024 in Vienna, Austria. Pain in RA: Different Drugs for Different Mechanisms Dr. Aurelie Najm reports from Eular 2024 in Vienna, Austria, about abstracts OP0072 and OP0086. Predicting Palindromic Prognosis Dr. David Liew discusses abstract OP0127 at Eular 2024 in Vienna, Austria. Top 3 Messages About JAK Inhibitor Safety Dr. Janet Pope discusses a debate she participated in at Eular 2024 in Vienna, Austria, and her top three messages regarding JAKi safety. Abatacept Misses on Shingrix Response Dr. David Liew discusses abstract POS0620 at Eular 2024 in Vienna, Austria. Artificial Intelligence Detection of CPPD on Hand Radiographs Dr. Antoni Chan interviews Dr. Thomas Hugle about abstract OP0112 presented at Eular 2024 in Vienna, Austria. Cognitive Function in Older Adults with Lupus Dr. Mrinalini Dey discusses abstract POS0730 presented at Eular 2024 in Vienna, Austria. Difficult-to-treat Rheumatoid Arthritis Validation of the EULAR Definition Dr. Mrinalini Dey discusses abstract OP0156 presented at Eular 2024 in Vienna, Austria. DMARDs and Herpes Zoster Vaccination To Stop or Not To Stop Dr. Jonathan Kay discusses abstracts POS0620 and OP0020 presented at Eular 2024 in Vienna, Austria. Has JAK POT Hit the Spot About Infection Risk? Dr. Yuz Yusof discusses abstract OP0092 presented at Eular 2024 in Vienna, Austria. Inspirations About RA-ILD Dr. Jonathan Kay discusses abstracts POS0070, POS0043 and POS0022 presented at the Eular 2024 meeting in Vienna, Austria. Depression and Anxiety Associated with Inability to Achieve Remission in RA and PsA Dr. Aurelie Najm reports on abstract POS0946 presented at Eular 2024 in Vienna, Austria. Digital Rheumatology Dr. Jonathan Kay reviews abstracts POS0451 and POS0607 presented at Eular 2024 in Vienna, Austria. Drug-resistant RA Does Blinatumomab BiTE? Dr. Yuz Yusof reports on abstract OP0193, presented at Eular 2024 in Vienna, Austria.  

Select your GCA Therapy Dr. David Liew discusses LBA0001 presented at Eular 2024 in Vienna, Austria. DMARDs and Herpes Zoster Vaccination: To Stop or Not To Stop Dr. Jonathan Kay discusses abstracts POS0620 and OP0020 presented at Eular 2024 in Vienna, Austria. Has JAK POT Hit the Spot About Infection Risk? Dr. Yuz Yusof discusses abstract OP0092 presented at Eular 2024 in Vienna, Austria. Depression and Anxiety Associated with Inability to Achieve Remission in RA and PsA Dr. Aurelie Najm reports on abstract POS0946 presented at Eular 2024 in Vienna, Austria. PsA Switch or Cycle, the Eternal Question Dr. Aurelie Najm reports on abstracts POS0278 and POS0266 presented at Eular 2024 in Vienna, Austria. DMARDs and Herpes Zoster Vaccination To Stop or Not To Stop Dr. Jonathan Kay discusses abstracts POS0620 and OP0020 presented at Eular 2024 in Vienna, Austria. Difficult-to-treat Rheumatoid Arthritis Validation of the EULAR Definition Dr. Mrinalini Dey discusses abstract OP0156 presented at Eular 2024 in Vienna, Austria. Has JAK POT Hit the Spot About Infection Risk? Dr. Yuz Yusof discusses abstract OP0092 presented at Eular 2024 in Vienna, Austria. Cognitive Function in Older Adults with Lupus Dr. Mrinalini Dey discusses abstract POS0730 presented at Eular 2024 in Vienna, Austria. Artificial Intelligence Detection of CPPD on Hand Radiographs Dr. Antoni Chan interviews Dr. Thomas Hugle about abstract OP0112 presented at Eular 2024 in Vienna, Austria. Abatacept Misses on Shingrix Response Dr. David Liew discusses abstract POS0620 at Eular 2024 in Vienna, Austria. Inspirations About RA-ILD Dr. Jonathan Kay discusses abstracts POS0070, POS0043 and POS0022 presented at the Eular 2024 meeting in Vienna, Austria. We've Got to Talk about CAR T cells Dr. Yuz Yusof discusses abstract OP0017 presented at the Eular 2024 meeting in Vienna, Austria. Does Withdrawing Steroids Increase Flares in SLE? Dr. Janet Pope reports on abstract OP0180 presented at Eular 2024 in Vienna, Austria. Tapering Treatment for Lupus Dr. Andrea Fava at Eular 2024 in Vienna, Austria, shares his perspectives on several sessions that addressed tapering treatment in lupus. The Crossroads of Autoinflammation and Autoimmunity Dr. Andrea Fava shares his perspectives on autoinflammation and autoimmunity at Eular 2024 in Vienna, Austria. Cognitive Function in Older Adults with Lupus Dr. Mrinalini Dey discusses abstract POS0730 presented at Eular 2024 in Vienna, Austria.

Dr. Jonathan Kay discusses abstracts POS0620 and OP0020 presented at Eular 2024 in Vienna, Austria.

Dr. Jonathan Kay discusses abstracts POS0620 and OP0020 presented at Eular 2024 in Vienna, Austria.

Join us for the latest axSpA podcast brought to you by the Immune-mediated Inflammatory Disease forum! This month Dr Sofia Ramiro is joined by Professors Hideto Kameda and Atul Deodhar to discuss the retention rate of secukinumab over two different time periods. Our faculty then move on to discuss another publication, which compares the improvements is sacroiliac joint symptoms across patients with AS and axSpA treated with different DMARDs.

CardioNerds (Dr. Amit Goyal) join Dr. Anureet Malhotra, Dr. John Fritzlen, and Dr. Tarun Dalia from the University of Kansas School of Medicine for some of Kansas City's famous barbeque. They discuss a case of Hydroxychloroquine induced cardiomyopathy. Notes were drafted by Dr. Anureet Malhotra, Dr. John Fritzlen, and Dr. Tarun Dalia. Expert commentary was provided by Dr. Pradeep Mammen. The episode audio was edited by Dr. Akiva Rosenzveig. Drug-induced cardiomyopathy remains an important and under-recognized etiology of cardiomyopathy and heart failure. Hydroxychloroquine is a disease-modifying antirheumatic drug used for various rheumatological conditions, and its long-term use is well-known to have toxic effects on cardiac muscle cells. Multiple cardiac manifestations of these drugs have been identified, the most prominent being electrophysiological disturbances. In this episode, we discuss a biopsy-proven case of hydroxychloroquine-induced cardiotoxicity with detailed histopathological and imaging findings. We develop a roadmap for the diagnosis of hydroxychloroquine-induced cardiomyopathy and discuss the various differentials of drug-induced cardiomyopathy. We highlight the importance of clinical monitoring and early consideration of drug-induced toxicities as a culprit for heart failure. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media - Hydroxychloroquine induced cardiomyopathy Pearls - Hydroxychloroquine induced cardiomyopathy Continued decline in left ventricular systolic function despite appropriate guideline directed medical therapy should prompt a thorough evaluation for unrecognized etiologies and warrants an early referral to advanced heart failure specialists. Transthoracic echocardiogram is a valuable non-invasive screening tool for suspected pulmonary hypertension, but right heart catheterization is required for definitive diagnosis. Cardiac MRI can be used for better characterization of myocardial tissue and can aid in the evaluation of patients with non-ischemic cardiomyopathy. Hydroxychloroquine (HCQ) is a commonly used DMARD that remains an underrecognized etiology of cardiomyopathy and heart failure. In addition to ophthalmological screening, annual ECG, as well as echocardiography screening for patients on long-term HCQ therapy, should be considered in patients at risk for cardiovascular toxicity, including those with pre-existing cardiovascular disease, older age, female sex, longer duration of therapy, and renal impairment. Management of hydroxychloroquine-associated cardiomyopathy consists of discontinuing hydroxychloroquine and standard guideline-directed medical therapy for heart failure.  HCQ cardiomyopathy may persist despite medical therapy, and advanced therapy options may have to be considered in those with refractory heart failure. Show Notes - Hydroxychloroquine induced cardiomyopathy What are the various cardiotoxic effects of hydroxychloroquine (HCQ) and the mechanism of HCQ-mediated cardiomyopathy? One of the most frequently prescribed disease-modifying antirheumatic drugs (DMARDs), HCQ is an immunomodulatory and anti-inflammatory agent that remains an integral part of treatment for a myriad of rheumatological conditions. Its efficacy is linked to inhibiting lysosomal antigen processing, MHC-II antigen presentation, and TLR functions.8 The known cardiac manifestations of HCQ-induced toxicity include conduction abnormalities, ventricular hypertrophy, hypokinesia, and lastly, cardiomyopathy. Conduction Abnormalities - by binding to and inhibiting the human ether-à-go-go-related gene (hERG) voltage-gated potassium channel,

Can a novel scoring system help prevent dementia and stroke? Find out about this and more in today's PV Roundup podcast.

Join Professor Iain McInnes in this month's CSF Podcast, where he discusses the latest information and data in rheumatology. In this episode, he discusses two papers that look at the incidence of disease. The first paper, the GBD 2021 Other Musculoskeletal Disorders Collaborators systematically analysed the global burden of musculoskeletal disorders, and used these data to predict prevalence up to 2050 and the second paper, Yvette Meissner and her colleagues used the German RABBIT registry to investigate the relationship between MACE risk and JAK inhibitors, TNF inhibitors, and DMARDs. To access detailed summary slides for the papers discussed today, visit cytokinesignalling.com.

In this enlightening episode of Inside GRAPPA, we delve deep into the intricate world of peripheral arthritis in psoriatic disease. Today's host, Dr. Sebastian Herrera, is joined by the esteemed Dr. Katy Leung, and Professor Oliver Fitzgerald to discuss the significance, manifestation, and management of peripheral arthritis in patients with psoriatic disease.Dr. Herrera is a rheumatologist at Clínica Las Américas Auna and ARTMEDICA in Medellín, Colombia and also an Associate Professor of Rheumatology at Universidad CES and a member of Young GRAPPA. Dr. Leung is an Associate Professor at Singapore General Hospital and Duke-NUS Medical School in Singapore. Dr. Leung has interest in clinical and translational research in PsA, is the co-chair of the GRAPPA-OMERACT Outcome Measure Working group, and is also a member of the GRAPPA Education Committee. Dr. Fitzgerald is based at University College Dublin and has a major interest in clinical and translational research in PsA. More recent studies have explored genetic factors and biomarker development. Dr. Fitzgerald has been involved for many years with GRAPPA and took up the office of co-President in July 2021. He has been advocating for grant application opportunities addressing critical unmet needs in PsA for some time and this has culminated in the award of the first, significant, joint EU/industry funded Innovative Medicines Initiative (IMI) grant in PsA, the HIPPOCRATES consortium.

In this episode I discuss a quiz from the My Spondylitis Team that discusses how much you may know on DMARDs. As always, this is designed to help you plan the conversations you may need to have with your doctor(s). Here is a link to the article and quiz. Here are the links to the Youtube channels for:Yoga for ASAlex Levine, Fitness Alex's Full Workout VideoAll the below links are affiliate links. If you purchase any of the items, I may earn a small commission. It does not change the price of items. Get paid to take tests. Here is a link to Rare Patient Voice. If you take participate in a study, you can get paid (amount varies). https://rarepatientvoice.com/TheAxialSpondyloarthritisPodcast/Here are some links to Amazon showing some of the items I discussed. Ankylosing Spondylitis and Axial Spondyloarthritis The Facts Series by Dr. KhanUberlube - https://amzn.to/3i604N2 Here is the Bean Bag neck warmer https://amzn.to/3uN6mcgBiofreeze - https://amzn.to/33gygBSCane - https://amzn.to/3uN9ftsHeating Pad - https://amzn.to/3Bjd5vzWeighted Blanket - https://amzn.to/36RCdi7Steff Di Pardo's new book - I Am Not Invisible - https://amzn.to/3JpDScAAll My Ankylosing Spondylitis Shit: Pain and Symptom Tracker by Kinsella Love https://amzn.to/34CHhpx

On this podcast episode, I cover etanercept pharmacology, adverse effects, drug interactions and much more. Etanercept is classified as a DMARD but is different from older DMARDs in that it is a biologic agent and needs to be injected. Vaccination assessment in patients is important prior to initiating etanercept due to the fact that the medication may blunt the effectiveness of the vaccines. Immunosuppression from etanercept can lead to an increased risk for infection and malignancy.

Episode 146: RA vs OA    Future Dr. Magurany explains how to differentiate rheumatoid arthritis from osteoarthritis.  Written by Thomas Magurany, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.1. Etiology: Rheumatoid Arthritis (RA): RA is an autoimmune disease wherein the immune system mistakenly attacks healthy tissues, particularly the synovial joints, usually between the ages of 30-50. Genetic predisposition, environmental factors such as smoking or infections, hormonal imbalances, and lower socioeconomic status have been associated with an increased risk of developing RA(1).Osteoarthritis (OA): OA primarily arises due to mechanical stress on the joints over time. Factors contributing to OA include age, obesity, joint injury or trauma, repetitive joint use or overuse, genetic abnormalities in collagen structure, and metabolic disorders affecting cartilage metabolism (2).The greatest risk factor for the development of OA is age with most patients presenting after 45 years of age. The greatest modifiable risk factor for OA is weight. People with a BMI >30 were found to have a 6.8 times greater risk of developing OA. (3) Primary OA is the most common and is diagnosed in the presence of associated risk factors such as: older age, female gender, obesity, anatomical factors, muscle weakness, and joint injury (occupation/sports activities) in the absence of trauma or disease. Secondary OA occurs alongside a pre-existing joint deformity including trauma or injury, congenital joint disorders, inflammatory arthritis, avascular necrosis, infectious arthritis, Paget disease, osteopetrosis, osteochondritis dissecans, metabolic disorders (hemochromatosis, Wilson's disease), Ehlers-Danlos syndrome, or Marfan syndrome.2. Pathogenesis:Rheumatoid Arthritis (RA):In some patients, RA is triggered by some sort of environmental factor in a genetically predisposed person. The best example is tobacco use in a patient with HLA-DRB1. The immune response in RA starts at sites distant from the synovial joints, such as the lung, gums, and GI tract. In these tissues, modified proteins are produced by biochemical reactions such as citrullination. (4)In RA, an abnormal immune response leads to chronic inflammation within the synovium lining the joints. The inflammatory cytokines released cause synovitis and lead to the destruction of articular cartilage and bone erosion through pannus formation. Immune cells infiltrate the synovium causing further damage. (4) In summary: formation of antibodies to citrullinated proteins, these antibodies begin attacking wrong tissues.Osteoarthritis (OA):The primary pathological feature of OA is the degeneration of articular cartilage that cushions the joints causing surface irregularity, and focal erosions. These changes progress down the bone and eventually involve the entire joint surface. Mechanical stress triggers chondrocyte dysfunction, leading to an imbalance between cartilage synthesis and degradation that cause cartilage outgrowths that ossify and form osteophytes. This results in the release of enzymes that degrade the extracellular matrix, leading to progressive cartilage loss. As more of the collagen matrix is damaged, chondrocytes undergo apoptosis. Improperly mineralized collagen causes subchondral bone thickening; in advanced disease, bone cysts infrequently occur (5). In summary: Osteophytes formation and cartilage loss.3. Clinical Presentation:Rheumatoid Arthritis (RA):The most common and predominant symptoms include joint pain and swelling, usually starting insidiously over a period of weeks to months. RA typically affects multiple joints symmetrically, commonly involving small joints of the hands, wrists, feet and progresses to involve proximal joints if left untreated. Morning stiffness lasting more than an hour is a characteristic feature. The affected joint will be painful if pressure is applied to the joint or on movement with or without joint swelling. Synovial thickening with a "boggy" feel on palpation will be noted. The classical physical findings of ulnar deviation, metacarpophalangeal joint subluxation, swan neck deformity, Boutonniere deformity, and the "bowstring" sign (prominent and tight tendons on the dorsum of the hand) are seen in advanced chronic disease. (4) Around ¼ of patients with RA may present with rheumatoid noduleswhich are well demarcated, flesh-colored subcutaneous lumps. They are usually described as being doughy or firm and are not typically tender unless they are inflamed. They are usually found on areas susceptible to repeated trauma or pressure and include the elbows, fingers and forearms. Osteoarthritis (OA):OA primarily affects weight-bearing joints such as knees, hips, spine, and hands. Symptoms include joint pain aggravated by activity and relieved with rest, morning stiffness lasting less than 30 minutes, joint swelling due to secondary inflammation, and occasionally the formation of bony outgrowths called osteophytes (6). Tenderness may be present at joint lines, and there may be pain upon passive motion. Classic physical exam findings in hand OA include Heberden's nodes (posterolateral swellings of DIP joints), Bouchard's nodes (posterolateral swellings of PIP joints), and “squaring” at the base of the thumb (first Carpal-Metarcapal or CMC joints), bony enlargement, crepitus, effusions (non-inflammatory), and a limited range of motion. Patients may also experience bony swelling, joint deformity, and instability (patients complain that the joint is “giving way” or “buckling,” a sign of muscle weakness). (5)4. Lab findings:Rheumatoid Arthritis: Laboratory testing often reveals anemia of chronic disease (increased ferritin, decreased iron and TIBC) and thrombocytosis. Neutropenia may be present if Felty syndrome is present. RF is present in 80-90% of patients with a sensitivity of 69%. In patients who are asymptomatic or those that have arthralgias, a positive RF and especially CCP predicts the onset of clinical RA. Patients with RA with RF, ACPA, or both are designated as having seropositive RA. About 10% of RA patients are seronegative. ESR and levels of CRP are usually elevated in patients with active disease and can be used to assess disease activity. The synovial fluid in RA will also reveal low C3 and C4 levels despite elevated serum levels.(4) Some non-specific inflammatory markers such as ESR, CRP can help you guide your diagnosis of RA.Osteoarthritis:Lab findings are not significant. Clinical diagnosis if the following are present: 1) pain worse with activity and better with rest, 2) age more than 45 years, 3) morning stiffness lasting less than 30 minutes, 4) bony joint enlargement, and 5) limitation in range of motion. Blood tests such as CBC, ESR, rheumatoid factor, ANA are usually normal but usually ordered to rule out an inflammatory process. Synovial fluid should show a white blood cell count less than 2,000/microL, predominantly mononuclear cells (non-inflammatory). X-rays of the affected joint can show findings consistent with OA, such as marginal osteophytes, joint space narrowing, subchondral sclerosis, and cysts; however, radiographic findings do not correlate to the severity of the disease and may not be present early in the disease. (5)5. Treatment Approaches:Rheumatoid Arthritis (RA):There is no cure for RA.The goal of treatment in RA is inducing remission and optimizing quality of life. This is initially done by beginning DMARDs, include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide. Methotrexate is the initial DMARD of choice. Anti-TNF-alpha inhibitors include etanercept, infliximab, adalimumab, golimumab, and certolizumab may be used if DMARDs fail. NSAIDs are used to control joint pain and inflammation. Corticosteroids may be used as a bridge therapy to DMARDs in a newly diagnosed patient with a very active disease. (7) Coronary artery disease has a strong association with RA. RA is an independent risk factor for the development of coronary artery disease (CAD) and accelerates the development of CAD in these patients. Accelerated atherosclerosis is the primary cause of morbidity and mortality. There is increased insulin resistance and diabetes mellitus associated with RA and is thought to be due to chronic inflammation. When treated with specific DMARDs such as hydroxychloroquine, methotrexate, and TNF antagonists, there was a marked improvement in glucose control in these patients. (8) RA is not just a disease of the joints, it is able to affect multiple organ systems.Osteoarthritis (OA):OA treatment aims at reducing pain and improving joint function through a combination of non-pharmacological interventions like exercise programs tailored to strengthen muscles around affected joints, weight management strategies, and assistive devices like braces or walking aids if required (9). Medications including analgesics or nonsteroidal anti-inflammatory drugs may be prescribed for pain relief when necessary. Duloxetine has modest activity in relieving pain associated with OA. Intraarticular glucocorticoid joint injections have a variable response but are an option for those wanting to postpone surgical intervention. In severe cases where conservative measures fail, surgical options like joint replacement may be considered (9). Weight loss is a critical intervention in those who have overweight and obesity; each pound of weight loss can decrease the load across the knee 3 to 6-fold. (5) Summary: Medications (NSAIDs, topical, duloxetine), weight loss, PT, intraarticular injections of corticosteroids, and joint replacement.________________________________Conclusion: Now we conclude episode number 146, “RA vs. OA.” Future Dr. Magurany explained that rheumatoid arthritis is an autoimmune disease that presents with joint pain and inflammation, mostly on hands and small joints, accompanied by morning stiffness longer than 1 hour. The rheumatoid factor and ACPA may be positive in a percentage of patients but not always. The base of treatment is early treatment with disease-modifying antirheumatic drugs to induce remission of the disease. OA affects weight-bearing joints with little to no inflammation, treatment is mainly lifestyle modifications, analgesics, intraarticular injections, and joint replacement.This week we thank Hector Arreaza and Thomas Magurany. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Myasoedova E, Crowson CS & Gabriel SE et al. (2010). Is the incidence of rheumatoid arthritis rising?: Results from Olmsted County, Minnesota, 1955-2007. Arthritis and Rheumatism, 62(6), 1576-1582.Goldring MB & Goldring SR. (2007). Osteoarthritis. Journal of Cellular Physiology, 213(3), 626-634.King LK, March L, Anandacoomarasamy A. Obesity & osteoarthritis. Indian J Med Res. 2013;138(2):185-93. PMID: 24056594; PMCID: PMC3788203.Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.Sen R, Hurley JA. Osteoarthritis. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.Hunter DJ, Bierma-Zeinstra S. & Eckstein F. (2014). OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for primary hip and knee osteoarthritis: An expert consensus initiative of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) Task Force in collaboration with the Osteoarthritis Research Society International (OARSI). Osteoarthritis Cartilage, 22(7), 363-381.van Everdingen AA, Jacobs JW, Siewertsz Van Reesema DR, Bijlsma JW. Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Ann Intern Med. 2002 Jan 1;136(1):1-12. doi: 10.7326/0003-4819-136-1-200201010-00006. PMID: 11777359.Nicolau J, Lequerré T, Bacquet H, Vittecoq O. Rheumatoid arthritis, insulin resistance, and diabetes. Joint Bone Spine. 2017 Jul;84(4):411-416.Fernandes L, Hagen KB, Bijlsma JWJ et al. (2019). EULAR recommendations for non-pharmacological core management of hip and knee osteoarthritis. Annals of Rheumatic Diseases, 79(6), 715-722.Royalty-free music used for this episode: "Driving the Point." Downloaded on July 29, 2023, from https://www.videvo.net/ 

4.05 Scleroderma Rheumatology review for the USMLE Step 1 exam Scleroderma is a chronic autoimmune connective tissue disease that causes thickening and hardening of the skin, as well as fibrosis (excess deposition of collagen and other ECM proteins) throughout the body. Autoreactive immune cells activate endothelial cells, which produce large amounts of endothelin 1, leading to overactivation of fibroblasts that overexpress collagen. It typically affects younger women (35-50 years old) with a F:M ratio of 5:1. There are two distinct forms of scleroderma: diffuse (systemic) and limited, each associated with unique antibodies and clinical presentations. Diffuse scleroderma involves the skin and internal organs and is rapidly progressive. Skin tightens especially in the fingers, and internal organs including the lungs, kidneys, GI system, and heart can be affected. It is associated with anti-Scl-70 antibody and anti-RNA III polymerase. Limited scleroderma tends to only affect the skin, characterized by the mnemonic CREST: Calcinosis cutis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. It is associated with anti-Centromere antibody. Treatment involves NSAIDs and DMARDs for musculoskeletal pain, H2 blockers or PPIs for esophageal reflux, and Ace inhibitors for scleroderma renal crisis. There is no cure for the disease.

Join Prof Iain McInnes as he reviews two interesting papers that help to broaden our understanding and knowledge on the safety of biologic and targeted synthetic DMARDs. In the first of today's papers, Matthew Baker and colleagues determine the risk of developing interstitial lung disease (ILD) in patients with RA, undergoing treatment with different biologic and targeted synthetic DMARDs. In the second paper, Lars Kristensen and team analyse data from ORAL Surveillance to help identify subpopulations with different relative risk (i.e., 'high-risk' and 'low-risk') with tofacitinib versus TNFi. To access detailed summary slides of the papers discussed today, visit cytokinesignalling.com.

Cheryl C. and Cheryl K. share key tools for thriving with arthritis, like finding ways to ask for help, developing health literacy, practicing self-compassion, and getting support. They also discuss the safety of modern medicine and how to balance it with complementary therapies to create an individualized plan for managing rheumatoid arthritis.  Additionally, they delve into the mental health techniques that have helped them cope, including: reframing exercises, and working past bias. Cheryl K. shared how she used her experiences to form Arthritis Consumer Experts, a patient-led and science-based organization with the goal of providing better education to people with arthritis.Episode at a glance:Navigating chronic illness when the internet was just starting: Cheryl Koehn had an athletic background, but when symptoms struck she went to the library to do her own research and advocated for herself despite medical gaslighting.Trialing treatment options: Cheryl K. initially denied Western Medicine before she ended up with 36 active swollen joints within a year and progressively worsening quality of life. Following this, she received gold injections and other conventional DMARDs initially, adding in Methotrexate and later transitioning to newer medications like biologics as they became available.Coping with peer pressure: People trying to convince her that “natural is better” and to avoid medications, however natural isn't inherently better at controlling disease and newer medications are backed by research. Cheryl C. and Cheryl K. discuss how a balance of complementary therapies and medication help people safely manage their conditions. Koen practices reframing exercises, works on explicit and implicit bias, and considers “what can I learn from this person today” with an open mind.Wisdom for newly diagnosed patients: Find ways to ask for help! Develop health literacy as a tool for advocating for yourself and to guide decision making.What does it mean to thrive with rheumatic disease: Practice self-love and self-compassion, love what you do, and give yourself room to breathe.Arthritis Consumer Experts (ACE): Cheryl K. used her experiences of running her own consulting firm, volunteering, and being on the board at the Arthritis Society to form this organization. Her goal is to provide better education to people with arthritis, and to not be the only person with arthritis with a say in arthritis organizations.Medical disclaimer:All content found on Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.Episode SponsorsRheum to THRIVE, an online course and support program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. See all the details and join the program or waitlist now!For Full Episode Details Including Transcript:Go to the Arthritis Life website

For more information, contact us at 859-721-1414 or myhealth@prevmedheartrisk.com. Also, check out the following resources: ·Newsletter Sign Up·Purchase an Appointmen Today!·PrevMed's Locals·PrevMed's Rumble·PrevMed's website·PrevMed's YouTube channel·PrevMed's Facebook page·PrevMed's Instagram·PrevMed's LinkedIn·PrevMed's Twitter ·PrevMed's Pinterest

This week's episode features Naomi Abrahams, a PhD student at the University of Ottawa, who lives with Juvenile Idiopathic Arthritis. The episode starts off by Naomi talking about how life felt like when being misdiagnosed for 3 years. She brings Natasha along her journey to when her symptoms started with joint swelling and pain in her hips that then moved to her elbows. Eventually, she wasn't able to brush her teeth or eat food without pain. Her world changed and she had frequent visits to the dentist and had tons of MRIs. This led her to finally figure out her personal medication and treatment journey. Moreover, Naomi explains how she never experienced pediatric care but was experiencing symptoms when she was 15. On her 18th birthday, she was given her new diagnosis in which she felt as though she was “thrown into the adult world”. Additionally, Natasha and Naomi both discuss the pros and cons of having a rheumatoid factor negative vs positive one. They also discuss the similarities they had in terms of medications they had been on (DMARDS and biologics). Following that, they continue the conversation by talking about their own physiotherapy pathway, specifically what it's like to do physiotherapy in a flare up and the financial aspects of getting billed through insurance. They discuss the MRI vs infusion fatigue, moving out to university with arthritis, and hair loss/growth with medications. Then, they get into the fun stuff like how Naomi told her boyfriend that she had arthritis and how he now supports her. Natasha and Naomi discuss how they met each other specifically through the Choice Research Lab, patient engagement in research and how important patient partners are. Last but not least, they end off the episode discussing their experience together at the CBC Ottawa Radio station, filming the CBC documentary and more! CBC documentary and article: https://www.cbc.ca/news/canada/ottawa/juvenile-idiopathic-arthritis-podcast-creator-network-cbc-1.6614184CBC radio segment: https://www.cbc.ca/listen/live-radio/1-100-ottawa-morning/clip/15943512-juvenile-idiopathic-arthritis Check out Naomi's socials: Instagram: @naomiabrahams Check out our socials: Website: https://www.takeapaincheck.com/Instagram: https://www.instagram.com/takeapainch... Twitter: https://twitter.com/takeapaincheck​​​ Tiktok: https://www.tiktok.com/@takeapaincheck Growing Pains, Copyright, 2018, Alessia Cara

Frailty in Vasculitis Dr. Patricia Harkins sits down with Professor Sebastian Sattui to discuss Abstract 0444, Prevalence of Frailty and Associated Factors in Patients with Vasculitis, being presented on Saturday at ACR22 Convergence. Lupus, Sex and STDs Dr. Kathryn Dao discusses abstract 0939 presented at the ACR22 Convergence meeting in Philadelphia, PA. Abstract 0939: Pilot Study: A Novel Method for Cervical Health Monitoring in African American Women with Systemic Lupus Erythematosus (SLE) Using a Self- Sampling Brush to Assess Cervical HPV Infection and Cervical Cytology Much gusto for GUSTO: Efficacy of Tocilizumab Monotherapy for Giant Cell Arteritis Dr. Richard Conway discusses abstract 0470, being presented during Poster Session A on Saturday, November 12, 2022 at the ACR 2022 meeting.  Abstract 0470: Long-term Efficacy of Tocilizumab Monotherapy After Ultra-short Glucocorticoid Administration to Treat Giant Cell Arteritis – One Year Follow-up of the GUSTO Trial NSAIDs and CV risk in Inflammatory Arthritis Dr. Richard Conway discusses abstract 1207, being presented during Poster Session C on Sunday, November 13, 2022 at the ACR 2022 meeting.  Abstract 1207: Risk Factors for Major Cardiovascular Events (MACE) in Inflammatory Arthritis: A Time-dependent Analysis on the Inflammatory Burden, Use of DMARDs, NSAIDs, and Steroid Should You Repeat the ENA Panel? Dr. Kathryn Dao discusses abstract 0725, presented at ACR22 Convergence.  Abstract 0725: Utility of Repeat Extractable Nuclear Antigen Antibody Testing- a Retrospective Audit To Beta Block or Not in GCA and Large Vessel Vasculitis Dr. Patricia Harkins discusses abstract 0477 presented on Saturday, November 12, 2022, at ACR22 Convergence. Abstract 0477: Can Beta-blockers Prevent Aortic Dilation in Patients with Giant Cell Arteritis and Large Vessel Vasculitis? A Novel Treatment Response Measurement Tool for Lupus Dr. Kathryn Dao discusses abstract 2054 with Dr. Eric Morand at the ACR22 Convergence meeting. Abstract 2054: Towards a Novel Clinician-Reported Outcome Measure for SLE – Outcomes of an International Consensus Process Sarilumab in Polymyalgia Rheumatica: Results from Phase 3 Trial Dr. Michael Putman interviews Dr. Robert Speira about abstract 1676 presented at the ACR22 Convergence meeting in Philadelphia, PA.  Abstract 1676: Sarilumab in Patients with Relapsing Polymyalgia Rheumatica: A Phase 3, Multicenter, Randomized, Double Blind, Placebo Controlled Trial (SAPHYR) Welcome to ACR 2022 Dr. Jack Cush, Executive Editor of RheumNow, welcomes you to Philadelphia for ACR22 Convergence! 2022 ACR/EULAR Classification Criteria for GCA Dr. Michael Putman discusses interesting take-home messages from the Vasculitis Investigators Meeting at ACR22 Convergence regarding the 2022 ACR/EULAR Classification Criteria for GCA. Gender in AxSpa Dr. Peter Nash, Philadelphia Do Disease Activity Measures Really Capture AS in Women? Dr. Rachel Tate interviews Dr. Sinead Mcguire about Abstract 0406, presented at ACR22 Convergence in Philadelphia, PA. Abstract 0406: https://acrabstracts.org/abstract/are-the-basdai-basfi-capturing-the-full-impact-of-disease-activity-on-quality-of-life-in-women-with-axial-spondyloarthritis/ Dr Aurelie Najm  Opoids and health care utilization in PsA and AS Abstract 402 Poor Medication Adherence in SLE  and How to Improve It Dr. Janet Pope discusses three abstracts presented at the ACR22 Convergence meeting in Philadelphia, PA. 0343: Severe Non-adherence to Hydroxychloroquine Is Associated with Flares, Early Damage, and Mortality in Systemic Lupus Erythematosus: Data from 660 Patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort 0115: Facilitators of Immunosuppressive Medication Adherence in Systemic Lupus Erythematosus: A Qualitative Study of Racial Minority Patients, Lupus Providers and Clinic Staff 0063: Implementability of a SLE Medication Adherence Intervention Sputum anti-CCP the new diagnostic test in at-risk RA? Dr. Aurelie Najm discusses abstract 0533 at the ACR22 Convergence meeting in Philadelphia, PA. Abstract 0533: Sputum RA-Associated Autoantibodies Independently Associate with Future Development of Classified RA in an At-Risk Cohort of Individuals with Systemic Anti-CCP Positivity Drs Cush and Fava:  Urinary Biomarkers in Lupus Dr. Jack Cush interviews Dr. Andrea Fava about Abstract 536 at the ACR22 Convergence meeting in Philadelphia, PA. Abstract 0536: Change in Urinary Biomarkers at Three Months Predicts 1-year Treatment Response of Lupus Nephritis Better Than Proteinuria Social Media in Rheumatology Academia Dr. Kathryn Dao, Dallas Jorena Lim, third-year medical student, UTSW, Dallas Abstract 0220 Treatment Choices and Mortality in RA ILd Dr. Julian Segen, Philadephia Dr. Bryant England, Philadephia Dr Tate PsA Cycling or Switching MOAs with Dr  Ogdie Abstracts 1600 and 402. Dr Cassy Sims The Impact of Upacitinib vs  Adalimumab in Psoriatic Arthritis using RAPID Abstract 192. Urinary Biomarkers in Lupus Dr. Jack Cush interviews Dr. Andrea Fava about Abstract 536 at the ACR22 Convergence meeting in Philadelphia, PA. Abstract 0536: Change in Urinary Biomarkers at Three Months Predicts 1-year Treatment Response of Lupus Nephritis Better Than Proteinuria Dr Janet Pope Switching from a JAK Inhibiter Abstract 0274. Dr Yusof Effect of voclosporin in Class 5 lupus nephritis Abstract 0355. Best of PsA Dr. Rachel Tate Drs Yusof and Sexena Breakthrough COVID infection in a lupus cohort during Omicron era Session # 12S119. PsA Cycling or Switching MOAs Dr. Rachel Tate interviews Dr. Alexis Ogdie at ACR22 Convergence in Philadelphia, PA.  Abstract 1600: The Impact of Second-Line Therapeutic on Disease Control After Discontinuation of First Line TNF Inhibitor in Patients with PsA: Analysis from the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry Abstract 402: Opioid Use and Healthcare Utilization in Adults with PsA and AS Urine Proteomics in SLE with Dr. Michelle Petri Dr. Michelle Petri discusses abstract 0536, Change in Urinary Biomarkers at Three Months Predicts 1-year Treatment Response of Lupus Nephritis Better Than Proteinuria, being presented Saturday at ACR22 Convergence.

Episode #2 of a 2-part series. Part 2 is all about how to handle specific scenarios and clinical pearls. We delve into methotrexate optimization, what to do when therapy fails, the safety of JAK inhibitors, pregnancy management in RA, DMARDs and malignancy, palindromic rheumatism, perioperative management, biosimilars and more.

https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.122.059410?af=RThe Biomarkers say REDUCE-IT was a scamhttps://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2791663NO! Just NO-- stick with the calculator for nowhttps://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.059038start the SLGT-2 inhibitors early! maybe an early dischargehttps://pubmed.ncbi.nlm.nih.gov/35849407/If we could get the EMR to do it automatically else you cant expect providers tohttps://pubmed.ncbi.nlm.nih.gov/35727595/the head CT for psych stuff can probably be put on holdhttps://eprints.whiterose.ac.uk/180135/continue the disease modifying agents

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, fellowship trained foot and ankle surgeon, talk about rheumatoid foot, an autoimmune disease that affects the joints. They talk about the development of DMARD medications and how they help control deformities in patients.   “If I was looking at just one joint I would think this is probably osteomyelitis or some type of septic arthritis. But if we are seeing it (no cartilage) uniform across all their joints we know this is most likely rheumatoid arthritis.” -Dr. Raafae Hussain [07:17]   “If your patient is on DMARDs, they are relatively well controlled and they're not dealing with polyarthritis all the time, I would treat them like any other hallux rigidus patient. Give them the option of fusing it or doing an implant. Because this is a progressive problem, you want joint fusion over an implant” -Dr. Damien Dauphinee [22:45]   Top Takeaways: What is rheumatoid foot? Treatment options for rheumatoid arthritis Post-surgery recovery    What You Will Learn: [00:50] Intro [02:00] What is rheumatoid foot  [10:14] Offloading weight from bone sites  [15:17] Treatment options [20:05] DMARDs [23:25] Implants [26:00] Recovery   Resources: Visit our website: https://thepoddoctors.com/ Book Mentioned: Saving Limbs, Saving Lives: Advanced Treatments for Preventing Amputations in Diabetic Populations by Dr. Damien Dauphinee

Join Dr Laura Coates, Prof Enrique Soriano, Prof Chris Ritchlin, and Ass Prof Frank Behrens for our first podcast dedicated to the latest publications in PsA! In this edition, our Steering Committee members look at three key papers published in May 2022. The first, from Egeberg et al, looks at drug survival using a large, nationwide cohort study from the DANBIO and DERMBIO registries. The second looks at pooled data from SELECT-PsA-1 and -2 to investigate the safety profile of upadacitinib versus adalimumab in patients with active PsA and IR to biologic/non-biologic DMARDs. And finally, our speakers discuss new data from Merola et al on the effect of secukinumab CV risk factors and inflammatory biomarkers. Everything discussed is available in a more detailed slide format in the publications section at cytokinesignalling.com.

Co-leads Dr Laura Coates (Oxford, UK) and Dr William Tillett (Bath, UK) join us live from our Annual Conference to discuss the new 2022 BSR guideline for the treatment of psoriatic arthritis with biologic and targeted synthetic DMARDs. This episode is hosted by Dr Marwan Bukhari. 

In the first part of this episode, I discuss the website The Faces of Ankylosing Spondylitis. Here is a link to https://thefacesofankylosingspondylitis.com/?blogsub=confirming#subscribe-blog (website). I'm number 158 if you are curious. If you are not part of this wonder page, submit your story. Cookie wants to get to 2700 people on the site, but I bet we can get her way past this. In this episode, I review an article about Conventional DMARDS vs Biologic DMARDS for AS. Here is the link to the https://www.myspondylitisteam.com/resources/conventional-vs-biologic-treatments-for-axial-spondyloarthritis (article). All the below links are affiliate links. If you purchase any of the items, I may earn a small commission. It does not change the price of items. Get paid to take tests. Here is a link to Rare Patient Voice. If you take participate in a study, you can get paid (amount varies). https://rarepatientvoice.com/TheAxialSpondyloarthritisPodcast/ (https://rarepatientvoice.com/TheAxialSpondyloarthritisPodcast/) Here are some links to Amazon showing some of the items I discussed. Uberlube - https://amzn.to/3i604N2 (https://amzn.to/3i604N2) Here is the Bean Bag neck warmer https://amzn.to/3uN6mcg (https://amzn.to/3uN6mcg) Biofreeze - https://amzn.to/33gygBS (https://amzn.to/33gygBS) Cane - https://amzn.to/3uN9fts (https://amzn.to/3uN9fts) Heating Pad - https://amzn.to/3Bjd5vz (https://amzn.to/3Bjd5vz) Weighted Blanket - https://amzn.to/36RCdi7 (https://amzn.to/36RCdi7) Steff Di Pardo's new book - I Am Not Invisible - https://amzn.to/3JpDScA (https://amzn.to/3JpDScA) All My Ankylosing Spondylitis Shit: Pain and Symptom Tracker by Kinsella Love https://amzn.to/34CHhpx (https://amzn.to/34CHhpx)

A quick run through medications that are used to control or reduce inflammation. I review NSAIDs, Corticosteroids, Antigout, and DMARDs. Including the most important points to know about each from a nursing perspective. 

In this episode we talk to Dr Simon Fraser who is an associate professor of public health at the School of Primary Care at the University of Southampton. Paper: Persistently normal blood tests in patients taking methotrexate for RA or azathioprine for IBD: a retrospective cohort study https://doi.org/10.3399/BJGP.2021.0595 (https://doi.org/10.3399/BJGP.2021.0595) Clinical guidance from the National Institute for Health and Care Excellence recommends 3-monthly blood-tests for the ongoing safety monitoring of conventional synthetic disease-modifying anti-rheumatic drugs, but questions have been raised about the need for this testing frequency. Using 2 years' data from a large primary care database, this study found that persistent normality of blood-test results was common and abnormalities were dominated by reduced renal function among older people, with relatively few hepatic or haematological abnormalities. Greater stratification of monitoring may reduce workload and costs for patients and health services, but more evidence is required on the long-term safety, acceptability, and cost-effectiveness of changing current practice. BJGP research on optimising primary care research dissemination: an online surveyERGO number: 70228.A1 We would like to find out how often practising GPs and GP trainees access primary care research (in any form), and how we could improve its dissemination. We are very much interested in the views of those who don't access research regularly, as well as those who do. We would therefore be very grateful if you could consider completing a short online survey which will take less than 5 minutes to complete. If you are willing to participate, please access the survey via this link: https://southampton.qualtrics.com/jfe/form/SV_bIRKhaA0CrmZJ3w (https://southampton.qualtrics.com/jfe/form/SV_bIRKhaA0CrmZJ3w)

Prof Iain McInnes discusses the risk of herpes zoster in RA patients taking biologics and DMARDS. He also discusses reactivation of hepatitis B in patients with RA taking tofacitinib. Keep-up to date with the latest in arthritis and cytokine signalling with Prof Iain McInnes. Everything discussed is available in a more detailed slide format in the publications section at cytokinesignalling.com.

On this episode, we discuss the management of rheumatoid arthritis. We start by reviewing some background information. Then, we compare and contrast the various medications options including DMARDs, TNF-alpha biologics, and non-TNF-alpha biologics.  Thanks for listening! If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable Power Point slides for each lecture. You can find our account at the website below:  www.patreon.com/corconsultrx If you have any questions for Cole or me, reach out to us on any of the following: Text - 415-943-6116 Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com Instagram and other social media platforms - @corconsultrx This podcast reviews current evidence-based medicine and pharmacy treatment options. This podcast is intended to be used for educational purposes only and is intended for healthcare professionals and students. This podcast is not for patients and not intended as advice or treatment.

New to RheumNow? Rheumnow.com is a news source dedicated to the field of Rheumatology. It is written by experts in the field, and written for rheumatologists and individuals working in related fields. In this episode, Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com Study of 435 #SLE pts seen during the pandemic. Comparing those seen F2F vs telemedicine, there was no significant difference in SLE disease activity (by SLEDAI-2K) or SLE flare rates or steroid prescribing between visit types https://bit.ly/39wWoQ6 Encouraging DBRPCT of Rituximab in #PMR: 116 screened, 49 enrolled, 47 completed: 23 on RTX vs 24 on PBO. Steroid-free remission at 21 wks seen with 11/23 (48%) RTX pts vs 5/24 (21%) on PBO (p=0·049). Infusion Rxns: 10 RTX vs 3 PBO); 1 SAE (PE) on RTX https://bit.ly/3lSI0rj Pregnancies exposed to ixekizumab (from Eli Lilly Global Safety Database) found 193 pts with psoriasis, PsA, or axSpA who were IXE exposed. Live births reported for 53.8 and 61.1% of known outcomes. No congenital malformations seen. https://t.co/M1rvCH81hT FDA approves Jakafi for chronic GVHD. Ruxolitinib (Jakafi, Incyte), an oral Janus kinase 1/2 inhibitor, previously received approval for treatment of patients aged 12 years or older with steroid-refractory acute GVHD. https://t.co/isItDebNZ8 Retrosp. review of 10–24 yr olds w/ newly Dx #SLE shows 78% given steroid-sparing DMARDs by year 1; Most (69%) given HCQ & fewer (34%) given other immunosuppressants. Adults less likely to recv immDMARDs @1 yr https://t.co/aLi6FXlMd3 Case controlled study shows CPPD pts have no higher risk for MACE. 23,124 CPPD vs 86,629 non-CPPD, w/ ⋗ 250,000 Pt-Yrs FU. CPPD MACE risk not increased (HR 0.98), but there was incr risk of MI, CVA & acute coronary syndr. https://t.co/pgmZBxTg9O Trade names: Generic PFIZER = Comirnaty; MODERNA= Spikevax Moderna; J&J (pending) https://t.co/MM7XiSCczl Prospective study of 77 RA patients in remission -- ⋗ vax w/ BNT162b2 (BioNTech-Pfizer) (w/ temp D/C of DMARDs per ACR) found a vaccine-related flare rate of 7.8% (6 pts) w/ 5/6 flares after 2nd dose (2.6 days), resolved w/in 2 wks https://t.co/YOL3YVS2ne Dr. Calabrese shares his Delta COVID-19 breakthrough story on the blog today. https://t.co/timjB2YPys BMJ Breakthrough infections from UK QResarch database: Among 6.95 million vaccinated, 74.1% recv two vaccine doses, there were 2031 covid-19 deaths & 1929 hosp admissions; ~4.0% deaths & admissions were ⋗14 days after 2nd dose Addendum: COVID deaths increased w/ age, deprivation, male, Indian & Pakistanis. Highest risk w/ Down's syndr (HR 12.7), renal transplant (8.1), sickle cell (7.7), Nursing home (4.1), chemotherapy (4.3), HIV/AIDS (3.3), liver cirrhosis (3), CNS dz (2.6) Addendum: Other conditions w/ a 1.2-2 fold higher risk of COVID death (admission) were CKD, hematologic cancer, epilepsy, COPD, CVD, stroke, atrial fibrillation, CHF, thromboembolism, PVD, type 2 diabetes. https://t.co/bbDsb1zLhX Claims case-controlled study shows statin use does not increase the risk of #RA - 32,726 RA and matched controls ; statin use (34 vs 32%) slightly increased RA risk (OR 1.12, 1.06–1.18), but signif lost after correcting for hyperlipidemia https://t.co/EcTlyE1MPx High Comorbidity Rates with Inclusion Body Myositis Guselkumab Treats Axial Disease in Psoriatic Arthritis 11 Drugs That Cause Arthritis https://rheumnow.com/news/11-drugs-ca... Viewer Question – A positive anti ds DNA in the absence of clinical evidence of lupus? CONNECT WITH RheumNow ✩ Website - https://rheumnow.com/ ✩ Subscribe @ RheumNow: https://rheumnow.com/user/register ✩ LinkedIn - https://www.linkedin.com/in/john-cush... ✩ RheumNow LinkedIn: https://www.linkedin.com/company/rheu... ✩ Twitter - https://twitter.com/RheumNow Listen | PODCAST Apple Podcasts: https://podcasts.apple.com/us/podcast... Spotify: https://open.spotify.com/show/4Mjzj5j... Stitcher: https://www.stitcher.com/show/the-rhe... TuneIn: https://tunein.com/podcasts/Health--W... Podbean: https://rheumnow.podbean.com/ Got a Rheumatology question or case for Dr. Jack Cush? Record it here and we'll feature it on an upcoming podcast. Tell us your name and where you practice rheumatology. BackTalk:https://rheumnow.com/submit-podcast-question-or-comment

Episode at a glanceIntroduction to Episode with Methotrexate facts (0:00-5:00)Patient introductions (5:00-10:00)Patient stories about being on methotrexate: Paulina, Cheryl, Ali & Ananthi (10:00 - 41:00)Discussion about natural methods versus medications and decision making around that (41:00 - 47:40)More patient stories about being on methotrexate: Jo, Aashi, Kristen, Jenny  (47:40 - 1:09:00)Patients share tips on injecting methotrexate or other rheumatic disease medications (1:09:00 - 1:31:00)Tips for coping with “miracle cures,”  unsolicited advice & medication shamers (1:31:00 - Speaker Handles:Aashi Bhimani @solo_spoonie on InstagramCheryl Crow @Arthritis_Life_Cheryl on InstagramAnanthi Ramachandran @ar_versus_ra on InstagramAli Digiacomo @anotherdaywithRA on InstagramKristen Brogan @warriorsmovemountains on InstagramJo Mistreanu @thejosphere on InstagramJenny Parker @cute_n_chronic on InstagramCheryl Crow is an occupational therapist who has lived with rheumatoid arthritis for seventeen years. She's passionate about helping others with rheumatoid arthritis live a full life, by using effective tools to manage physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare she say) FUN patient education and self-management resources.Episode SponsorThis episode is brought to you by Rheum to THRIVE, a 6-month education and support program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. Registration is open through September 30th and then won't open again until 2022!Episode links:Resources to learn more about Methotrexate:Rheumatoid Arthritis “In the Clinic” - Annals of Internal Medicine Article (2019) ““In most patients, RA is a chronic, progressive disease character-ized by episodes of disease flares or long-term chronic inflamma-tion. Only a few patients achieve long-term remission without the need for long-term medications.” “About half of all patients treated with methotrexate have little or no radiographic progression, although 30% will require addi-al DMARDs (like biologics):Global Healthy living Foundation research into how prominent methotrexate side effects are Methotrexate Side Effect Stats from the Arthritis FoundationCheryl's Arthritis Life social media pages:Arthritis Life Podcast, Practical Tips and Positive, Realistic Support - Facebook groupCheryl &  Arthritis Life on InstagramCheryl's website: Arthritis LifeArthritis Life Tiktok: @ArthritisLife Arthritis Life Facebook PageCheryl's Twitter: @realcc Arthritis Life Youtube channelArthritis Life Program LinksJoin the waitlist for Rheum to THRIVE, a membership community Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. Rheumatoid Arthritis Roadmap, an self-paced online course Cheryl created that teaches people with RA how to confidently manage their physical, social and emotional life with this condition.Medical disclaimer: All content found on Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.Full episode transcriptFor additional details including a transcript, please go to www.Arthritis.TheEnthusiasticLife.Com

New to RheumNow? Rheumnow.com is a news source dedicated to the field of Rheumatology. It is written by experts in the field, and written for rheumatologists and individuals working in related fields. In this episode, Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com Metanalysis of JAK inhibition (tofacitinib & ruxolitinib) in alopecia areata - 12 studies, 346 Pts, Rx success (using SALT50 resp) was 66%, not influenced by age, sex, subtype. Alopecia recurrence seen w/in 3 mos of JAK D/C (in74%) https://t.co/CBSy4Kci80 Population study shows risk of H. Zoster in adults to be high among bDMARD and CTX, also increased w/ AZA and HCQ but not MTX SSZ or LEF users. Data from 254065, 1,826311 Pt-Yrs F/U, 6295 new DMARD users, 17024 incident HZ https://t.co/1TeOAWN9LB MMWR reports that during the COVID Delta variant era, Vaccination against COVID-19: - Reduces risk of COVID-19 infection 5X - Reduces risk of COVID-19 Hospitalization ⋗10X - Reduces risk of COVID-19 DEATH 10X https://t.co/rMRY84xX5F Study of 265 students w/ a positive COVID-19 test looked at 378 close contacts. Infx rates w both persons masked -7.7%, but when unmasked-32.4% (aORs = 4.9) https://t.co/fYdH33JbWR Effect of Diet on COVID Outcomes Probenecid, an OAT3 inhibitor, has inhibitory effects on RNA viruses (influenza, RSV) & decreases ACE2 expression. May have utility in COVID-19 as it was shown to inhibit SARS-CoV-2 replication in animal modelshttps://t.co/MClSjpqpSa Mease and colleagues have catalogued the current practices assessed in the CORRONA registry, noting that increased DMARD switching and decreased time on a given therapy by US physicians. https://t.co/cIWZw6KsuI A retrospective study of systemic sclerosis patients shows that acute hospitalization and mortality were not uncommon and were often linked to SSc-related lung disease. #RheumNow https://t.co/s5wSlndTrt Cases and Questions (AKA Back Talk) “What treatment do you use after 2 years of teraparitide in a woman with a hx of OP, spiral fracture while on a bisphosphonate”? Forteo PI. “Do you have any inside info on the vaccines for COVID-19 during pregnancy?” OCOG Statement “Status of the Tocilizumab Shortage”? Genentech Statement “How would you treat polyarthritis in a renal transplant patient?” CONNECT WITH RheumNow ✩ Website - https://rheumnow.com/ ✩ Subscribe @ RheumNow: https://rheumnow.com/user/register ✩ LinkedIn - https://www.linkedin.com/in/john-cush... ✩ RheumNow LinkedIn: https://www.linkedin.com/company/rheu... ✩ Twitter - https://twitter.com/RheumNow Listen | PODCAST Apple Podcasts: https://podcasts.apple.com/us/podcast... Spotify: https://open.spotify.com/show/4Mjzj5j... Stitcher: https://www.stitcher.com/show/the-rhe... TuneIn: https://tunein.com/podcasts/Health--W... Podbean: https://rheumnow.podbean.com/ Got a Rheumatology question or case for Dr. Jack Cush? Record it here and we'll feature it on an upcoming podcast. Tell us your name and where you practice rheumatology. BackTalk:

New to RheumNow? Rheumnow.com is a news source dedicated to the field of Rheumatology. It is written by experts in the field, and written for rheumatologists and individuals working in related fields. In this episode, Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com Metanalysis of JAK inhibition (tofacitinib & ruxolitinib) in alopecia areata - 12 studies, 346 Pts, Rx success (using SALT50 resp) was 66%, not influenced by age, sex, subtype. Alopecia recurrence seen w/in 3 mos of JAK D/C (in74%) https://t.co/CBSy4Kci80 Population study shows risk of H. Zoster in adults to be high among bDMARD and CTX, also increased w/ AZA and HCQ but not MTX SSZ or LEF users. Data from 254065, 1,826311 Pt-Yrs F/U, 6295 new DMARD users, 17024 incident HZ https://t.co/1TeOAWN9LB MMWR reports that during the COVID Delta variant era, Vaccination against COVID-19: - Reduces risk of COVID-19 infection 5X - Reduces risk of COVID-19 Hospitalization ⋗10X - Reduces risk of COVID-19 DEATH 10X https://t.co/rMRY84xX5F Study of 265 students w/ a positive COVID-19 test looked at 378 close contacts. Infx rates w both persons masked -7.7%, but when unmasked-32.4% (aORs = 4.9) https://t.co/fYdH33JbWR Effect of Diet on COVID Outcomes Probenecid, an OAT3 inhibitor, has inhibitory effects on RNA viruses (influenza, RSV) & decreases ACE2 expression. May have utility in COVID-19 as it was shown to inhibit SARS-CoV-2 replication in animal modelshttps://t.co/MClSjpqpSa Mease and colleagues have catalogued the current practices assessed in the CORRONA registry, noting that increased DMARD switching and decreased time on a given therapy by US physicians. https://t.co/cIWZw6KsuI A retrospective study of systemic sclerosis patients shows that acute hospitalization and mortality were not uncommon and were often linked to SSc-related lung disease. #RheumNow https://t.co/s5wSlndTrt Cases and Questions (AKA Back Talk) “What treatment do you use after 2 years of teraparitide in a woman with a hx of OP, spiral fracture while on a bisphosphonate”? Forteo PI. “Do you have any inside info on the vaccines for COVID-19 during pregnancy?” OCOG Statement “Status of the Tocilizumab Shortage”? Genentech Statement “How would you treat polyarthritis in a renal transplant patient?” CONNECT WITH RheumNow ✩ Website - https://rheumnow.com/ ✩ Subscribe @ RheumNow: https://rheumnow.com/user/register ✩ LinkedIn - https://www.linkedin.com/in/john-cush... ✩ RheumNow LinkedIn: https://www.linkedin.com/company/rheu... ✩ Twitter - https://twitter.com/RheumNow Listen | PODCAST Apple Podcasts: https://podcasts.apple.com/us/podcast... Spotify: https://open.spotify.com/show/4Mjzj5j... Stitcher: https://www.stitcher.com/show/the-rhe... TuneIn: https://tunein.com/podcasts/Health--W... Podbean: https://rheumnow.podbean.com/ Got a Rheumatology question or case for Dr. Jack Cush? Record it here and we'll feature it on an upcoming podcast. Tell us your name and where you practice rheumatology. BackTalk: https://rheumnow.com/submit-podcast-question-or-comment

Prof Iain McInnes discusses long-term data from the SELECT-PsA 2 study, and the impact of DMARDs on COVID-19 outcomes. Keep-up to date with the latest in arthritis and cytokine signalling with Prof Iain McInnes. Everything discussed is available in a more detailed slide format in the publications section at cytokinesignalling.com.

The Journal of Rheumatology's Editor-in-Chief Earl Silverman discusses this month's selection of articles that are most relevant to the clinical rheumatologist. Included are excerpts from this month's Editor's Picks spotlight interviews with 2 authors; Jessica Widdifield, PhD, ICES, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto, and Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada and Grace C. Wright, MD, PhD, Association of Women in Rheumatology, New York, New York, USA. This month's selections also include: Pathi, et al: The Rheumatoid Arthritis Gene Expression Signature Among Women Who Improve or Worsen During Pregnancy: A Pilot Study - https://doi.org/10.3899/jrheum.201128 Stovall, et al: Relation of NSAIDs, DMARDs, and TNF Inhibitors for Ankylosing Spondylitis and Psoriatic Arthritis to Risk of Total Hip and Knee Arthroplasty - https://doi.org/10.3899/jrheum.200453 Mehta, et al: Giant Cell Arteritis and COVID-19: Similarities and Discriminators. A Systematic Literature Review - https://doi.org/10.3899/jrheum.200766 Widdifield, et al: Feminization of the Rheumatology Workforce: A Longitudinal Evaluation of Patient Volumes, Practice Sizes, and Physician Remuneration - https://doi.org/10.3899/jrheum.201166 Bachiller-Corral et al: Risk of Severe COVID-19 Infection in Patients With Inflammatory Rheumatic Diseases - https://doi.org/10.3899/jrheum.20075 Ornetti, et al: Perforating Rheumatoid Nodule Mimicking Malignant Soft-tissue Mass of the Forearm - https://doi.org/10.3899/jrheum.201290 Guillaune-Czitrom, et al: A Recurrent Central Band Keratopathy in a Child - https://doi.org/10.3899/jrheum.200462 To read these, and other full articles visit www.jrheum.org. Music by David Hilowitz

High-yield discussion of pharmacotherapy in rheumatoid arthritis; includes choice of the drug based on the stage of disease management (Non-DMARDs, conventional DMARDs, Biological DMARDs including TNF-inhibitors & non-TNF inhibitors);  The understanding of the medication choice, their side effects and pretreatment or follow up assessment is essential for many other rheumatology chapters in internal medicine & pediatrics (including seronegative spondyloarhtropathies, vasculitis arthritis, Juvenile Idiopathic Arthritis)

Comparing & Contrasting the Pathogenesis, Clinical features, Patterns of joint involvement, Diagnostic workup and Management options for rheumatoid arthritis versus osteoarthritis (AKA Degenerative Joint Disease); Next episode will provide a more in depth-discussion of rehumatoid arthritis management with focus on pharmacotherapy with DMARDs.

This week join your patient co-hosts, Tiffany Westrich-Robertson, CEO of the International Foundation for Autoimmune and Autoinflammatory Arthritis (AiArthritis), and recurring 2021 patient co-host Deb Constien as they welcome two special guests to the table for a new episode of our Special Series on COVID-19. They are joined today by two practicing adult rheumatologists: Dr. Al Kim ("Al") of the Washington University School of Medicine and Dr. Jeff Sparks ("Jeff") of the Harvard School of Medicine *.  This debrief they focus on sessions that involved communication and office visit needs (patient side and rheumy side), as well as shared-decision making and the evolution of visits to include discussions on comorbidities (and multi-morbidities).  The rheumies also update us on COVID-19 vaccinations and new research.  Jeff received an abstract award at the conference for his research on COVID-19 disease outcomes for patients taking immunosuppressant medications and Al is doing research, led by Washington University, tracking vaccine response in autoimmune patients.  Shared decision making about therapeutic plans, including vaccination, is the other hot topic for the day! The rheumies and our co-hosts dish about the topics on patients' minds including antibodies, boosters, and next steps. And Tiffany gives a special thank you to Janssen Pharmaceuticals for investing in the organizations new initiative to prepare patients to engage in shared decision making about COVID-19 and vaccines.    This special episode was recorded during a EULAR 2021 debrief. You can watch the entire, unedited video recording (that also includes Katie and Patrice) HERE.  While there, watch all of our EULAR 2021 content on our YouTube Channel. *Actually, at minute marker 20 in the full video, Al and Jeff zoom-bombed our patient-led debrief, the first time non-patient stakeholders were invited to the table for this series. But it was about rheumy communication, so why not?!    Now, if you are a patient, a parent of a juvenile patient, or any other stakeholder (doctor, nurse, researcher, industry representative, or other health services person) - are you ready to join the conversation? It's your turn to pull up a seat. Join our new AiArthritis Voices program, where people living with AiArthritis diseases and other stakeholders who we need 'at the table' to solve problems that impact education, advocacy, and research sign up to have a voice in our initiatives. By signing up, you'll get notified of opportunities to be more involved with this show - including submitting post-episode comments and gaining insider information on future show topics. JOIN TODAY!   AiArthritis Voices 360 is produced by the International Foundation for Autoimmune and Autoinflammatory Arthritis. Visit us on the web at www.aiarthritis.org/talkshow. Find us on Twitter, Instagram, or Facebook (@ifAiArthritis) or email us (podcast@aiarthritis.org) to have your seat at the table.   Episode 63: COVID-19, Vaccinations, Shared-Decision Making, & Rheumy Communications 01:37 - Tiffany welcomes listeners. 03:12 - Tiffany is joined today by recurring co-host Deb and rheumatologists Dr Al Kim and Dr Jeff Sparks. 05:16 - Today's episode will focus on COVID-19 vaccinations and new research on COVID-19, as well as the launch of a new AiArthritis initiative to promote shared decision making regarding COVID-19 vaccinations. 07:47 - Thank you to Johnson & Johnson for funding our work on this important initiative.  09:01 - Jeff explains his award-winning research abstract presented at EULAR 2021. 10:33 - Jeff's research found that COVID-19 patients who were taking Rituximab and JAK inhibitors prior to diagnosis had more severe disease courses compared to patients who were not treated with these drugs or were treated with different DMARD or Biologics. 10:58 - This is especially interesting because some trials have shown that JAK inhibitors can be effective in treating COVID-19 in patients who were not taking immunosuppressant medications prior to diagnosis. 13:19 - COVID-19 is a unique disease in that it creates a second stage inflammatory state where immunosuppressants can be helpful in preventing death and facilitating recovery. 13:48 - Research from Yale shows that a patient's ability to produce antibodies effectively in the early stage of the disease is crucial to preventing the more serious form of the disease, so patients taking immunosuppressants have an increased risk of developing severe COVID even though these drugs are helpful in treating the disease in the second stage. 15:32 - AiArthritis (in conjunction with EULAR PARE) just launched the Pathway of Patient Engagement in Rheumatology Research, which features Jeff's research abstract. 16:32 - What should patients be preparing for before their rheumatology appointments as new information about COVID-19 and vaccines continues to develop? 17:00 - Al still thinks that testing patients for antibodies doesn't make sense because antibody status is not actionable information from the rheumatologist's perspective. 17:47 - Prophylactic monoclonal antibodies are substantially restricted because they have only been approved under an Emergency Use Authorization by the FDA, so your rheumatologist cannot just prescribe them for you because your vaccine did not yield COVID-19 antibodies. 18:05 - Booster shots for COVID-19 have also not been approved by the FDA yet, so some patients are lying about their vaccination status to get a second set of shots.  Please note that neither AiArthritis nor the rheumatologists appearing in this episode recommend this course of action. 22:21 - Rituximab is generally considered to be a very safe drug, but it elevates risk for patients with COVID-19. 23:06 - This raises questions for doctors about whether they should continue prescribing it in light of the risk that patients may be facing from COVID-19. 23:15 - It will be very important for patients to engage in shared decision making with regard to drugs that elevate COVID-19 risks. 24:11 - Special thanks to Janssen Pharmaceuticals for their support in funding our work on promoting shared decision and helping patients with regard to COVID-19 vaccination decisions. 26:36 - To watch the entirety of this conversation, check out our EULAR debrief video #6 on our YouTube Channel. 26:55 - If you are interested in going to conferences with us, find out how you could attend a conference with us at aiarthritis.org/conferences. 27:11 - You can also find any of our previous podcast episodes at aiarthritis.org/talkshow. 27:17 - Please consider donating at aiarthritis.org because we need your support to keep this show and all of our initiatives moving forward. 27:54 - Tiffany thanks listeners for their support.   Links discussed in this debrief: 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis - https://ard.bmj.com/content/early/2021/06/13/annrheumdis-2021-220249 Exploring intentional medication non-adherence in patients with systemic lupus erythematosus: the role of physician-patient interactions - https://pubmed.ncbi.nlm.nih.gov/33604502/ Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis: Results from the COVID-19 Global Rheumatology Alliance physician registry - https://pubmed.ncbi.nlm.nih.gov/34049860/ Glucocorticoids and B Cell Depleting Agents Substantially Impair Immunogenicity of mRNA Vaccines to SARS-CoV-2 - https://www.medrxiv.org/content/10.1101/2021.04.05.21254656v2.full.pdf Learn more about the Pathway of Patient Engagement in Rheumatology Research: www.rheumactioncouncil.org/pathway   Be sure to check out our top-rated show on Feedspot!  

In the first episode of the European Alliance of Associations for Rheumatology (EULAR) 2021 Virtual Congress series, we spoke with co-authors Jeffrey Sparks, MD, and Zachary Wallace, MD, about their research – the association between disease-modifying antirheumatic drug (DMARD) use and COVID-19 outcomes in rheumatoid arthritis (RA) – conducted on behalf of the COVID-19 Global Rheumatology Alliance. The study was presented by Dr Sparks and Dr Wallace at the EULAR 2021 meeting and has been published in BMJ. 

In this podcast, rheumatologists and research scientists Jeffrey Sparks, MD, and Zachary Wallace, MD, discuss the findings of their research into the outcomes of patients with rheumatoid arthritis taking DMARDs at baseline who contracted COVID-19.

*This episode was recorded on February 4, 2021 so the information presented was as of this recording* In this episode, we finish out  panel discussion with PollyAnnamazing and Jeff about the COVID-19 vaccine.     In part 2 we continue discussion of the vaccine, use of the vaccine and DMARDS and NSAIDs, surgery and the vaccine, as well as vaccine rollout. In our new segment, we roll out Second Opinion, a segment where we flip the script and ask a question of our listeners on social media. Just Some Podcast Social Media Facebook Twitter Instagram YouTube Special Thanks to Falcon Five-O for use of songs "Hard Living" and "Failures Not the Same Without You"

QD128 - Sawtooth Steroid Taper https://youtu.be/wIzZEw2hWEg QD129 - Surgery Rules for DMARDs & Biologics https://youtu.be/V9zwoQhnbmk QD130 - RA & DVT https://youtu.be/b2FkusWZn88 QD131 - Traveling to Medical Meetings during COVID https://youtu.be/3rGwRFZIunI QD132 - Hemoptysis and SLE https://youtu.be/jpUsu1YtZuE QD133 - When to do Genetic Testing in Febrile Patients https://youtu.be/VDw_bpmxmHA QD Clinic is sponsored by RheumNow.Live

The Whole View, Episode 443: Covid-19 Vaccines Part 3 - Myths and FAQ’s Welcome back to episode 443 of the Whole View. (0:27)       Stacy explains that this is part 3 of the Covid Vaccine Shows: you can find Part 1 here and Part 2 here. She thanks every listener for all their positivity and understanding. The point of these shows is to give the information needed to make an informed decision for yourself. She also extends a bit thanks to Sarah, who has logged a ridiculous amount of hours doing extensive research to arm listeners with all the information she can. Sarah explains that this show may be on the long side. But she hopes to answer some questions followers have and dispel or shed light on common myths around these vaccines. Stacy adds that this show is all about the facts. Nothing they say is meant to be opinion based not backed up by science. She also reminds listeners that she and Sarah are not medical professionals. They are not qualified to give medical advice on whether you should get the vaccine or not. The best practice is to consult your primary care physician. Stacy hopes that all this information can help listeners make an informed decision they are happy with. Listener FAQ: Covid-19 Vaccines Myths Sarah goes through several positive comments left by viewers, expressing their appreciation of the science included in previous shows and arming them with as much research as Sarah did. (7:45)    She takes a moment to emphasize that the FDA reports and all of the peer-reviewed papers on these clinical trials are full public access.  They will be included in these show notes so listeners can go to the source for more information and formulate their own opinions based on the science. Stacy jokes that will be a theme of the show today: science and information. The first question Sarah takes comes from a listener on Patreon. Sarah reminds listeners that Patreon is the best platform to reach them and was the first place they went when pulling questions.  If you've not joined the Patreon family, she invites you to for bonus content and extra episodes! Herd Immunity The first question Sarah takes is about herd immunity and why wearing masks is still encouraged after vaccination. (13:30) Sarah explains the there are multiple positive outcomes that we hope to get from the vaccines: Prevent disability and death Ease the burden on the healthcare system to ensure patients get the necessary attention Ease the burden on the economy so we can open schools, etc. back up Achieve herd immunity, so we don't have to live with covid forever She adds that even if we can achieve the first three without the fourth, that's a huge win, and we don't necessarily need herd immunity for the vaccine to be a success. The benefit of herd immunity (why it's ideal) is it limits the spread to pockets that more easily die out because they don't have as many places to go. Sarah explains that we don't have all the information yet to determine how long immunity from vaccination will last. There is still a lot of tests needing to be done to accurately calculate those numbers. Sarah does say that the preliminary data (early outlooks) looks promising for reducing asymptomatic cases. That's why it's still important to wear a mask in the meantime. We need to keep the disease spread as low as possible to give researchers time to figure out what the future will look like for herd immunity. Sarah adds that this is actually very exciting early data. She explains data for the newer Oxford/Astrazeneca vaccine maybe 59 percent effective at stopping asymptomatic infection. However, Sarah emphasizes that we definitely need more data before saying people with the vaccine can go without masks and social distancing. Long-Term Effects of Asymptomatic Cases  Sarah jumps to another listener's question on whether those asymptomatic or mild cases carry the risks of long covid or other long-term damage. (22:32) Sarah recaps long-covid, which she and Stacy talked about long covid and tissue damage on our previous covid shows. She does a quick recap on what long-term effects are known to be associated with Covid-19 infections, such as the tissue damage seen in long-Covid.  There's no evidence from the clinical trials about possible long-term damage comparable to mild cases. Myocarditis is shown to occur in between 15-35% of covid patients and even 15% in young college athletes with mild or asymptomatic cases. Sarah reminds listeners that not everyone who gets covid will suffer permanent heart damage. She does agree it's a concern but doesn't want to scare anyone. While this hasn't been methodically studied yet, the early data points to the only likely long-term effect of getting vaccinated being immunity to covid-19. Stacy adds that many people involved in the clinical trials actually reached out to her and Sarah. They spoke of the attentiveness they experienced and how closely monitored they were.  Stacy thanks those followers for sharing their crucial experiences! Stacy also shares her experiences with long-covid and does not wish it on anyone. Both vaccines were thoroughly tested for anything and everything that could possibly go wrong. Pregnant Women Another listener asks if the Covid-19 vaccines are safe for pregnant women and children yet, due to it being super unclear in the media. (37:20) Pregnant women were excluded from trials, but some became pregnant after enrolling. Those women were followed closely for monitoring.  There is very limited human testing in this area. However, WHO recently said pregnant women can get the covid vaccine due to the few cases. No issues with pregnancy were detected in animal studies of vaccines. Sarah mentions that pregnant women are considered high-risk, and that's definitely something to keep in mind when deciding if vaccination is right for you. Pregnant women are overall 3-3.5x more likely to require ventilation. And 70% more likely to die from covid than their age and risk factor-matched controls. It's even worse for AMA, pregnant women aged 35–44 years with COVID-19:  nearly four times as likely to require invasive ventilation twice as likely to die than were non-pregnant women of the same age Sarah recommends reviewing this article for more information. She also mentions that despite being considered "high-risk," the absolute risk is still low. This is why even though data is preliminary for vaccines, some organizations recommend it.  CDC recommends pregnant women have a conversation with their doctors. Another listener asks for recommendations for breastfeeding. Sarah says that nothing is saying that breastfeeding could be problematic. But it does warrant a conversation with your doctor. Stacy adds that what's in your blood is different from what's in your milk. Children Pfizer already tested in 16-18-year-olds. It showed good safety, efficacy consistent with adult data and already has EUA to 16+. (40:41) Pfizer is currently testing in 12-15-year-olds, fully enrolled, and expect data in the summer. Moderna is currently testing 12 to 18-year-olds, still enrolling, and hoping to have approval in time for 2021/2022 school year.  Sarah actually enrolled her daughter because they are having issues filling slots for those studies. She and her family are waiting to find out if she'll be in the trial. Then they'll move into younger and younger children (6-11 then 1-5).  They go slow, start with a lower dose to be extra cautious, and so these trials take longer. Moderna doesn't expect to have data in children 1 to 11 until well into 2022, so we just have to wait for now. Young Women and Future Pregnancy Sarah addresses a question from a listener regarding information she heard about the possibility of hurting the lining of their placenta when they want to have children. What is the premise of this? (49:50) She explains that this is one of those myths based on a kernel of truth but took on a life of its own on the internet. Sarah goes in-depth about the spike protein and how antibodies affect them. She adds that the same thing has a chance of happening in natural infection. And even then, the numbers are very slim. Sarah summarizes that it's not impossible but highly improbable, and we have no examples to point to. Autoimmune Diseases In More Detail Sarah covers another question on whether a vaccine could cause something with no history of autoimmune conditions to trigger a response for a lifelong autoimmune condition. (53:02) She goes in-depth, looking at numerous case reports indicating that vaccines could potentially worsen autoimmune disease activity and increase measurable autoantibody levels.  This is most likely attributed to the adjuvants in vaccines.  However, several large-scale prospective studies indicate no link between vaccines and autoimmune disease or autoantibody formation.  Sarah explores several different studies that looked at this research topic and breaks down what the data shows.  In fact, early data shows vaccines could potentially reduce autoimmune diseases by preventing environmental triggers for it. However, this still needs to be studied in a lot more detail before we can say for sure. Sarah adds that for the covid mRNA vaccines, clinical trials included autoimmune sufferers (even those on DMARDS) and tracked autoimmune disease as possible adverse events. Sarah revisits vaccine injury, which they discussed in the Covid first show, and the timeframe. She adds EAU will transition to full regulatory approval once there are 6 months of follow-up data and we're actually nearly there. Clinical trial participants will also be followed for 24 months. Final Thoughts Stacy reflects on how much it blows her mind the comparison between the study group and the placebo. (1:07:14) When out of 30,000 people, you have one person in the study group and one placebo group both have an immune response, it sounds way better to Stacy than if that's the same one person was extrapolated from the data, and the rest left out. Sarah reiterates that this is the point of these shows: to provide listeners with the big picture and all the data. Not facts that may or may not have been taken out of context. Stacy mentions that she and Sarah didn't want to skimp on any information. For this reason, decided to cut this two-hour show into two parts.  Join us again next week for more Covid-19 vaccine myths dispelled! And be sure to pop over and join Sarah and Stacy on Patreon.

This week join your patient co-hosts, Tiffany Westrich-Robertson, CEO of the International Foundation for Autoimmune and Autoinflammatory Arthritis, and Kelly Conway, co-founder of AiArthritis and author of the popular blog As My Joints Turn: My Autoimmune Soap Opera, as they sit down with Dr. Al Kim, Rheumatologist and Founder & Co-Director of the Lupus Clinic at the Washington University School of Medicine. Today’s episode will be a heart-to-heart conversation with Dr. Kim about questions, concerns, and mixed messages surrounding the COVID-19 vaccine.Tiffany and Kelly, as people who live with AiArthritis diseases and participate in online patient communities, realized patients still had a lot of questions about the vaccine. How might their diseases and treatments affect its safety and efficacy? Should they even get it?  They also discovered that not all rheumatologists were recommending the COVID-19 vaccine for patients, despite the general consensus that vaccination is suggested by groups like the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR).So is the vaccine safe for us?  How will our treatments interfere with the safety and efficacy of the vaccine, if at all?  And what can we do as a community if rheumatologists are providing inconsistent and misguided advice that patients then share with each other, leading to more confusion and questions? So we turned to an expert who understands the importance of the informed patient’s role in a shared decision-making model.Dr. Kim and his colleagues are leading a study called COVID-19 Vaccine Responses in Patients with Autoimmune Diseases which seeks to examine the quantity and quality of immune responses generated to the vaccine by autoimmune patients, as well as the safety of the vaccine for those patients. He provides answers to all of our patient-generated questions and provides actionable advice you can use to make the best decision for your own care.Now, if you are a patient, a parent of a juvenile patient, or any other stakeholder (doctor, nurse, researcher, industry representative, or other health services person) - are you ready to join the conversation? It's your turn to pull up a seat! Join Tiffany, Kelly, and all the other Voices 360 co-hosts to continue this conversation inside our new, coordinating AiArthritis Voices online community - where patients unite with others around the world to talk, learn, and connect.  JOIN TODAY! AiArthritis Voices 360 is produced by the International Foundation for Autoimmune and Autoinflammatory Arthritis. Visit us on the web at www.aiarthritis.org/talkshow. Find us on Twitter, Instagram, or Facebook (@ifAiArthritis) or email us (podcast@aiarthritis.org) to have your seat at the table.   Special thanks to Bristol Myers Squibb for sponsoring our COVID-19 & AiArthritis Series. ________________________________________________________________________Disclaimer: This is meant to be informative, but not to provide medical advice.  Every person living with AiArthritis diseases must make vaccination choices based on their self-education then contact their rheumatologist or practicing physician and determine a solution together (shared-decision making). It is important you determine the best course of action for YOU, based on your own individual health situation. _______________________________________________________________________________________ Show Notes: Episode 54 – COVID19 & AiArthritis Special Series - Join patients & rheumys to tackle questions & mixed messages surrounding the COVID19 vaccine. Questions bolded were submitted by our patient community. 00:53 - Tiffany welcomes listeners.01:20 - Tiffany welcomes her rheumatologist, Dr. Alfred Kim and fellow patient co-host, Kelly.02:00 - Today’s episode is about the COVID-19 vaccine and AiArthritis patients.02:17 - Patients are sharing many differing pieces of information - not all of it accurate or clear - about the safety and efficacy of the available COVID-19 vaccines, so our organization decided to put together this episode, and the information will be added as an extension to our existing website @ aiarthritis.org/covid19 - subpage Vaccines. We will be constantly updating this information as more resources become available.03:44 - Dr. Kim is an adult rheumatologist on the faculty at Washington University School of Medicine, as well as the founder and co-director of the Lupus Clinic at Washington University.04:34 - Kelly is a co-founder of AiArthritis, as well as a patient living with Rheumatoid Arthritis and the author of the blog As My Joints Turn: My Autoimmune Soap Opera.05:42 - Patients will always talk to other patients when making decisions about their own care, so the widespread sharing of misinformation about the COVID vaccine, as well as patient fears and concerns about the effect the vaccine could have on their disease, should be addressed so that all members of the AiArthritis patient community can make the best decision for their individual care.07:05 - Dr. Kim, can you give us some general background information on vaccines?07:11 - According to Dr. Kim, vaccines represent the most important modern medical advancement.07:55 - After the immune system fights off a pathogen, it creates a memory response of the disease and the best way to kill it. Vaccines leverage this function of the immune system to protect patients from specific diseases.09:03 - Is the COVID-19 vaccine a live virus vaccine?09:12 - There are four basic types of vaccines: live attenuated (which are not generally recommended for patients on immunosuppressant medications), inactivated, subunit, and toxoid vaccines. 13:03 - Inactivated, subunit, and toxoid vaccines are all safe for patients on immunosuppressive medications.16:05 - Some patients have already made a decision without accurate information about the vaccine or based on either misinformation about the virus itself or poorly informed advice from their doctor.16:50 - People only know what they know, but it’s dangerous when they don’t know what they don’t know because then they start acting thinking they have complete knowledge of a situation.17:07 - “This is a real problem in my mind that there are doctors saying that [the vaccine is] too new.” This science is not new. It has been used for decades. Dr. Kim will elaborate on this point later.19:30 - The COVID-19 vaccine is not “FDA approved,” but it does have an Emergency Use Authorization from the United States Food and Drug Administration, which effectively does the same thing.20:10 - Kelly lost her father and uncle to COVID-19 in November and December of 2020, which influenced her decision to get the vaccine as soon as possible.22:53 - Some patients have even received conflicting advice from different doctors they see, making it very difficult for anyone to make an informed decision.24:10 - Physicians - like everyone - don’t know what they don’t know. 24:15 - The technology used in the COVID-19 vaccine is new for humans, but it has been used in animals for decades. People who say it is “new” are uninformed, and some doctors are making recommendations to patients based on misunderstandings.25:21 - Dr. Kim’s faculty is trying to make sure that all doctors in their region understand that every rheumatologist should be offering the COVID-19 vaccine to all of their patients.26:00 - How is the vaccine going to impact rheumatology patients? Will it cause patients to flare?  Will it activate AiArthritis diseases that may be in remission or well managed?  Could AiArthritis patients experience significant negative impacts as a result of taking the vaccine?27:37 - The honest response is: most likely it won’t, but nobody can be sure on an individual level because studies are looking at population level statistics28:09 - There are significant potential benefits to AiArthritis patients because we know that COVID-19 impacts rheumatic patients more severely than the general patient population.28:35 - It is possible that patients may experience a rheumatic disease flare for up to a month after receiving the vaccine.30:10 - The vast majority of rheumatic disease patients, regardless of their medication, will be fine to receive the vaccine and will not experience a disease flare or increased incidence of adverse events compared to the general patient population.31:56 - If patients have a history of adverse reactions to biologics or other medications, should they be concerned about getting the COVID-19 vaccine? 32:27 - Because the components of the vaccine are very different than those used in biologics or other medications, these are unrelated situations. The likelihood of them having another reaction is very low.34:36 - Should AiArthritis patients discontinue biologics or DMARDs before or after taking the vaccine to optimize the efficacy of the vaccine?38:00 - Dr. Kim is advising his patients to continue their medications and receive the COVID-19 vaccine. Patients on Rituximab should assume that their vaccine response will be reduced and deal with that separately.41:27 - One problem highlighted by the COVID-19 pandemic has been the need for a method of disseminating actionable and trusted information to physicians and patients in rapidly changing situations.44:58 - Is it true that AiArthritis patients are likely to have reduced antibody responses to the COVID-19 vaccine due to immune suppression? Or that our medications will impact the effectiveness of the vaccine?45:30 - It is possible that some patients on a few medications (specifically rituximab/Rituxin, methotrexate, and Abatacept/Orencia) may have reduced antibodies, but it is not clear that this will compromise the effectiveness of the actual vaccine.47:17 - Dr. Kim and his colleagues are leading a study called COVID-19 Vaccine Responses in Patients with Autoimmune Diseases which seeks to examine the quantity and quality of immune responses generated to the vaccine by autoimmune patients, as well as the safety of the vaccine for those patients.48:09 - The study will also look at how immune responses to the vaccine evolve over time and how immunosuppression impacts long term effects.49:34 - There is a theoretical risk that patients on immunosuppressants may not be protected to new mutant strains of SARS-CoV-2, so the study will also seek to address this concern.51:31 - Dr. Kim is hoping to be able to report early results of the study within a month and more detailed results possibly as early as Summer of 2021.53:41 - Which COVID-19 vaccine should I choose?53:59 - The Moderna and Pfizer vaccines are very similar, and patients should get whichever version they can access.54:35 - There was a theoretical risk that the vaccine could have triggered flares in Lupus patients, but the stability changes made to the vaccine coincidentally made the RNA in the vaccine significantly less inflammatory. Lupus patients are now advised to get the vaccine if they can.58:56 - Bottom line:  Should I take this vaccine?59:22 - The vast majority of rheumatic patients - regardless of medications - will likely have a positive response to the COVID vaccine with minimal issues concerning safety or flares.59:42 - As previously noted, patients on rituximab/Rituxin, methotrexate, and Abatacept/Orencia may be the exception with regard to vaccine efficacy, but it is still a safe option for them that could convey some protection from COVID-19.1:00:00 - Dr. Kim would like to see all rheumatic patients get the vaccine to protect them from the potential for severe impacts of COVID infection.1:00:54 - According to Dr. Fauci, we will be able to relax public health measures (like wearing masks) when 70-80% of the US population has been vaccinated. Until then, everyone should continue taking precautions to avoid spreading the COVID-19 virus even if you have been vaccinated.1:01:12 - Will I need another COVID vaccine next year?1:01:25 - Dr. Kim will reach out to a colleague for an answer on this and update us. Follow our website @ aiarthritis.org/covid19 for these updates. Dr. Kim’s best guess is that the vaccine will not need to be re-administered every year because the virus does not mutate as fast as influenza (which does need to be done annually), but boosters may need to be redone every few years.1:03:23 - This vaccine technology was already in place and was easily adapted, and the vaccines are relatively easy to make. Hopefully this information helps allay fears from people who were concerned that the vaccine was made “too quickly.”1:03:48 - Tiffany thanks listeners for joining us today.1:04:34 - If you have additional questions, email us @ podcast@aiarthritis.org or visit us on the web @ aiarthritis.org/covid19 1:04:55 - If you are a person living with these diseases or the parent of a juvenile patient, go to aiarthritisvoices.org and sign up to join our online community space where we will talk more about COVID-19 and all our other projects and events.1:05:12 - If you love the show, please give us a rating and subscribe wherever you listen to podcasts. Be sure to check out our top-rated show on Feedspot!

In this episode, Dr. Stanley Cohen, Dr. Sheetal Desai, and Dr. Eric Ruderman discuss how to translate information on JAK inhibitors and other treatments for your patient population in the clinic, covering practical tips on using:Treat-to-target approachesDisease activity measuresShared decision-makingDecision aidsTranslating clinical trial evidenceAlso included are the experts’ answers to questions from clinicians like you.Stanley B. Cohen, MDClinical ProfessorDepartment of Internal MedicineUniversity of Texas Southwestern Medical SchoolCo-DirectorDivision of RheumatologyPresbyterian HospitalCo-Medical DirectorMetroplex Clinical Research CenterDallas, Texas  Sheetal Desai, MD, MSEdChief of RheumatologyProgram DirectorUniversity of California, IrvineIrvine, CaliforniaEric M. Ruderman, MDProfessor, Associate ChiefDivision of RheumatologyNorthwestern University Feinberg School of MedicineClinical Practice DirectorNorthwestern Medical GroupChicago, IllinoisDownload the accompanying slides at:https://bit.ly/3gHDE3sSee the interactive video at:https://bit.ly/3oCOtpV

In this episode, Dr. Stanley Cohen, Dr. Sheetal Desai, and Dr. Eric Ruderman discuss the recent changes in rheumatoid arthritis treatment options, reviewing the landscape of targeted DMARDs and JAK inhibitors, including:Kinase signalingJAK inhibitor activity and signalingJAK selectivityPresenters:Stanley B. Cohen, MDClinical Professor Department of Internal MedicineUniversity of Texas Southwestern Medical SchoolCo-DirectorDivision of RheumatologyPresbyterian HospitalCo-Medical DirectorMetroplex Clinical Research CenterDallas, Texas Sheetal Desai, MD, MSEdChief of RheumatologyProgram DirectorUniversity of California, IrvineIrvine, CaliforniaEric M. Ruderman, MDProfessor, Associate ChiefDivision of RheumatologyNorthwestern University Feinberg School of MedicineClinical Practice DirectorNorthwestern Medical GroupChicago, IllinoisDownload the accompanying slides at:https://bit.ly/3447GceSee the interactive video at:https://bit.ly/3oCOtpV

In this episode, Dr. Stanley Cohen, Dr. Sheetal Desai, and Dr. Eric Ruderman interpret the latest safety and efficacy data for JAK inhibitors in RA, including the ORAL, BEACON, BEAM, SELECT, and FINCH series inbDMARD-IRMTX-IRMTX naiveAlso included is an in-depth discussion of JAK safety, including MACE and VTE, and use in the clinic including JAK cyclingPresenters:Stanley B. Cohen, MDClinical ProfessorDepartment of Internal MedicineUniversity of Texas Southwestern Medical SchoolCo-DirectorDivision of RheumatologyPresbyterian HospitalCo-Medical DirectorMetroplex Clinical Research CenterDallas, Texas  Sheetal Desai, MD, MSEdChief of RheumatologyProgram DirectorUniversity of California, IrvineIrvine, CaliforniaEric M. Ruderman, MDProfessor, Associate ChiefDivision of RheumatologyNorthwestern University Feinberg School of MedicineClinical Practice DirectorNorthwestern Medical GroupChicago, IllinoisDownload the accompanying slides at:https://bit.ly/37bm6cJSee the interactive video at:https://bit.ly/3oCOtpV

SHR # 2621 :: Discoveries Reshape Understanding of Gut Microbiome + New Research Predicts Whether Rheumatoid Arthritis Patients Will Respond to Treatment - Dr. Kirk Bergstrom, Ph.D. – Dr. Jesmond Dalli Ph.D. - The human gut is home to microorganisms that outnumber our cells by a factor of 10 to 1. Now, discoveries by scientists at the Oklahoma Medical Research Foundation have redefined how the so-called gut microbiome operates and how our bodies coexist with some of the 100 trillion bacteria that make it up. The new findings appear in the journal Science and could lead to new therapies for inflammatory bowel disease and people who've had portions of their bowels removed due to conditions like colon cancer and ulcerative colitis. They also help explain why the use of antibiotics can create a multitude of problems in the digestive system. PLUS A new study led by researchers at Queen Mary University of London provides potential novel biomarkers for predicting patient responsiveness to disease modifying anti-rheumatic drugs (DMARDs). Rheumatoid Arthritis (RA) patients are commonly treated with disease modifying anti-rheumatic drugs (DMARDs) despite the fact that up to 50% of patients are unresponsive to treatment. Up until now, there has been no way to find out whether a patient will effectively respond to treatment. Studies discussed on today's show OMRF discoveries reshape understanding of gut microbiome - https://omrf.org/2020/10/22/omrf-discoveries-reshape-understanding-of-gut-microbiome/ . Blood pro-resolving mediators are linked with synovial pathology and are predictive of DMARD responsiveness in rheumatoid arthritis - https://www.nature.com/articles/s41467-020-19176-z

SHR # 2621 :: Discoveries Reshape Understanding of Gut Microbiome + New Research Predicts Whether Rheumatoid Arthritis Patients Will Respond to Treatment - Dr. Kirk Bergstrom, Ph.D. – Dr. Jesmond Dalli Ph.D. - The human gut is home to microorganisms that outnumber our cells by a factor of 10 to 1. Now, discoveries by scientists at the Oklahoma Medical Research Foundation have redefined how the so-called gut microbiome operates and how our bodies coexist with some of the 100 trillion bacteria that make it up. The new findings appear in the journal Science and could lead to new therapies for inflammatory bowel disease and people who've had portions of their bowels removed due to conditions like colon cancer and ulcerative colitis. They also help explain why the use of antibiotics can create a multitude of problems in the digestive system. PLUS A new study led by researchers at Queen Mary University of London provides potential novel biomarkers for predicting patient responsiveness to disease modifying anti-rheumatic drugs (DMARDs). Rheumatoid Arthritis (RA) patients are commonly treated with disease modifying anti-rheumatic drugs (DMARDs) despite the fact that up to 50% of patients are unresponsive to treatment. Up until now, there has been no way to find out whether a patient will effectively respond to treatment. Studies discussed on today's show OMRF discoveries reshape understanding of gut microbiome - https://omrf.org/2020/10/22/omrf-discoveries-reshape-understanding-of-gut-microbiome/ . Blood pro-resolving mediators are linked with synovial pathology and are predictive of DMARD responsiveness in rheumatoid arthritis - https://www.nature.com/articles/s41467-020-19176-z

On this episode we cover part 1 of rheumatoid arthritis. We discuss some background information and compare RA to osteoarthritis. We then discuss the use of common non-biologic DMARDs as treatment (methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine.  Thanks for listening! If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable Power Point slides for each lecture. You can find our account at the website below:  www.patreon.com/corconsultrx If you have any questions for Cole or me, reach out to us on any of the following: Text - 415-943-6116 Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com Instagram and other social media platforms - @corconsultrx This podcast reviews current evidence-based medicine and pharmacy treatment options. This podcast is intended to be used for educational purposes only and is intended for healthcare professionals and students. This podcast is not for patients and not intended as advice or treatment.

Dr Jack Cush sings the news and journal reports from the past week on RheumNow.com Discussions on H2H trial of UPA vs ABA in RA, DMARDs in localized scleroderma, VTE risk augmented by disease activity and more...

As many people begin returning to work during this pandemic, those living with arthritis may be feeling an increase in anxiety and stress about the risks of contracting COVID-19. In this episode of the Live Yes! With Arthritis Podcast, Dr. Kevin Winthrop, a leading expert in infectious disease and rheumatology, provides an update on what we now know– and still don’t know – about this new coronavirus and its effects on people with arthritis. He shares the latest information about the research, risks, testing and the future of potential vaccines. This is the first of 2 episodes in a COVID-19 Special Edition Series, sponsored by Novartis. Visit the Live Yes! With Arthritis Podcast site to read the blog, get show notes and a full transcript: https://arthritis.org/liveyes/podcast We want to hear from you. Tell us what you think about the Live Yes! With Arthritis Podcast. Get started here: https://arthritisfoundation.az1.qualtrics.com/jfe/form/SV_ebqublsylCl7BIh Special Guest: Dr. Kevin Winthrop, MD, MPH.

DMARDs

Welcome back listeners to The Whole View, episode 41.! (0:27) Sarah corrected Stacy, this is episode 401. One of the things that Sarah is finding to be challenging during the coronavirus quarantine is the lack of things that mark the passage of time. Every day seems the same, which is disorienting. This time has been eye-opening to Stacy from a quality of life standpoint. If you missed the announcement on episode 400, this show is now The Whole View. However, it is the same podcast, just with a new name. This week Stacy and Sarah are going to jump right in and talk covid-19. Stacy is in week six of quarantine. If you are enjoying this show, please leave a review. And if you left a review when the show was The Paleo View, please leave a new review. This will help people find the updated show. Sarah has received some amazing compliments on the coronavirus podcast episodes that have aired so far.   Listener Comments “Thanks for all of the amazing actionable content during this health crisis! I’ve been tuning in to the podcast every week.” - Mariel (4:43) “I’m a long time listener, one of those who’s gone back and “caught up,” I know Stacy, but they were so helpful! I mainly attribute the fact that I’ve maintained control of my RA for 3 years without my double dose of DMARDs to you two! Saved my life! Thank you both for all that you do. It would be an honor just to be given a shout out on the new show: The Whole View, congrats! I can’t wait to hear the first episode!” - Amy “Thank you for all the energy and passion you put into every episode! I learn something new every time and I've even gotten my husband to listen along with me.” - Renee   Listener Questions Sarah wanted to give a special shoutout Charissa who does all the pre-show prep and is Sarah's, Chief Operations Officer. (6:47) Charissa goes through all the listener questions and the podcast inbox and organizes them into topic groups. She then helps Stacy and Sarah put together their recording calendar, and puts a ton of time in the pre-production projects. Sarah wanted to say a huge thank you for all that Charissa does. She was a huge help in collecting and organizing the questions for this week's show. The first question is, what is our way out? The scale of shutdowns globally is unprecedented. This is unique in human history. These shelter-in-place orders have had a huge effect on the global economy, with unemployment numbers extremely high. All of this has been done to flatten the curve, which Sarah explained in greater detail. One of the big challenges with this virus is that it has a high hospitalization rate. This virus is highly infectious and is a strain on the healthcare system. Because this is such a challenging virus and we don't have a treatment yet, our only option has been to quarantine. So the question is, how do we get back out? And life as normal? The way to get beyond this is that we need one of three things to happen. The first thing, which will be the most effective, is herd immunity. Sarah broke down the way that herd immunity works. In the absence of herd immunity, the other big thing that would get us back to life as normal would be an effective anti-viral treatment. There is also the option of using medications that would prevent the virus from infecting a person. However, this is much less likely since there aren't many drugs that are effective that do this. In the absence of those two options, the other option is to do these shutdowns and quarantines long enough to ramp up testing capabilities. There were countries that ramped up testing at the beginning who were able to successfully slow the spread of the virus.   More on the Three Options There are challenges with each one of these three cases, which Sarah will breakdown further. (18:42) None of these scenarios are fast. The fastest way out is probably the discovery of an effective antiviral. There are a number of candidate drugs that are being tested. Many have been shown to kill the coronavirus in test tubes. However, this doesn't mean that the drug will successfully reach the part in our body that would make it effective. Understanding safe dosages is critical. We actually don’t have many truly effective antivirals. For example, Tamaflu can decrease the duration of influenza illness by 30% to 40%, and decrease flu severity by about 40%. However, it only works if taken in the first 36 to 48 hours of illness. As commonly taken, it shortens the duration of flu by about a day. It has not been proven to have a positive impact on hospitalizations or mortality of seasonal, avian, or pandemic influenza. There are some good examples of effective antiviral treatments though. The best example we have is the antiviral cocktail that is given to HIV positive patients. Sarah explained the way in which the HIV cocktail works in the body. We do have these examples of antivirals that can be very effective.   The Need for Data However, what we need right now for covid-19 is randomized controlled, double-blind clinical trials of the antivirals that we already have. We need to look for drug combinations, and we need to establish risk profiles. Safety is a huge concern with antivirals in general. Many have high adverse reaction rates, which is why we don’t have an antiviral for the common cold. Data is needed to make decisions. The hydroxychloroquine initial trial was unblinded, uncontrolled in 20 patients, and excluded severe illness from the study. All these types of trials are supposed to do is indicate whether something is worthy of further study. Sarah shared more on this study out of Brazil. Preliminary findings suggest that the higher CQ dosage (10-day regimen) should not be recommended for COVID-19 treatment because of its potential safety hazards. Such results forced us to prematurely halt patient recruitment to this arm. Given the enormous global push for the use of CQ for COVID-19, results such as the ones found in this trial can provide robust evidence for updated COVID-19 patient management recommendations. There is promise with antivirals as a treatment for covid-19. However, it is very important to take preliminary studies with a very large grain of salt. We need bigger studies to prove efficacy and safety, which takes time. Matt made a very rare appearance on the show to add this breaking update to Sarah's recommendations. (31:55)   Vaccine Development More tricky than antivirals is vaccine development. One of the things that is really important to understand is that vaccine development, especially for a new virus, takes years. The fastest vaccine that has ever been developed was for mumps, which took four years. The Ebola virus vaccine was a close second and took five years to develop. We are trying to develop a vaccine for the coronavirus in a year, which is unrealistically optimistic, given the challenges with developing vaccines against other members of the coronavirus family. Covid-19 is the seventh identified coronavirus that infects humans. The early vaccine development for 2002 SARS cause vaccine-enhanced immunity in rodents. Not all antibody responses are protective. By the time they had a candidate, researchers were unable to test their SARS vaccine candidates for effectiveness in humans because they would have had to inoculate a population that was exposed to SARS, and the disease was effectively wiped out using public-health measures before that could happen. What is happening now with covid-19, is that vaccine research is picking up where SARS vaccine research left off. We need to understand the antibody response to covid-19. There have been some studies that show that the bodies producing several different types of antibodies when it is infected with covid-19. However, they are not all neutralizing antibodies. The chances of a vaccine causing vaccine enhanced infection are still there with covid-19. Sarah shared information from this study.   The Complexity of Vaccine Development It will be complex to develop an effective vaccine against the novel coronavirus. There are many different vaccines that are in phase-one clinical trials. We will need to do the human trials at the same time as the animal trials in order to expedite the timeline. It will also take a huge investment in mass-producing vaccines. Once a vaccine is proven to be effective, it takes six months to a year to mass-produce that vaccine to the level that we will need to achieve herd immunity. We hope that the SARS vaccine research was progressed far enough that picking up from that for this related virus will help expedite the vaccine development. Stacy shared her appreciation for these facts. These details help to give perspective.   Natural Immunity There is this whole other side of it, which is developing natural immunity by people getting infected. (41:25) However, there are still some questions as to how immune people are after getting the disease and how long that immunity lasts. Sarah shared information on this study out of China on antibodies in coronavirus cases. There is still this piece of science that needs to be figured out and researched. We need to understand what kind of antibodies need to be produced by our bodies to be immune, and how much. Once we know that, we need to know how long those are going to last. One of our ways through this is by ramping up testing, which needs to be done on both active infections and immunity. There have been a ton of antibody tests that have been rolled out. This is interesting to Sarah because tests have been introduced without basic science to interpret the data. Tests don’t have high enough specificity or sensitivity. Poor sensitivity means false negatives, poor specificity means false positives.   Testing We need the antibody tests to be better, and we need the diagnostic tests to be a rapid test. (47:33)  Right now, testing is taking five to twelve days to get results back. We need a diagnostic test that acts very much like the rapid strep test. Once we have the testing capabilities and we have a good enough handle with the shutdown, then we could potentially start returning to a more normal life without waiting for a vaccine or antiviral. This requires a huge amount of tests. Sarah explained that way widespread frequent testing would help. However, contact tracing presents privacy issues with smartphone tracking. This is a resource-intensive process. Stacy added that she loves the idea of using tech for these purposes! Sarah shared more on the flaws in this approach. We need to be able to take the human resources out of contact tracing, and crazily ramp up testing. We need to be testing as many people per day as we have tested total in America so far. Then we need to do these targeted quarantines based on who has been exposed. We also need to better protect our healthcare workers. While the mortality rate from covid-19 increases dramatically with age, the hospitalization rate is still really high in young people. The rate of severe illness requiring hospitalization is not that different between young, healthy people and either people with preexisting conditions or who are older.   Continuing Our Work Together We have to figure out how to carefully return to life as normal bit by bit so that we don't completely overwhelm hospitals.  This is the part that is painful and heartbreaking for Stacy to deal with. Thinking about those healthcare professionals and those other people on the frontlines and the sacrifices that they are making. We are coming together as a community to help those people who are still fighting that fight and who are risking their lives. Stacy focuses on these realities, which makes all the other frustrations worth it. She has so much to be grateful for, and these are the pieces she focuses on. We can all find something to give us that compassion for those who are fighting on the frontlines.  Sarah shared on the struggle of sympathizing with those on the front lines who are facing a very different set of challenges while trying to also process and address your own personal challenges. It is very important to give people permission to know that their struggles are valid.  Do not dismiss the challenges that each one of us are having. Also, work to maintain awareness about the things that deserve gratitude. From a mental health perspective, it is really important to be able to appreciate that we have these challenges. Then be able to apply a solution-oriented mindset to them. If you are feeling frustrated and overwhelmed, something that has given Stacy hope and something to look to is donating time, resources, and money when they can.   Reinfection The other group of questions that have come up has to do with reinfection. (1:02:44) There have been some reports out of South Korea and China where they have people who tested as negative and then were rehospitalized a couple of days later after testing positive. It is probably a testing failure. We know that in the course of covid-19, people who are going to have a mild course of the disease tends to resolve in 10 to 14 days. The moderate to a severe course of the disease is a four to six weeks recovery timeline. So around that 10-day mark, people start to feel like they are getting better. If they received a false negative, and then developed into a severe case, this is what would have led to hospitalization. The reinfection cases are likely a result of false negatives with testing. Thus far, the research shows that people cannot actually be reinfected with the virus, at least on the time scales that we have been dealing with. Sarah shared information from this reinfection study out of Bejing. There was another study on reinfection out of China that Sarah shared on, which you can find here. Right now the data points to once you've had it and gone through the other side, you should be good.  We don't know if you will be good for the rest of your life, or a few years, but definitely for the next little while.   Face Masks Do non-medical grade face masks really make a difference? (1:08:49) The answer is yes. Face masks reduce our aerosol exposure by a combination of the filtering action of the fabric and the seal between the mask and the face. In order to have an effective homemade mask, you want both a material that will do a good job of filtration and you want it to fit around your face well. You still want to social distance and be very careful about what you are touching.  Still, work to not touch your face while you are out of the house until you have had the opportunity to thoroughly wash your hands.  Also, when you take the face mask off, you want to think of it as if it is contaminated.  You want to take it off carefully and put it directly into the washing machine, and then wash your hands again. Think of the mask as a contaminated surface.  There was a study done on homemade masks made of different fabrics and how effective they are based on the various design factors.  This is not an N95 mask that is going to protect you against everything.  It is still really important for two reasons.  One, if you have it and don't know, it is going to contain a large amount of the virus in which you are shedding. This will reduce your risk of infecting others around you. Second, this is going to help you if you are exposed to an infectious person. The virus exposure, how much you are exposed to when you are infected, is a major contributor to the severity of the illness.  One of the challenges that healthcare workers face is that they are being exposed to so many different particles when they do get exposed, due to their proximity with so many different covid-19 patients.  This is why we need the appropriate levels of PPE for our healthcare workers, and we need them to be able to change them between patients.    Closing Thoughts If you are exposed to the virus when you are out of the house, but you are wearing an air mask that reduces your risk by 75% you just decreased your inoculation dose by 75%. Statistically, this will increase the liklihood of a more mild course of the disease. Stacy learned so much in this episode and thanked listeners for asking these questions, and Sarah for taking the time to research and answer these questions.  If you have enjoyed the show be sure to share it with people in your life who you think would also enjoy the show.  And leave a review and rating on whatever platform you enjoy listening in.  Stacy and Sarah thank you so much for following along on the Whole View.  It is taking Stacy and Sarah a little bit of time to get use to this change. We have received so much great feedback on this change, and Stacy feels like we are celebrating this milestone as a family.  Thank you for being a part of this community! We will be back again next week! (1:21:40)

Kevin covers helpful BSR guidance including a risk stratification and scoring grid for those with rheumatological conditions who are receiving immunosuppressive therapies, and considers which patients should be advised to practice shielding.

Kevin covers helpful BSR guidance including a risk stratification and scoring grid for those with rheumatological conditions who are receiving immunosuppressive therapies, and considers which patients should be advised to practice shielding.

Drs. Cush and Kavanaugh Discuss the downside of stopping Plaquenil, DMARDs and biologics in lupus, RA and pregnancy

What are some strategies for addressing mental health during the COVID-19 outbreak? Find out about this and more in today's PV Roundup podcast.

Welcome to AiArthritis Voices 360. This episode join your host, Tiffany, as she and co-host Danielle Dass welcome Joe Coe from Creaky Joints / Global Health Living Foundation to discuss COVID-19 and the potential impact on the AiArthritis Community. This is the first episode in a breakout series of AiArthritis Voices 360 episodes on COVID-19 and what you can do to protect yourself during the pandemic. Are you among the people considered to be at an elevated risk during this pandemic? How can social distancing help you and your community? What other topics will the series cover in the coming episodes? Tune in the find out! AiArthritis Voices 360 is produced by the International Foundation for Autoimmune and Autoinflammatory Arthritis. Visit us on the web at www.aiarthritis.org/podcast. Find us on twitter, instagram, or Facebook (@ifAiArthritis) or email us (podcast@aiarthritis.org) to have your seat at the table.  Show Notes: Episode 19 – “COVID-19” 00:52 - Tiffany welcomes listeners and co-host, Danielle 02:13 - Danielle is a former teacher of AP Human Geography and has taught Population Studies, a topic which includes pandemics and epidemics03:10 – Danielle is diagnosed with Rheumatoid Arthritis and Axial Spondyloarthritis, as well as an autoimmune liver disease.03:20 - People who are immunosuppressed fall into the “high risk” category for COVID-1903:44 - Tiffany and Danielle are joined by special guest, Joe Coe from Creaky Joints / Global Healthy Living Foundation 05:00 - Creaky Joints has been working to gather COVID-19 information and amplify the voices of the marginalized members of the chronic and invisible illness community06:56 - No medical advice will be given in this episode.  07:02 - This is the first episode in a larger series on the COVID-19 pandemic07:19 - The next episode will feature physicians and will address many common medical questions surrounding the virus08:38 - Creaky Joints noticed early on that organizations were defining the at-risk populations in very broad strokes, which created a lot of confusion about who was actually at risk09:36 - Creaky Joints has published a webpage called “Coronavirus Questions for Immunocompromised Patients and the Best Answers We Have Right Now.” This page is updated regularly and can be viewed at: creakyjoints.org/coronavirus10:51 - Creaky Joints was told by several rheumatologists that patients should check with their doctor, but the impact of uncontrolled inflammation could be very detrimental so patients should not assume that discontinuing treatments is a good idea 12:44 - None of the research about coronavirus has been peer-reviewed, and all studies are very early12:56 - Especially since scientists are studying some DMARDs as potential treatments for COVID-19, patients MUST speak with their doctor before making any decision about discontinuing their medications.13:26 - There is a lot of misinformation being circulated on the internet, so our community needs reliable sources for information14:20 - People may not interpret scientific studies correctly so word of mouth may not be very reliable 16:44 - A lot of the information being circulated is targeted for the general public and may not be the right advice for immunocompromised people20:05 - AiArthritis patients who had teen or adult onset are very familiar with the concept of a “new normal,” and all of us understand social distancing already20:40 - Some healthy people who compare COVID-19 to influenza don’t seem to understand that vulnerable members of the community are at risk from serious illness during any disease outbreak22:03 - Negating an experience based on another bad experience undermines the work that all of us should be doing to listen to the voices of people impacted by epidemic diseases 22:19 - Responses to epidemics and pandemics should be centered on the voices of the people most impacted by them23:40 - A pandemic is a disease that has spread across multiple countries and impacts a large percentage of the population24:20 - Epidemics spread through contagion diffusion, which means everyone who contracts the disease is physically located in the same geographic area as all the rest of the patients with the disease24:50 - Network diffusion is when the disease spreads along a network of individuals like when a disease spreads through a network of airports28:07 - “Flattening of the curve” refers to slowing the spread of the virus30:33 - Slowing the spread of the disease will prevent hospitals from being overburdened 30:49 - Social distancing protects individuals, but it also saves lives by protecting hospitals’ ability to respond to patients with the serious version of the virus31:43 - Idris Elba tested positive for coronavirus despite having no symptoms 32:36 - Tiffany has been experiencing concerning symptoms, but she wasn’t able to be tested for COVID-19 due to testing shortages34:25 - Nobody will know the mortality rate for COVID-19 until it has run its course35:30 - COVID-19 is significantly more deadly than the seasonal flu36:00 - Creaky Joints interviewed a woman in Texas who had exposure to people with COVID-19 but wasn’t able to be tested for the disease38:00 - The situation with COVID-19 indicates that our society really needs to reevaluate our priorities and put an emphasis on public health and the value of medically fragile lives39:30 - Our society needs to believe in science and trust journalists to combat the widespread dissemination of misinformation41:14 - Autoimmune patients may experience severe morbidity or a loss of efficacy of treatments as the result of serious viral infection 42:12 - Patient advocates have been using #highriskCOVID19 on social media to raise awareness of people living with invisible diseases who are at elevated risk45:05 - It has always been the policy of Global Healthy Living Foundation to practice social distancing whenever an individual is sick to reduce the spread of infections46:20 - Society is currently having to grapple with the impacts of social isolation in a way that the chronic disease community already has47:06 - Social distancing is an opportunity to build bridges with people who don’t understand the social isolation that can be a part of AiArthritis diseases 48:03 - Services that help support social distancing may be overwhelmed right now and unavailable to patients who normally depend on them, and creative solutions may be helpful50:33 - Deep breathing exercises, movement, hydration, and avoiding smoking can help make your lungs be in the best shape possible in case you contract the disease51:30 - Making mental health a priority and seeking needed support is also very important52:30 - Everyone should be respectful of other people’s fears53:25 - Creaky Joints has a webpage for coronavirus information (creakyjoints.org/coronavirus), or patients can receive social support from their Facebook page (@creakyjoints), instagram (@creaky_joints), or twitter (@CreakyJoints)55:30 - IFAA is creating a group for COVID-19 information on Facebook (check the IFAA FB page @IFAiArthritis to access it) and launching AiArthritisVoices.org where patients can participate in an anonymous forum56:22 - IFAA will make the AiArthritisVoices 360 platform available to all non-profits or rheumatologists who want to disseminate important information about COVID-1957:28 - IFAA and CreakyJoints have teamed up with a number of non-profits and rheumatologists to support rheum-covid.org to create a registry for research into rheumatology and COVID-1958:33 - Tiffany thanks Joe for participating in today’s episode59:22 - If you would like to take a seat at the table, visit us on the web at aiarthritis.org/podcast, on social medias @IfAiArthritis on all platforms, or email us @ podcast@aiarthritis.org

QD Clinic - Lessons from the clinic What DMARD do you Choose when Many have Failed? Features Dr. Jack Cush YouTube link: https://youtu.be/nyPaPQXyjSM

 Welcome to AiArthritis Voices 360. This week the show is wading into the complex world of therapeutic cannabis. Tiffany is joined by patient cohost Bridget Seritt, founder of the Canna Patient Resource Connection, an organization that collects comprehensive patient information for therapeutic use of cannabis products. They will discuss the various types of cannabis - CBD products specifically - legal issues, drug interactions, and how to safely incorporate CBD into your treatment plan. Whether you are a long time cannabis user or brand new to the idea of CBD, you will learn something new and useful in this episode. Listen in and then join us for a special Facebook event where you can ask your questions about therapeutic CBD.The conversation doesn't end here! Join us on Facebook for a 'live' event where you can comment and ask questions about this episode. Tiffany and Bridget will be online periodically to check in. No worries if you can't make it today, it's Facebook, the posts aren't going anywhere: http://bit.ly/AiArthritisVoices360_CBD_Everywhere  AiArthritis Voices 360 is produced by the International Foundation for Autoimmune and Autoinflammatory Arthritis. Find us on the web at www.aiarthritis.org/podcast.  Show Notes: Episode 16 – “CBD: It's EVERYWHERE!” 00:52 - Tiffany welcomes listeners and Bridget to the show01:10 - Bridget Seritt founded Canna Patient Resource Connection, an organization that collects comprehensive patient information for therapeutic use of cannabis products03:20 - Today’s topic will focus on CBD 04:07 - Conversations will focus on the patient experience. Bridget is not a doctor and cannot prescribe medication. You should take information back to your health care provider and discuss treatment options with them.05:59 - The widespread availability of CBD products is confusing for patients and doctors06:50 - Prior to 1960, all hemp products were legally classified as marijuana. Definition was changed in response to industrial lobbying.07:19 - The only difference between hemp and marijuana is the level of THC in it. 07:28 - Federal definition of hemp is a plant that contains .3% or less THC.10:24 - There are no standard definitions for broad spectrum, full spectrum, and isolate. But generally, full spectrum CBD contains all the cannabinoids, terpenes, and THC. Broad spectrum removes as much THC as possible. 11:45 - THC is the part of cannabis that produces an intoxicating effect.15:15 - Information about CBD is primarily available online and is generally being circulated by people who want to sell CBD or have a political agenda. It may not be accurate.17:42 - One site Bridget reviewed claimed CBD was legal in all 50 states, but it failed to mention any potential legal problems it could create for people19:16 - CBD was removed from the schedule of controlled substances, but it was transferred to the regulatory authority of the FDA which considers it a “drug product.”19:37 - The 2018 Farm Bill that legalized hemp also contained a clause that said the bill did not prevent states from regulating further. So unless state laws have been modified to remove CBD from their own controlled substances list, you could be violating state law even if it is federally legal. 21:34 - Using CBD would be a felony drug violation in South Dakota, even though it is totally legal in some other states.23:24 - Always check with local municipalities for laws and regulations before beginning to use CBD.23:40 - Canada allows all adults to use CBD, but they will not allow anyone to import it across the border.24:10 - CBD isolates are legal in Idaho, but only ones made from hemp seeds and stalk. But CBD cannot be made from hemp seeds and stalk.25:20 - In the United States, each state has a legal loophole that makes it illegal to give CBD to minors unless you participate in a state registry program. The Canna Patient Resource Connection has worked with four families recently who were in trouble with Child Protective Services for giving CBD to their child.26:30 - In the US, mandated reporters, including teachers and doctors, are required by law to report you to CPS if you tell them that your child is taking CBD.30:18 - The Arthritis Foundation surveyed people and found that over 70% were either interested in using CBD or already using it, so there is a lot of demand for accurate information about CBD.34:19 - Very few patients experience relief immediately from taking CBD. It usually takes consistent use over time to see results.37:12 - Cannabis has different effects at lower doses than it does at higher doses. Low doses tend to be more stimulatory, while higher doses tend to be more sedative.37:38 - Some people may experience intoxication, so begin CBD therapy or increase your dose on a day when you do not need to be alert in case you experience a sedative effect.40:48 - Oral CBD helps alleviate inflammation and neuropathic pain. Oral varieties are most comparable to extended release medications.41:39 - Inhaled CBD via vaping is primarily recommended for acute symptoms.42:39 - Vaping does not involve smoke or burning plant materials, and it is safe from reputable sources. Probably best for people with extreme nausea that do not have lung issues.43:13 - Topical CBD products that include complementary essential oils are best. Entourage effects with topicals and essential oils are the most effective preparations for pain management.46:07 - “Edibles” are a form of oral CBD where food is infused with CBD.47:10 - Be wary of any commercial CBD infused products until you have researched them and seen lab testing. Most products infused with CBD are not going to be therapeutic.47:59 - Avoid purchasing CBD from sources that you have not researched because there is no regulation currently in the US. Companies do not have to tell you what is in their product.49:09 - Before you buy from a company, make sure that companies are batch testing every batch for THC content, solvent residues, heavy metals, and contaminants.49:43 - Hemp is used to decontaminate soil. It will absorb many contaminants from the soil, so it is critically important that your CBD supplier be testing every batch for ground contaminants and heavy metals. Organic farming methods will not mitigate this risk.51:18 - Always ask where a company is sourcing their hemp, and try to find a company that is using clean growing practices with local sourcing.55:57 - Also ask what part of the plant is processed. You don’t want something from seeds or stalks. Ideally you want CBD sourced from flowers and some of the leaves.53:48 - Look for a CBD that tells you how many mgs of CBD are in each mL of tincture, caplet, etc. so that you can regulate your dose for therapeutic purposes.55:14 - Every oral drug that is metabolized by the cyp450 system will have some kind of drug interaction with CBD. 55:22 - CBD also cancels out some drugs completely, independent of the aforementioned liver action.55:35 - CBD will cause some drugs to have a stronger effect than intended.55:53 - CBD does interact with opiate receptors, so always consult a pharmacist before taking any opiate with CBD due to the potential for a toxic effect.56:50 - Just because CBD comes from a plant doesn’t mean it is safe to use in every situation.57:20 - CBD for aiarthritis diseases should be used in conjunction with prescribed medications, not as a substitute for DMARDs or Biologics.58:55 - Most doctors and nurses have not received any formal training on therapeutic uses for cannabis. 1:01:43 - In states with legal medical cannabis programs, you can find a physician with cannabis training, and they should really be involved in your care decisions if you want to use therapeutic CBD.1:03:09 - Visit the Canna Patient Resource Connection at keepitlegalcolorado.org for more information about therapeutic CBD use.1:04:01 - Visit aiarthritis.org/podcast to continue the conversation about AiArthritis and CBD.1:04:19 - Tiffany and Bridget will be hosting a Facebook event where you can ask questions about CBD. You can access that @IFAiArthritis on Facebook under the Event tab.

Hello and welcome to this episode of The Ankylosing Spondylitis Podcast. I hope everybody is doing fantastic as this episode reaches you. It's been just a great couple of weeks going on here as far as health wise, I mean, I've been dealing with some fatigue, but, you know, I hope everybody is feeling great, fighting the fatigue that you can keep up that good battle against Ankylosing Spondylitis.  So recently I joined a service that pushes any reviews that that come in from anywhere in the world and I received two of them. One of them was from Australia, and it was from amwave, and this was from November of 2019. And they wrote,  “I really enjoyed the well researched content and practical relatable tips.” Well, thank you and amwave, if you are listening, please reach out to me through the website http://www.spondypodcast.com/ (spondypodcast.com) I'd love to get in touch with you. The other review came in from the United States and it was left in January 19th by somebody that goes by wiscobri, and same with you, if you are listening, please contact me through the spondypodcast.com website. And they wrote, ”Such a great podcast full of relevant conversations related to AS. Anyone living with AS will benefit from and relate to these open and honest chats.” That's what it's all about. I just want to do these things so that all of us that have Ankylosing Spondylitis can somehow relate, listen and not feel so alone. And before I do this week's Question of the Week, I thought I would point out that you may have heard an ad that I ran at the beginning of each episode The last few episodes for Joy Organics. I had Courtney Garber on an episode or two episodes ago talking about Joy Organics line of CBD products. So I encourage you to go out there and check there'll be a link in the show notes. Anything that you buy, it does create a small payment back to the show to keep it going. So I really appreciate it. If you follow that link and you're in the market for CBD products, I really appreciate it if you consider Joy Organics.  So the Question of the Week, this week, I kind of decided to, instead of speaking a specific question, I'm going to pick one that I've seen a recurring theme for over the last several years, and that's something to use of DMARDs or otherwise known as biologics. And what I thought I would do is over the next few months, I'm going to start releasing some episodes, and doing some episodes on the DMARDs. There's really, I think, a lot of confusion out there. And I'm going to start at the maybe the 30,000 foot level, and then work down to a more more granular level of each type of product. I think some of the things that are being posted, may not factually be correct, but I don't know? The best way to to approach each of those. So I thought what I'd do is just anyway, do a number of different episodes, starting off at the real high level about biologics and working down to a more granular level, they won't all come at one time, they will come over a series of, you know, several months. So, you know, if you have really good or bad experiences with biologics, I'd love it if you went out to spondee podcast calm and contacted me to let me know what happened. And are you 100% able to relate that use of the biologic to the condition that developed where you told 100% by doctors that this is what caused it? We know this is what led to it? Or is it just anecdotal that you developed something around the same time that you took the biologic, and you're relating to that I'd love to know and try to see about putting some of that information together for a show as well. So you get no judgment. I don't. You're 100% able to believe anything. You want as far as what might or might not have happened with your medical treatment, I just want to be able to get it all together to share with everybody that listens. So that's this week's Question of the Week. It's really more of a... Support this podcast

Ira Pastor, ideaXme longevity and aging ambassador and founder of Bioquark, interviews Dr. Virginia Byers Kraus, Professor of Medicine, Pathology, and Orthopaedic Surgery, and a faculty member of the Duke Molecular Physiology Institute in the Duke University School of Medicine. Ira Pastor Comments: Arthritis is a term often used to mean any disorder that affects joints (the most common forms being osteoarthritis (OA) and rheumatoid arthritis (RA)), where symptoms generally include joint pain, stiffness, redness, warmth, swelling, and decreased range of motion. In some types of arthritis (on the auto-immune side of things) other organs can be affected, and onset of arthritis can be gradual or sudden. There is no known cure for either rheumatoid or osteoarthritis. Joint replacement surgery may be required in eroding forms of arthritis. Treatment options vary depending on the type of arthritis and can include physical therapy, lifestyle changes (including exercise and weight control), orthopedic bracing, and various medications which can help reduce inflammation in the joint (and immune responses in case of auto-immune forms of arthritis) which can help decrease pain and potentially slow the rate of joint damage, hopefully to "zero", which is the nature of the current class of “holy grail-ish” type drugs in the Rheumatoid Arthritis space known as Disease Modifying Anti-Rheumatic Drugs (DMARDs). No drug fulfilling the criteria for a "Disease Modifying Osteoarthritis Drug " (or DMOAD) is approved by the regulatory agencies such as the FDA or EMEA. But whether one is looking for a DMOAD, or looking beyond the current state of the art of the DMARDs to the next RA holy grail type intervention, many thought leaders would agree that it would be a form of intervention that stimulates Chondrogenesis, or the process by which new fresh cartilage is created in the joint, literally reversing the pathogenesis of such diseases, as opposed to just slowing or stopping them. Once damaged in humans, cartilage has very limited repair capabilities. Because chondrocytes are bound in lacunae, they cannot migrate to damaged areas. Also, because hyaline cartilage does not have a blood supply, the deposition of new matrix is slow. Damaged hyaline cartilage is usually replaced by fibrocartilage scar tissue instead. But this is not the case in other species such as newts and zebrafish, where fresh cartilage is regrown and regenerates perfectly over a lifetime. Today’s guest who is going to take us further into all these themes is Dr. Virginia Byers Kraus. With an MD and PhD from Duke University, Dr. Kraus is Professor of Medicine, Pathology, and Orthopaedic Surgery, and a faculty member of the Duke Molecular Physiology Institute in the Duke University School of Medicine. She is a practicing Rheumatologist with 20 years’ experience in Osteoarthritis research. Dr. Kraus is past president of the Osteoarthritis Research Society International (OARSI), the premier organization focused on the prevention and treatment of osteoarthritis through the promotion and presentation of research, education, and the worldwide dissemination of new knowledge. In 2019, she was elected to the Association of American Physicians and awarded the Lifetime Achievement Award from OARSI. She is co-principal investigator of the OARSI/Foundation for NIH Osteoarthritis Biomarkers Consortium Project, which advances the validation and qualification of biomarkers for OA diagnosis, prognosis, and clinical trials. She also directs the Duke Biomarkers Shared Resource which is a facility that assists investigators with the design and implementation of molecular and protein assays to evaluate biochemical and inflammatory markers. Dr. Kraus is also the Director of the Molecular Measures Core in the Center for the Study of Aging and Human Development. On this show we will hear from Dr. Kraus: How she developed an interest in science, medicine, and rheumatology. The importance of appropriate biomarker development, validation and qualification in the diagnosis, prognosis, and development of effective interventions in arthritis. Her recent paper entitled Analysis of “Old” Proteins Unmasks Dynamic Gradient of Cartilage Turnover in Human Limbs, in which she highlights the discovery of interesting protein / microRNA constituency differences of various joints of the body, leading to clues for different regenerative medicine interventional possibilities. Finally, we’ll discuss her work in the Molecular Measures Core in the Center for the Study of Aging and Human Development where her group is focused on "understanding the means to optimize whole person reserve and resilience through analyses of molecular factors indicative of cellular and tissue level ability to withstand and recover from stressors.” ideaXme is a global podcast, creator series and mentor programme. Mission: Move the human story forward!™ ideaXme Ltd.

RheumNow Podcast Fight Or Switching (DMARDs) (10.18.19) by Dr. Cush

Dominate perioperative medication management with tips from Kashlak’s newly minted Chief of Perioperative Medicine, @aoglasser, Avital O’Glasser MD, FACP, FHM (OHSU). We cover perioperative anticoagulation, why “bridging is dead”, aspirin, dual antiplatelet therapy, DMARDS, diabetic medications, buprenorphine, and much more! Be sure to check out Dr. O’Glasser’s previous episode #135 Perioperative Medicine: Assess and Optimize Risk to get a full overview of perioperative medicine. ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).  Full show notes https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and Produced by: Avital O’Glasser MD, FACP, FHM and Matthew Watto MD, FACP  CME Questions: Matthew Watto MD, FACP Infographic: Matthew Watto MD, FACP Cover Art: Kate Grant MBChB DipGUMed Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP  Editor: Matthew Watto MD, FACP Guest: Avital O’Glasser MD, FACP, FHM Time Stamps 00:00 Intro, disclaimer, guest bio 03:20 Guest one-liner 04:46 Picks of the Week*: A Moment of Lift (book) by Melinda Gates; Crawl (film); Rich Roll (podcast) episodes w/Valter Longo and David Sinclair 09:35 Avi’s mantras for perioperative management and other core tenants 14:40 NPO and The Consult Guys 17:23 Medical cannabis (marijuana) in perioperative medicine 19:24 Case #1 Ms. Bridge - perioperative anticoagulation: to bridge or not to bridge 25:00 Low bleeding risk surgeries and anticoagulation 27:25 Moderate to high bleeding risk surgeries and anticoagulation; What about the CHA2DS2 Vasc of 7? 28:42 Bridging for venous thromboembolism (VTE) 31:30 How to give instructions for holding warfarin 32:30 Bridging a DOAC 36:16 Recap on bridging VKAs and use of DOACs 37:48 Neuraxial anesthesia and anticoagulation 39:49 Biologic DMARDS; Nonbiologic DMARDS 43:48 Supplements and herbals 48:40 Case #1 wrap up 50:16 Case #2 -Mr. DAPT; Perioperative Aspirin; DAPT -dual antiplatelet therapy 57:20 Summary of perioperative antiplatelet therapy 63:18 Statins 64:45 Beta blockers 67:21 ACEI and ARB; Diuretics 69:17 Oral hypoglycemics and newer diabetes agents (SGLT2 inhibitors, GLP1 agonists); What about metformin? 72:04 Insulin 74:40 Case #2 wrap up 75:35 Case #3 Ms. GB Stone who takes lithium and buprenorphine 77:30 NSAIDS, Buprenorphine 81:45 ART, transplant meds, Lithium, MAOIs, Levothyroxine; Watch out for lithium 86:34 Case #3 wrap up 87:25 Take Home Points 88:45 Outro 90:15 Avi and Mr. Rogers  *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goals Listeners will develop a practical approach to perioperative medication management and review special considerations for the various drug classes. Learning objectives After listening to this episode listeners will... Frame perioperative medication management decisions as another type of patient-centered, surgery-specific perioperative “risk/benefit” decision Discuss guideline recommendations for the perioperative management of multiple classes of medications Examine more nuanced or challenging medications to manage in the perioperative setting Explore professional, patient-centered and multidisciplinary communication techniques when disagreements arise regarding best medication management recommendations Disclosures Dr O’Glasser reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation O’Glasser A, Williams PN, Watto MF. “#174 Perioperative Medication Management”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. September 23, 2019.

¡Gracias por Escuchar! En esta ocasión hablaré acerca del mecanismo de acción del fármaco mas importante y de mayor uso para el tratamiento de varias enfermedades, principalmente Artritis Reumatoide, el Metotrexato. Para este episodio consulté varias fuentes, tratando de presentar evidencia en humanos sobre su interesante funcionamiento. Recuerden que su retroalimentación es bienvenida y muy importante. Les pido amablemente dejen sus calificaciones y comentarios sobre el podcast en iTunes. Próximamente el podcast estará disponible en Google Play y se encuentra disponible en Spotify, pudiendo también acceder a el a través de su gestor de podcasts favorito.A continuación se encuentra una lista de las referencias consultadas para este episodio.Lopez-Olivo, M. A. et al. Methotrexate for treating rheumatoid arthritis. Cochrane Database Syst. Rev. 6, CD000957 (2014).Kavanaugh, A. et al. Clinical, functional and radiographic consequences of achieving stable low disease activity and remission with adalimumab plus methotrexate or methotrexate alone in early rheumatoid arthritis: 26-week results from the randomised, controlled OPTIMA study. Ann. Rheum. Dis. 72, 64–71 (2013).Detert, J. et al. Induction therapy with adalimumab plus methotrexate for 24 weeks followed by methotrexate monotherapy up to week 48 versus methotrexate therapy alone for DMARD-naive patients with early rheumatoid arthritis: HIT HARD, an investigator-initiated study. Ann. Rheum. Dis. 72, 844–850 (2013).Horslev-Petersen, K. et al. Adalimumab added to a treat-to-target strategy with methotrexate and intra- articular triamcinolone in early rheumatoid arthritis increased remission rates, function and quality of life. The OPERA Study: an investigator-initiated, randomised, double-blind, parallel-group, placebo- controlled trial. Ann. Rheum. Dis. 73, 654–661 (2014).O’Dell, J. R. et al. Validation of the methotrexate-first strategy in patients with early, poor-prognosis rheumatoid arthritis: results from a two-year randomized, double-blind trial. Arthritis Rheum. 65, 1985–1994 (2013).Bathon, J. M. et al. A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N. Engl. J. Med. 343, 1586–1593 (2000).Klareskog, L. et al. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet 363, 675–681 (2004).Goekoop-Ruiterman, Y. P. et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 52, 3381–3390 (2005).Breedveld, F. C. et al. The PREMIER study: a multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis. Rheum. 54, 26–37 (2006).Soubrier, M. et al. Evaluation of two strategies (initial methotrexate monotherapy versus its combination with adalimumab) in management of early active rheumatoid arthritis: data from the GUEPARD trial. Rheumatology 48, 1429–1434 (2009).Tak, P. P. et al. Inhibition of joint damage and improved clinical outcomes with rituximab plus methotrexate in early active rheumatoid arthritis: the IMAGE trial. Ann. Rheum. Dis. 70, 39–46 (2011).de Jong, P. H. et al. Induction therapy with a combination of DMARDs is better than methotrexate monotherapy: first results of the tREACH trial. Ann. Rheum. Dis. 72, 72–78 (2013).Emery, P. et al. Golimumab, a human anti-tumor necrosis factor monoclonal antibody, injected subcutaneously every 4 weeks in patients with active rheumatoid arthritis who had never taken methotrexate: 1-year and 2-year clinical, radiologic, and physical function findings of a phase III, multicenter, randomized, double-blind, placebo- controlled study. Arthritis Care Res. (Hoboken) 65, 1732–1742 (2013).Takeuchi, T. et al. Adalimumab, a human anti-TNF monoclonal antibody, outcome study for the prevention of joint damage in Japanese patients with early rheumatoid arthritis: the HOPEFUL 1 study. Ann. Rheum. Dis. 73, 536–543 (2014).Nam, J. L. et al. A randomised controlled trial of etanercept and methotrexate to induce remission in early inflammatory arthritis: the EMPIRE trial. Ann. Rheum. Dis. 73, 1027–1036 (2014).Emery, P. et al. Evaluating drug-free remission with abatacept in early rheumatoid arthritis: results from the phase 3b, multicentre, randomised, active- controlled AVERT study of 24 months, with a 12-month, double-blind treatment period. Ann. Rheum. Dis. 74, 19–26 (2015).Whittle, S. L. & Hughes, R. A. Folate supplementation and methotrexate treatment in rheumatoid arthritis: a review. Rheumatology 43, 267–271 (2004).Schiff, M. H., Jaffe, J. S. & Freundlich, B. Head-to-head, randomised, crossover study of oral versus subcutaneous methotrexate in patients with rheumatoid arthritis: drug-exposure limitations of oral methotrexate at doses ≥15 mg may be overcome with subcutaneous administration. Ann. Rheum. Dis. 73, 1549–1551 (2014).Hoekstra, M. et al. Splitting high-dose oral methotrexate improves bioavailability: a pharmacokinetic study in patients with rheumatoid arthritis. J. Rheumatol. 33, 481–485 (2006).Wegrzyn, J., Adeleine, P. & Miossec, P. Better efficacy of methotrexate given by intramuscular injection than orally in patients with rheumatoid arthritis. Ann. Rheum. Dis. 63, 1232–1234 (2004).Hasko, G. & Cronstein, B. Regulation of inflammation by adenosine. Front. Immunol. 4, 85 (2013).Baggott, J. E., Morgan, S. L., Sams, W. M. & Linden, J. Urinary adenosine and aminoimidazolecarboxamide excretion in methotrexate-treated patients with psoriasis. Arch. Dermatol. 135, 813–817 (1999).Varani, K. et al. A2A and A3 adenosine receptor expression in rheumatoid arthritis: upregulation, inverse correlation with disease activity score and suppression of inflammatory cytokine and metalloproteinase release. Arthritis Res. Ther. 13, R197 (2011).Peres, R. S. et al. Low expression of CD39 on regulatory T cells as a biomarker for resistance to methotrexate therapy in rheumatoid arthritis. Proc. Natl Acad. Sci. USA 112, 2509–2514 (2015).Nesher, G., Mates, M. & Zevin, S. Effect of caffeine consumption on efficacy of methotrexate in rheumatoid arthritis. Arthritis Rheum. 48, 571–572 (2003).Nesher, G., Osborn, T. G. & Moore, T. L. In vitro effects of methotrexate on polyamine levels in lymphocytes from rheumatoid arthritis patients. Clin. Exp. Rheumatol. 14, 395–399 (1996).Nesher, G., Osborn, T. G. & Moore, T. L. Effect of treatment with methotrexate, hydroxychloroquine, and prednisone on lymphocyte polyamine levels in rheumatoid arthritis: correlation with the clinical response and rheumatoid factor synthesis. Clin. Exp. Rheumatol. 15, 343–347 (1997).Huang, C. et al. Ornithine decarboxylase prevents methotrexate-induced apoptosis by reducing intracellular reactive oxygen species production. Apoptosis 10, 895–907 (2005).Smith, D. M., Johnson, J. A. & Turner, R. A. Biochemical perturbations of BW 91Y (3-deazaadenosine) on human neutrophil chemotactic potential and lipid metabolism. Int. J. Tissue React. 13, 1–18 (1991).Phillips, D. C., Woollard, K. J. & Griffiths, H. R. The anti-inflammatory actions of methotrexate are critically dependent upon the production of reactive oxygen species. Br. J. Pharmacol. 138, 501–511 (2003).Johnston, A., Gudjonsson, J. E., Sigmundsdottir, H., Ludviksson, B. R. & Valdimarsson, H. The anti- inflammatory action of methotrexate is not mediated by lymphocyte apoptosis, but by the suppression of activation and adhesion molecules. Clin. Immunol. 114, 154–163 (2005).Dolhain, R. J. et al. Methotrexate reduces inflammatory cell numbers, expression of monokines and of adhesion molecules in synovial tissue of patients with rheumatoid arthritis. Br. J. Rheumatol. 37, 502–508 (1998).Miranda-Carus, M. E., Balsa, A., Benito-Miguel, M., Perez de Ayala, C. & Martin-Mola, E. IL-15 and the initiation of cell contact-dependent synovial fibroblast-T lymphocyte cross-talk in rheumatoid arthritis: effect of methotrexate. J. Immunol. 173, 1463–1476 (2004).Wijngaarden, S., van Roon, J. A., van de Winkel, J. G., Bijlsma, J. W. & Lafeber, F. P. Down-regulation of activating Fcγ receptors on monocytes of patients with rheumatoid arthritis upon methotrexate treatment. Rheumatology 44, 729–734 (2005).Cooper, D. L. et al. FcγRIIIa expression on monocytes in rheumatoid arthritis: role in immune-complex stimulated TNF production and non-response to methotrexate therapy. PLoS ONE 7, e28918 (2012).Rudwaleit, M. et al. Response to methotrexate in early rheumatoid arthritis is associated with a decrease of T cell derived tumour necrosis factor α, increase of interleukin 10, and predicted by the initial concentration of interleukin 4. Ann. Rheum. Dis. 59, 311–314 (2000).Majumdar, S. & Aggarwal, B. B. Methotrexate suppresses NF-κB activation through inhibition of IκBα phosphorylation and degradation. J. Immunol. 167, 2911–2920 (2001).Mello, S. B., Barros, D. M., Silva, A. S., Laurindo, I. M. & Novaes, G. S. Methotrexate as a preferential cyclooxygenase 2 inhibitor in whole blood of patients with rheumatoid arthritis. Rheumatology 39, 533–536 (2000).Vergne, P. et al. Methotrexate and cyclooxygenase metabolism in cultured human rheumatoid synoviocytes. J. Rheumatol. 25, 433–440 (1998).Novaes, G. S., Mello, S. B., Laurindo, I. M. & Cossermelli, W. Low dose methotrexate decreases intraarticular prostaglandin and interleukin 1 levels in antigen induced arthritis in rabbits. J. Rheumatol. 23, 2092–2097 (1996).Leroux, J. L., Damon, M., Chavis, C., Crastes De Paulet, A. & Blotman, F. Effects of methotrexate on leukotriene and derivated lipoxygenase synthesis in polynuclear neutrophils in rheumatoid polyarthritis. Rev. Rheum. Mal. Osteoartic. 59, 587–591 (in French) (1992).Seitz, M. & Dayer, J. M. Enhanced production of tissue inhibitor of metalloproteinases by peripheral blood mononuclear cells of rheumatoid arthritis patients responding to methotrexate treatment. Rheumatology 39, 637–645 (2000).Tchetverikov, I. et al. Leflunomide and methotrexate reduce levels of activated matrix metalloproteinases in complexes with α2 macroglobulin in serum of rheumatoid arthritis patients. Ann. Rheum. Dis. 67, 128–130 (2008).Stamp, L. K. et al. Methotrexate polyglutamate concentrations are not associated with disease control in rheumatoid arthritis patients receiving long-term methotrexate therapy. Arthritis Rheum. 62, 359–368 (2010).Dervieux, T., Weinblatt, M. E., Kivitz, A. Kremer, J. M. Methotrexate polyglutamation in relation to infliximab pharmacokinetics in rheumatoid arthritis. Ann. Rheum. Dis. 72, 908–910 (2013).Wessels, J. A. et al. Relationship between genetic variants in the adenosine pathway and outcome of methotrexate treatment in patients with recent- onset rheumatoid arthritis. Arthritis Rheum. 54, 2830–2839 (2006).Wessels, J. A. et al. A clinical pharmacogenetic model to predict the efficacy of methotrexate monotherapy in recent-onset rheumatoid arthritis. Arthritis Rheum. 56, 1765–1775 (2007).Fransen, J. et al. Clinical pharmacogenetic model to predict response of MTX monotherapy in patients with established rheumatoid arthritis after DMARD failure. Pharmacogenomics 13, 1087–1094 (2012).Owen, S. A. et al. Genetic polymorphisms in key methotrexate pathway genes are associated with response to treatment in rheumatoid arthritis patients. Pharmacogenomics J. 13, 227–234 (2013).Aslibekyan, S. et al. Genetic variants associated with methotrexate efficacy and toxicity in early rheumatoid arthritis: results from the treatment of early aggressive rheumatoid arthritis trial. Pharmacogenomics J.14, 48–53 (2014). 

CME credits: 0.25 Valid until: 13-09-2020 Claim your CME credit at https://reachmd.com/programs/cme/new-perspectives-on-biologic-therapy-in-moderate-to-severe-ulcerative-colitis/10946/ Advancements in the treatment of ulcerative colitis (UC) have given us the ability to control patient symptoms, achieve inflammation control, prolong remission, and prevent disease progression. Join Dr. David Rubin as he discusses how biologic therapies and small molecule DMARDs play a role in the UC treatment paradigm.

#355 THE SURVIVAL MEDICINE HOUR PODCAST Southern California has been hit with a 7.1 magnitude earthquake which followed a 6.4 the previous day. Hundreds of smaller quakes have hit the general area as well, and residents are getting nervous. Although earthquakes are unpredictable, there are a number of things you can do to decrease the amount of damage and prevent injuries in most circumstances. Joe and Amy Alton MD spend time discussing what to do before, during, and after a seismic event. Also in this episode of the Survival Medicine Hour, Joe Alton MD answers a listener's concerns and questions about rheumatoid arthritis off the grid. In these days of advanced pharmaceuticals (DMARDS) meant to help sufferers, can anything be done to improve the quality of life in a survival setting? Nurse Amy discusses a number of alternative methods that might help. All this and more on the latest Survival Medicine Hour with Dr. Bones and Nurse Amy! Wishing you the best of health in good times or bad, Joe and Amy Alton Hey, don't forget to check out Nurse Amy's entire line of medical kits and supplies at store.doomandbloom.net. You'll be glad you did. Subscribe to our website at doomandbloom.net to get regular newsletters with special offers that will help get you medically prepared for any disaster.

#355 THE SURVIVAL MEDICINE HOUR PODCAST Southern California has been hit with a 7.1 magnitude earthquake which followed a 6.4 the previous day. Hundreds of smaller quakes have hit the general area as well, and residents are getting nervous. Although earthquakes are unpredictable, there are a number of things you can do to decrease the amount of damage and prevent injuries in most circumstances. Joe and Amy Alton MD spend time discussing what to do before, during, and after a seismic event. Also in this episode of the Survival Medicine Hour, Joe Alton MD answers a listener's concerns and questions about rheumatoid arthritis off the grid. In these days of advanced pharmaceuticals (DMARDS) meant to help sufferers, can anything be done to improve the quality of life in a survival setting? Nurse Amy discusses a number of alternative methods that might help. All this and more on the latest Survival Medicine Hour with Dr. Bones and Nurse Amy! Wishing you the best of health in good times or bad, Joe and Amy Alton Hey, don't forget to check out Nurse Amy's entire line of medical kits and supplies at store.doomandbloom.net. You'll be glad you did. Subscribe to our website at doomandbloom.net to get regular newsletters with special offers that will help get you medically prepared for any disaster.

Join(t) us in learning about rheumatoid arthritis care for the internist with Robert McLean MD, rheumatologist, Associate Clinical Professor at Yale, and President Elect of the ACP! We discuss the complexity of rheumatoid arthritis, how to differentiate from other arthritic conditions, and how to have a patient-centered framework for the evaluation and treatment of affected patients. ACP members can claim CME-MOC credit at on ACP's site.. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Writer (Interview & CME questions): Cyrus Askin MD Show Notes and Infographic by: Elena Gibson MS4 Hosts: Matthew Watto MD, Stuart Brigham MD Editors: Matthew Watto MD, Emi Okamoto MD Guest: Robert McLean MD Time Stamps 00:35 Disclaimer, intro and guest bio 03:38 Guest onliner; Nudge (book) on behavioral economics 08:30 Favorite failure; Stuart’s pick of the week 12:24 Key historical features of RA 15:30 Differential diagnosis 19:20 Physical findings in RA 20:58 Initial labs orders for suspected inflammatory arthritis; CRP vs high sensitivity (cardio) CRP assays 27:45 Epidemiology of RA; Is there a utility for scoring systems?; A bit more on inflammatory markers 32:30 Recap and test interpretation 36:22 High yield physical exam in RA 40:56 Initial counseling after RA diagnosis 46:00 Therapeutic trial with NSAIDS or steroids for inflammatory arthritis 50:29 When to reach for the DMARDS 52:40 Are steroids considered DMARDS? 54:50 Primary care considerations for patients starting steroids or DMARDS (TB, vaccinations) 60:34 When and how long to hold DMARDS for surgery or acute illness 62:10 Drug-drug interactions and monitoring with methotrexate, hydroxychloroquine, sulfasalazine 70:10 Anti-inflammatory diets 73:30 Take home points 76:00 Outro

Dr Danny Murphy talks in more detail with Dr Richard Haigh and Senior Specialist Nurse, Jill Moran, about the role of the specialist nurse, DMARDs, annual reviews and flare management.

Keep your cool in the face of inflammation, and make the path to vasculitis diagnosis less tortuous with Dr. Rebecca Sharim, Rheumatologist and Assistant Professor of Medicine at Temple University. In this episode, we go with the flow from large vessel to small vessel vasculitides, and then learn how to make the diagnosis and management of Giant Cell Arteritis (GCA) and polymyalgia rheumatica (PMR) less of a headache. Correspondent, Dr. Bryan Brown cohosts!  Special thanks to Dr. Bryan Brown for writing our show notes, and creating figures for our handouts. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Case from Kashlak Memorial:  A 75 year-old woman with a PMHx of hypertension presents to the ED with three days of worsening left sided headache, now with left sided vision loss during a Norwegian folk festival. On review of systems, she also endorses a week of soreness of her shoulders and hips. This has never happened to her before. Time Stamps 00:00 Intro 03:07 Picks of the week 09:13 Getting to know our guest 15:00 Clinical case of vasculitis 15:59 Defining and classifying vasculitis 20:55 Workup for suspected vasculitis 23:17 How to explain GCA to a patient 25:08 Typical symptoms of vasculitis 28:00 Chewing gum test 29:34 Interpreting ESR 32:54 Basic exam and lab workup for vasculitis 35:23 Headache and suspicion for GCA/temporal arteritis 38:10 Is a temporal artery biopsy still mandatory? 39:20 Polymyalgia rheumatica 40:59 Steps to take when GCA/temporal arteritis suspected in clinic 43:55 PCP prophylaxis with high dose steroids 46:30 DMARDs and steroid sparing agents 48:12 Imaging studies to aid in diagnosis of GCA 50:50 Complications of long term steroid therapy 52:31 Take home points 53:26 Outro Tags: giant, cell, arteritis, gca, vasculitis, steroids, temporal, biopsy, artery, esr, pmr, polymyalgia, rheumatica, vessel, headache, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, practitioner, professional, primary, physician, resident, student

Prof van Laar and Dr James Galloway, King's College London, UK, talk about the BSR guideline for the prescription and monitoring of non-biologic DMARDs. Dr Galloway explains the need for this update of existing guidelines due development of new drugs and previous treatments no longer being used. He highlights the headline changes from the previous guideline and discusses one of the more controversial recommendations made.

Prof van Laar and Dr James Galloway, King's College London, UK, talk about the BSR guideline for the prescription and monitoring of non-biologic DMARDs. Dr Galloway explains the need for this update of existing guidelines due development of new drugs and previous treatments no longer being used. He highlights the headline changes from the previous guideline and discusses one of the more controversial recommendations made.

Prof van Laar and Dr James Galloway, King's College London, UK, talk about the BSR guideline for the prescription and monitoring of non-biologic DMARDs. Dr Galloway explains the need for this update of existing guidelines due development of new drugs and previous treatments no longer being used. He highlights the headline changes from the previous guideline and discusses one of the more controversial recommendations made.

Dr James Galloway and Dr Samantha Hider, Keele University, UK discuss a paper by Polina Putrik et al. which looked at access to DMARDs. They discuss the findings of the paper which demonstrated that older patients with low levels of education have less access to DMARDs. They also explore the possible implications of these findings on the daily practice of rheumatologists and the importance of looking at health literacy of patients in practice.

Dr James Galloway and Dr Samantha Hider, Keele University, UK discuss a paper by Polina Putrik et al. which looked at access to DMARDs. They discuss the findings of the paper which demonstrated that older patients with low levels of education have less access to DMARDs. They also explore the possible implications of these findings on the daily practice of rheumatologists and the importance of looking at health literacy of patients in practice.

Dr James Galloway and Dr Samantha Hider, Keele University, UK discuss a paper by Polina Putrik et al. which looked at access to DMARDs. They discuss the findings of the paper which demonstrated that older patients with low levels of education have less access to DMARDs. They also explore the possible implications of these findings on the daily practice of rheumatologists and the importance of looking at health literacy of patients in practice.

Dr. Rosenblum discusses Rheumatoid Arthritis Discussed in this podcast: Diagnosis Treatment SLE Osteoarthritis DMARDs Methotrexate   PainExam Podcast Download our iphone App! Download our Android App! For more information on Pain Management Topics and keywords Go to PainExam.com David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com 718 436 7246 DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.  You should regularly consult a physician in matters relating to yours or another's health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.    Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.        References[edit] ^ "Handout on Health: Rheumatoid Arthritis". National Institute of Arthritis and Musculoskeletal and Skin Diseases. August 2014. Retrieved 2 July 2015. ^ Majithia V, Geraci SA (2007). "Rheumatoid arthritis: diagnosis and management". Am. J. Med. 120 (11): 936–9. doi:10.1016/j.amjmed.2007.04.005. PMID 17976416. Scott DL, Wolfe F, Huizinga TW (Sep 25, 2010). "Rheumatoid arthritis". Lancet 376 (9746): 1094–108. doi:10.1016/S0140-6736(10)60826-4. PMID 20870100.  Singh, JA; Wells, GA; Christensen, R; Tanjong Ghogomu, E; Maxwell, L; Macdonald, JK; Filippini, G; Skoetz, N; Francis, D; Lopes, LC; Guyatt, GH; Schmitt, J; La Mantia, L; Weberschock, T; Roos, JF; Siebert, H; Hershan, S; Lunn, MP; Tugwell, P; Buchbinder, R (16 February 2011). "Adverse effects of biologics: a network meta-analysis and Cochrane overview.". The Cochrane database of systematic reviews (2): CD008794. PMID 21328309.  Efthimiou P, Kukar M (2010). "Complementary and alternative medicine use in rheumatoid arthritis: proposed mechanism of action and efficacy of commonly used modalities". Rheumatology international 30 (5): 571–86. doi:10.1007/s00296-009-1206-y. PMID 19876631. ^ "Rheumatoid Arthritis and Complementary Health Approaches". National Center for Complementary and Integrative Health. Retrieved July 1,2015. GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet 385 (9963): 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442. ^ Landré-Beauvais AJ (1800). La goutte asthénique primitive (doctoral thesis). Paris. reproduced in Landré-Beauvais AJ (2001). "The first description of rheumatoid arthritis. Unabridged text of the doctoral dissertation presented in 1800". Joint Bone spine 68 (2): 130–43. doi:10.1016/S1297-319X(00)00247-5. PMID 11324929. Paget, Stephen A.; Lockshin, Michael D.; Loebl, Suzanne (2002). The Hospital for Special Surgery Rheumatoid Arthritis Handbook Everything You Need to Know. New York: John Wiley & Sons. p. 32. ISBN 9780471223344. Turesson C, O'Fallon WM, Crowson CS, Gabriel SE, Matteson EL (2003). "Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years". Ann. Rheum. Dis. 62 (8): 722–7. doi:10.1136/ard.62.8.722. PMC 1754626. PMID 12860726. Nicki R. Colledge, Brian R. Walker, Stuart H. Ralston, eds. (2010). Davidson's principles and practice of medicine. (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. ISBN 978-0-7020-3084-0. "An approach to Early Arthritis". Pn.lifehugger.com. 12 January 2009. Archived from the original on 2010-05-27. https://en.wikipedia.org/wiki/Rheumatoid_arthritis

Dr. Clifton Bingham from the Johns Hopkins Arthritis Center begins with a review of current best practices, including the issues related to diagnosis. Dr. George Lawry will follow with an overview of the risks and benefits of biologic therapy for patients with RA before Dr. Bingham presents on emerging DMARDs.The second half of the nearly 2 hour presentation covers the subject of comorbidities, presented by Dr. Lawry, on how to recognize comorbidities and how to best manage them. Dr. Bingham will follow up with the presentation of two cases to offer a clinical perspective to recognizing and treating comorbidities.

Background: The comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis (RA) is a selection of 96 categories from the ICF, representing relevant aspects in the functioning of patients with RA. Objectives: To study the responsiveness of the ICF Core Set for RA in rheumatological practice. Methods: A total of 46 patients with RA (72% women, mean (SD) age 53.6 (12.6) years, disease duration 6.3 (8.0) years) were interviewed at baseline and again after 6 months treatment with a disease-modifying antirheumatic drug (DMARD), applying the ICF Core Set for RA with qualifiers for problems on a modified three-point scale (no problem, mild/moderate, severe/complete). Patient-reported outcomes included Modified Health Assessment Questionnaire (MHAQ) and Short-Form 36 (SF-36) health survey, and disease activity was calculated. Responsiveness was measured as change in qualifiers in ICF categories, and was also compared with change in patient-reported outcomes. Results: After 6 months of DMARD treatment, improvement by at least one qualifier was seen in 20% of patients (averaged across all ICF categories), 71% experienced no change and 9% experienced worsening symptoms. Findings were similar across the different aspects of functioning. Mainly moderate effect sizes were seen for 6-month changes in the ICF Core Set for RA, especially in patients with improved health status, with similar effect size for disease activity. The components in the ICF Core Set for RA were only weakly associated with patient-reported outcomes and disease activity. Conclusions: The ICF Core Set for RA demonstrated moderate responsiveness in this real-life setting of patients where minor changes occurred during treatment with DMARDs.

Ce script représente mon interprétation entant qu'étudiant en 2e année de Médecine. Il est fourni entant qu'aide à l'étude et n'a pas comme objectif d'être une ressource primaire. Veuillez pardonner les erreurs grammaticales. Cet épisode porte sur • L’arthrite rhumatoïde, • Son importance clinique, • La pathophysiologie de l’arthrite rhumatoïde, • L’approche au patient qui se présente avec une douleur polyarticulaire, • Le différentiel de l’arthrite rhumatoïde, • et les principes de base du traitement. L’arthrite rhumatoïde est une maladie systémique, chronique et primairement inflammatoire de cause inconnue qui se manifeste par une douleur polyarticulaire. L’arthrite rhumatoïde touche environ 1% de la population. Elle peut atteindre les gens de tous âges et atteint les femmes 2 à 3 fois plus souvent que les hommes. L’incidence maximale est dans les 30 à 50 ans. L’évènement déclencheur de l’arthrite rhumatoïde n’est pas connu, mais on soupçonne les infections virales étant donné l’étiologie auto-immune. L’activation des lymphocytes T serait la première étape dans la pathogenèse de l’arthrite rhumatoïde. Cette activation serait induite par un antigène inconnu ou par un excès de signaux accessoires de stimulation. Le génotype HLA d’un individu peut le rendre plus susceptible à cette activation atypique des lymphocytes T, particulièrement certains allèles de la famille DR4. Cependant, la présence de facteurs génétiques n’est pas spécifique ou suffisante pour causer l’arthrite rhumatoïde. Une fois que la réponse immunitaire est déclenchée, l’inflammation est soutenue par une réaction auto-immunitaire qui PEUT cibler le collagène type II trouvé dans le cartilage, le fragment constant des immunoglobulines G ou des protéines contenant l’acide aminé modifié nommé citrulline. Le facteur rhumatoïde est un anticorps IgM ou IgA dirigé contre le fragment constant des anticorps IgG. La précipitation de complexes immuns contribue au maintien et à la progression de l’inflammation. La réaction inflammatoire stimule l’angiogenèse dans la membrane synoviale. Ceci augmente le transsudat dans l’articulation et facilite le recrutement de leucocytes dans la membrane et le liquide synovial. Les cellules de la membrane synoviale prolifèrent en réponse aux signaux inflammatoires et forment un tissu nommé pannus. Ces cellules synoviales envahissent le cartilage articulaire et le détruisent progressivement à l’aide de protéases qu’elles sécrètent. L’os sous-chondral est aussi détruit par les ostéoclastes qui sont activés et recrutés par les cytokines inflammatoires. L’inflammation peut être clairement visualisée dans le liquide synovial. Nous passons à l’approche au patient qui se présente au bureau pour une douleur articulaire. La première étape est d’exclure une urgence médicale, comme un traumatisme, une atteinte nerveuse ou une arthrite septique. L’arthrite septique touche souvent une seule articulation et est souvent accompagnée de signes systémiques d’infection et d’inflammation locale prononcée, et est facile à diagnostiquer à l’aide d’une arthrocentèse. Les atteintes nerveuses peuvent être accompagnées de paresthésies, de perte de réflexes ou de faiblesse musculaire. Le nombre d’articulations impliquées permet de faire une première réduction dans le diagnostique différentiel. Une douleur monoarticulaire suggère fortement une arthrite septique, une déposition cristalline, l’hémarthrose suite à un traumatisme ou une coagulopathie, un processus néoplasique primaire ou métastatique, une présentation précoce d’une maladie rhumatismale systémique, la nécrose avasculaire, ou un traumatisme intra-articulaire. Une douleur polyarticulaire peut être causée par : • Une infection systémique bactérienne, virale, ou autre, • Une séquelle d’une infection comme par exemple le syndrome de Reiter, • Un symptôme d’une maladie inflammatoire systémique ou auto-immune comme l’arthrite rhumatoïde, la spondylite ankylosante, l’arthrite psoriasique, le lupus, les vasculites, la polymyosite, • Une manifestation d’une dégénération cartilagineuse systémique comme dans l’arthrose • D’autres pathologies comme la déposition de cristaux, l’hypothyroïdie, un problème du métabolisme osseux, une inflammation des tissus mous, la dépression ou une atteinte neurologique. À l’histoire et à l’examen, il est important d’explorer : • l’acuité de la présentation initiale, • évaluation normale de la douleur, • la présence ou l’absence d’inflammation, • la distribution des articulations douloureuses, • le tableau clinique mis à part la douleur articulaire, • l’évolution de la maladie, • et le sexe, l’âge, la race et l’historique familial du patient Le tableau clinique ainsi dressé aidera à limiter et diriger les tests diagnostiques demandés. Les tests qui sont utiles pour le diagnostique de l’arthrite rhumatoïde peuvent inclure une formule sanguine, la vitesse de sédimentation globulaire, la présence d’autoanticorps comme le facteur rhumatoïde, les anticorps antinucléaires ou l’anti CCP, une arthrocentèse ou tout autre test nécessaire pour exclure toute pathologie qui pourrait raisonnablement expliquer le tableau clinique. Le diagnostique de l’arthrite rhumatoïde requiert une histoire de 6 semaines pour 4 des 7 critères suivants : • raideur articulaire matinale d’au moins 1 heure • arthrite d’au moins 3 articulations • arthrite de l’articulation metacarpophalangienne, interphalangienne proximale ou du poignet, • présence de nodules rhumatoïdes; • facteur rhumatoïde positif; • érosions marginales ou ostéopénie périarticulaire, à la radiographie. La présence de facteur rhumatoïde est déterminée par l’agglutination de billes de latex recouvertes d’IgG par les IgM pentamériques qui proviennent du sérum du patient. Le test est non-spécifique, et relativement non-sensible pour le dépistage de l’arthrite rhumatoïde dans la population générale, mais il permet d’évaluer le cours de la maladie et aide à établir le pronostic. La présence d’anticorps anti CPP est beaucoup plus spécifique à l’arthrite rhumatoïde. L’arthrite rhumatoïde se présente souvent de manière insidieuse, mais peut se présenter initialement par une douleur monoarticulaire, ou comme arthrite intermittente ou migratoire. Cependant, elle peut aussi se présenter de manière aigue associé à une fièvre, un malaise général, une perte de poids, une myalgie prononcée, la fatigue et la dépression. Les groupes articulaires typiquement affectés sont les MCP, les IPP, les poignets, MTP, et éventuellement les coudes, les épaules, les chevilles et les genoux. L’atteinte est typiquement symétrique. Il est possible que le patient ait aussi une ostéopénie articulaire, une anémie, des nodules rhumatoïdes, une pleurite, une péricardite, une atteinte neurologique, une épisclérite, la splénomégalie, un assèchement des muqueuses, une vasculite ou une néphropathie (entre autres). À la première inspection, on observe souvent une inflammation des articulations phalangiennes, une réduction des amplitudes de mouvement, et une perte de la force préhensile. Dans une maladie plus avancée, on peut observer une déviation ulnaire des doigts, une déviation radiale du poignet et les difformités en boutonnière et en cou de cygne des doigts. L’atteinte du squelette axial est habituellement limitée à la région cervicale. La maladie progresse souvent par vagues de poussées et de régression des symptômes. La rémission spontanée est rare. L’activité de la maladie peut varier, mais les dommages cartilagineux et osseux sont irréversibles. Ce tableau clinique peut ressembler à plusieurs autres maladies. Cependant, certains indices permettent de faire la différenciation. Le rhumatisme psoriasique présentera avec un érythème. La goutte requiert une hyperuricémie, se présente habituellement de manière aigue et on note la formation de concrétion tophacée. L’arthrose atteint habituellement les patients plus vieux, n’est pas principalement inflammatoire, n’est pas nécessairement symétrique, atteint les articulations phalangiennes distales, et présentes des trouvailles radiologiques atypiques de l’arthrite rhumatoïde. Les maladies causées par la déposition de cristaux peuvent être différenciées à l’arthrocentèse. Le syndrome de Reiter suit habituellement une infection et se présente souvent avec des symptômes oculaires et génito-urinaires ou gastro-intestinaux. Le profil des anticorps antinucléaires est habituellement différent dans la maladie du lupus érythémateux systémique. Il est toujours important d’établir comment la vie quotidienne du patient est affectée par sa condition médicale. Le traitement de l’arthrite rhumatoïde peut être divisé en non-pharmacologique, pharmacologique, et chirurgical. Étant donné la nature dégénérative et irréversible de la maladie, il est recommandé de traiter les patients avec des antirhumatismaux modificateurs de la maladie (ou DMARDs en anglais) de concert avec la thérapie non pharmacologique pour augmenter les chances d’induire une rémission. L’éducation du patient quant au cours de la maladie et le rôle des épreuves diagnostique et le traitement est essentielle. La société canadienne de l’arthrite offre des programmes pour le counseling des patients. L’exercice modéré est nécessaire pour prévenir l’atrophie musculaire, et pour maintenir la souplesse des tendons et des ligaments. La physiothérapie peut servir à réduire la douleur et l’inflammation de façon temporaire et pour conserver la fonction des articulations. Il faut aussi réduire le risque d’ostéopénie et d’athérosclérose à l’aide de la nutrition et de la pharmacothérapie appropriée. Le traitement pharmacologique symptomatique consiste d’analgésiques comme l’acétaminophène ou le tramadol ou d’anti-inflammatoires non-stéroïdiens comme les COX-2 (même s’ils ne modifient pas le cours de la maladie). Les glucocorticoïdes oraux, IV ou intra-articulaires fournissent une plus grande réduction de la douleur, mais ont le désavantage de contribuer à l’ostéoporose. Les antirhumatismaux modificateurs de la maladie sont des produits qui servent à prévenir ou réduire L’INFLAMMATION ET la dégénération articulaire pour maintenir un niveau maximal de fonction et de productivité. Il y a plusieurs classes d’agents pharmacologiques dans les DMARDs, comme des anticorps anti TNF, des inhibiteurs de la synthèse des purines comme le méthotrexate, des inhibiteurs de la prolifération leucocytaire, des inhibiteurs de synthèse de cytokines, des inhibiteurs de metalloprotéinases, des antagonistes de la fonction des interleukines, des anticorps anti lymphocytes B et autres. Toujours respecter les contrindications habituelles pour ces médicaments. Le traitement préféré au moment pour une présentation initiale est une forte dose de glucocorticoïdes avec une thérapie combinée DMARD / methotrexate avec une réduction rapide de la dose de glucocorticoïdes. Si les dommages articulaires sont prononcés, on peut fusionner l’articulation, ce qui est associé avec une perte considérable de fonction, ou remplacer l’articulation, qui est associé avec un risque accru d’infection, de thromboembolie et de disfonction.