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CKD & Osteoporosis Rx Revisited (7.25.2025)
Dr. Jack Cush reviews the news, journal and FDA updates from this past week on RheumNow.com.
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NHANES, Numbers, & Risk (7.18.2025)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com along with interesting case questions from "Ask Cush Anything".
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Hmmm Really? (7.11.2025)
Dr. Jack Cush reviews the news and journal reports from this past week - some obvious, other new thoughts and some - hmmm, reallly?
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ICYMI: Should Lupus Nephritis Receive PJP Prophylaxis?
A current review article suggests that the need for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in patients with systemic lupus erythematosus (SLE) and lupus nephritis will need to be individualized based on therapies and risk factors.
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ICYMI: AGA Guideline: Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals
The American Gastroenterology Association has published its revised clinical practice guidelines for the prevention and treatment of hepatitis B virus (HBV) reactivation in at-risk patients, particularly those with immune-mediated disease, receiving immunomodulatory therapy and steroids.
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Practical management of rheumatic immune-related adverse events with immune checkpoint inhibitors
Joint Bone Spine has published a full read review of the management of immune-related adverse events (irAEs) in patients receiving Immune checkpoint inhibitors (ICIs) for cancer. https://t.co/i3FMOCbyNg
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New CDC report confirms a record number of Measles cases in the USA, now at 1,319 (in 39 states), the highest since 1992. National cases are more than 4.5 times higher than the entirety of last year, which had an estimated 285 cases reported. https://t.co/KkqQu9C4cO https://t.co/bND6hPDUNA
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RA Lung Disease Portends Poor Outcomes
A retrospective Harvard affiliates study shows that rheumatoid arthritis (RA) patients with lung disease have higher mortality, especially respiratory and infection-related mortality than those without lung disease (LD). https://t.co/13h2u26ecb
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Diminishing trend in serious infections assoc w/ TNFi use in inflammatory arthritis over the years. ICEBIO study 1387 Rx w/ 1st TNFi 2003–2018 (vs 6936 comparators. Over tme the SI rate dropped 52% (IRR 0.48; 0.25–0.94), but not for controls (Abx use stable) https://t.co/jDsKlCrd0p
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Osteoarthritis (OA) degenerative or inflammatory? 296 pts w/ Knee OA (age 63 yrs, 2/3 had poor oral hygien, K&L grade 2, pain >40). Periodontitis in 62.5% & signif assoc w/ Xray K&L grade 4 (OR 5.39), poor oral hygiene (OR 34), dental visits (OR 8.54), brushing time (OR 21.9) https://t.co/xXIr2qxtt4
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MTX lowers risk of serious infxn (SI) - UK Observational study of 17 472 newly Dx RA (2018–2023); 10K on MTX, 4,540 other csDMARDs; 13680 corticosteroids (GC). 1307 SI (3/100 PY) w/ reduced adj HR 0.72 (95% CI: 0.63–0.82). 311 SI-related mortality (IR 0.69;0.61–0.77) https://t.co/iuxAivtrYZ
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Short full read review of the history, safety and use of Corticosteroids in Respiratory Medicine (including use in community-acquired pneumonia (CAP), ARDS, septic shock, ILD, COPD/asthma, COVID-19, Cancer, Sarcoid & IPF. https://t.co/aKMAT8IhLm https://t.co/RopoNnYJ6Z
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Sulfasalazine as a preventative against Pneumocystis (PJP). 594 RA pts & 848 Rx episodes - 181 on SSZ, 667 controls. W/ 850 Pt-Yrs F/U, 21developed PCP, 3 died of PCP. SSZ significantly lowered PJP risk (p = 0.003, rate ratio = 0.05; 95% CI 0.00–0.34). https://t.co/PAgBaJGldR https://t.co/PuTxGXTeRS
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MTX lowers risk of serious infxn (SI) - UK Observational study of 17 472 newly Dx RA (2018–2023); 10K on MTX, 4,540 other csDMARDs; 13680 corticosteroids (GC). 1307 SI (3/100 PY) w/ reduced adj HR 0.72 (95% CI: 0.63–0.82). 311 SI-related mortality (IR 0.69;0.61–0.77) https://t.co/YhJV3vyAmB
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Sulfasalazine as a preventative against Pneumocystis (PJP). 594 RA pts & 848 Rx episodes - 181 on SSZ, 667 controls. W/ 850 Pt-Yrs F/U, 21developed PCP, 3 died of PCP. SSZ significantly lowered PJP risk (p = 0.003, rate ratio = 0.05; 95% CI 0.00–0.34). https://t.co/PAgBaJGldR https://t.co/VV3MvVEGal
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Martinque, Afro-Caribbean population (n 354 800) study(2004-2022) of 33 AOSD pts (71%F; 79% systemic; 21% chr articular); 91% met Yamaguchi criteria; features as expected but more Pulmonary Dz(51%; 94% w/ a systemic pattern). Half Dx < age 35 yrs. Prevalence 7.6 /100 000 mean https://t.co/QWyfNuvhkl
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Study of 176 anti-MDA5-DM patients and 55 controls found anti-IFN-α Abs in 18% of MDA5-DM pts, higherin those >60 yrs. IFN-α Ab-positivity assoc w/ RP-ILD (68% vs. 41%) & pulmonary infxn (74% vs. 46%, esp fungi), Mortality (p = 0.006). https://t.co/6w6S3nozPI https://t.co/FoXEIuLBEk
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Diffuse idiopathic skeletal hyperostosis (DISH)is a structural cause of dysphagia due to anterior cervical osteophytes. Retrospective study 208 dysphagia pts w/ head/neck CT. DISH was Dx in 39%; predicted by low serum albumin, COPD, & chronic pain https://t.co/zrn4dnCtLc https://t.co/svE6khmUEm
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#RA linked to 40% incr risk of serious dental Infx. National Inpatient Sample (2016-2022) retrospective study of ~15 million adult inpatient records, 10.7K (0.07%) had oral Infx Hosp. Risk factors included RA (1.9%; OR 1.4, male (1.79), Black (1.23), smoking (1.33) https://t.co/pr4Uf6ywJ7
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Case series of 22 PsA pts treats w/ combination bioDMARDs & JAKi,TYK2i or APR
IL17i + JAKi 10.5 PY = 1 mild infectious stomatitis
IL23i + JAKi 3.7 PY = no AE
IL-17i + TYK2i 8.5 PY = 2 mild upper respiratory infections
IL-23i + TYK2i 8.3 PY = 2 mild URIs, 1 folliculitis
TNFi + https://t.co/hxhTxmJpbN
Dr. John Cush RheumNow ( View Tweet)
