Mike Putman

May as well join the fun: TYPES OF [X] PAPERS - RHEUM-EDITION! Special thanks to @BenMazer for this article theatlantic.com/science/archiv… And to this website: @guillaume-levrier/xkcd-types-paper" target="_blank" rel="nofollow noopener">observablehq.com/@guillaume-lev… And sorry if someone already did this! Had not seen yet for rheum but wouldn't be surprised ;)

New article out this morning! Deucravacitinib now approved for PsA. Thoughts on what it means / how big this will be as well as a nifty infographic I've been working on Check out out and subscribe below! open.substack.com/pub/autoimmune…

What's happening w/the FDA & avacopan? Have you heard of brepocitinib yet? And how is ALLEGORY going to fit into the current landscape of SLE therapies? New newsletter! Have a read & follow along: Avacopan Under Fire & B Cells are Having a Moment open.substack.com/pub/autoimmune…

Is it time for rheumatologists to prescribe GLP1’s? New data hints at better disease control in rheumatic conditions, and @ebrheum discusses whether it's time for rheumatologists to start prescribing them. Read here: buff.ly/FblQUJ4 #Rheumatology #GLP1 #MedTwitter

Same story with nipocalumab. Worked for ESSDAI, not ESSPRI Story for telitaciecept complicated... Matt Baker "We don't usually see this kind of non response for patients in placebo groups" I'll say it a little more bluntly: I don't believe this data. #RNL26

Assuming ianalumab will be coming soon to a NEJM / FDA near you Successful in ESSDAI but not really in ESSPRI... 😤 No benefit at all in pts w/low salivary flow at baseline What do we do with a marginal drug that costs >$100k/yr (assuming) & no benefit in ESSPRI? #RNL26

I really dislike ESSDAI as an outcome measure, ESSPRI makes way more sense Covers dryness, fatigue, and pain - aka "what matters most to most patients with Sjogrens" Neither baseline nor change in ESSDAI & ESSPRI correlate with each other (r=0.20 & r = 0.14!) #RNL26

My new favorite myositis specific antibodies slide, c/o Dr. Rohit Aggarwal Highlights the re-classification of prior cases of "polymyositis" Covers nuance with CCAR1 & TIF1y pts (ie low risk of +CCAR1) HJighlights lung cases (ie MDA5, overlaps, antisynthetase) #RNL26

Classic slide from Dr. Aggarwal, CK values skew rightwards, causing completely-normal values to be flagged as abnormal #RNL26 I use ~300 for women & ~500 for men w/wiggle room for BMI, muscle mass, and recent activities Great slide here non-rheum causes of CK elevations

If you're looking for information about the FDA/EMA-avacopan drama, some surprising nuggets in the publicly available legal documents None of this is new-to-the-FDA/EMA, but I bet some of it will be new-to-you. See 133, 136, 141, & 142, 175 chemocentryxsecuritieslitigation.com/home/8788/Docu…

Epic summary slide of current approvals and trials for SpA, I wish someone just maintained a website that updated things like this constantly. So useful for practice. #RNL26

Interesting pearl #RNL26 - re:imaging for AxSpA, MRI is better at the SI joints, CT better at the spine Nice slides highlighting extra-axial manifestations in this disease Uveitis is particularly tough: "For refractory uveitis, high dose JAK may be an option" -Dr. Bakewell

Revised calssification criteria for axSpA #RNL26 Pretty reasonable list, I like that we're giving more credence to various common manifestations (IBD, uveitis, enthesitis, etc) Lots o'points for MRI findings... still easy to overdiagnose

Great talk at #RNL by Dr. Poddubnyy - strongly recommend this paper from Lancet Rheum discussing the "imaging crisis" in axspa More sensitive evaluations find more axspa BUT also more false positives, resulting in overdiagnosis & overtreatment

JAKi's for allopurinol hypersensitivity? Have never seen it, but nice to have this in the back of your mind if you do #RNL26

Gout talk by Dr. Terkeltaub - really convicing me to try febuxostat first, no risk for allopurinol hypersensitivity & easier to uptitrate #RNL26

Gap between where we should be (controlling gout for everyone for under $100 per year) & where we are is vast. Great slide & stark rundown from Dr. Terkeltaub Also, description of the CARES trial: "Got a black box from a crappy trial that was a piece of crap" 😆#RNL26

Lots of great pearls for IL23 vs IL17 at #RNL26 from Dr. Ribeiro IL17A < IL23 for PSO... but what about IL17A/F? RCT pending For joints, TNF ~ IL17 ~ IL23, but some skepticism about IL23 in axial disease

I have been seeing this as well! Anyone else having a rash of people coming into clinic with worsening joint pains on dupilumab? #rnl26

Great flowchart for how to approach TNF induced skin eruptions for patients with PSO/PsA Nice to see continuing through would be an option for mild reactions Dr. Merola recommended JAKs as an nice option if you decide to class-switch #RNL26

#RNL26 regarding recommendations to hold biological therapies for surgery: "In an otherwise healthy patient, I am not sure holding is the right thing to do" -Susan Goodman