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Should Lupus Nephritis Receive PJP Prophylaxis?

Jack Cush, MD

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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An Epidural Letdown (4.4.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.

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Vamorolone: a New Steroid on the Horizon?

Jack Cush, MD

Vamorolone is a potentially new alternative to traditional glucocorticoids for use in inflammatory diseases.

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Steroids, Prophylaxis and Pneumocystis Pneumonia

Jack Cush, MD

A case-control study has shown that glucocorticoids and tapering glucocorticoids are risk factors for the development of Pneumocystis jirovecii pneumonia (PJP).

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Upadacitinib for Giant-Cell Arteritis - A Phase 3 Trial

Jack Cush, MD

The NEJM has published a randomized controlled trial in giant-cell arteritis (GCA) patients, demonstrating significant efficacy and safety of upadacitinib (UPA), given as 15 mg daily, as compared to placebo. 
 

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1st Line Biologics vs csDMARDs in Adult Still's Disease

Jack Cush, MD

A German multicentre, retrospective study assessed the first-line efficacy of biologics and conventional synthetic DMARD therapy in patients with adult-onset Still's disease and found biologic agents were significantly better with sustained, event-free remissions and fewer complications.

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Peripheral Nerve Blocks for Hip Fractures

Jack Cush, MD

JAMA reviews the use of peripheral nerve block with hip fractures as an effective pain management strategy that can be performed by credentialed clinicians outside of the operating room.

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Targeting Obesity in Rheumatic Disease Patients

Jack Cush, MD

Sattar et al. has published an informative overview of the effect of obesity on rheumatic and musculoskeletal diseases (RMDs). They estimate that nearly 70% of RMD patients are overweight or obese.

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RHEUMATOLOGISTS: Which regimen do you choose for Class V Lupus Nephritis

Dr. John Cush RheumNow ( View Tweet)

Vamorolone: a New Steroid on the Horizon? Vamorolone is a potentially new alternative to traditional glucocorticoids for use in inflammatory diseases. It is a dissociated steroidal compound with reduced side effects, and in an animal model of inflammation has shown effective https://t.co/38WTOAuuJy
Dr. John Cush RheumNow ( View Tweet)
Matched cohort study of 83,811 #RA pts showed RA had a 12% increased risk of avoidable hospitalizations (CHF, pulmonary edema; (IRR 1.12). Predictors of ACSC hosp. were age, Steroids, ambulatory comorbid Dxs. ambulatory care access & ^ primary care may reduce this risk. https://t.co/Tx7LO59RbP
Dr. John Cush RheumNow ( View Tweet)
Vamorolone: a New Steroid on the Horizon? Vamorolone is a potentially new alternative to traditional glucocorticoids for use in inflammatory diseases. It is a dissociated steroidal compound with reduced side effects, and in an animal model of inflammation has shown effective https://t.co/zHDyJbU23q
Dr. John Cush RheumNow ( View Tweet)
Steroids, Prophylaxis and Pneumocystis Pneumonia A case-control study has shown that glucocorticoids and tapering glucocorticoids are risk factors for the development of Pneumocystis jirovecii pneumonia (PJP). The authors provide guidance on the optimal timing for prophylaxis https://t.co/0nKVEKOEex
Dr. John Cush RheumNow ( View Tweet)
Matched cohort study of 83,811 #RA pts showed RA had a 12% increased risk of avoidable hospitalizations (CHF, pulmonary edema; (IRR 1.12). Predictors of ACSC hosp. were age, Steroids, ambulatory comorbid Dxs. ambulatory care access & ^ primary care may reduce this risk. https://t.co/AxQVoXoxxx
Dr. John Cush RheumNow ( View Tweet)
An estimated 118,000 people throughout the world have EGPA. Steroids & immunosuppressants have been the mainstay; but for managing EGPA. Mepolizumab (2015) & Benralizumab (2024) are FDA approved for EGPA. The latter (Fasenra) approval based on the MANDARA trial https://t.co/84W4sOig9d
Dr. John Cush RheumNow ( View Tweet)
Vamorolone, a promising alternative to traditional glucocorticoids for inflammatory diseases. ◦ #Vamorolone is a dissociated steroid compound with reduced side effects. ◦ Unlike conventional #glucocorticoids, vamorolone lacks the hydroxyl or ketone groups and is resistant to https://t.co/yvDWqcbXbn

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Alberto Giraldo alb_giraldo ( View Tweet)
Diagnosing PMR is easy before Pred initiation; but after steroids NO SO. Before Pred, PMR Dx from non-PMR (median probabilities 7.8 vs 2.8) w/ 86% sensitivity/83% specificity. After Pred Dx probability of PMR dropped to 1.0 w/ sensitivity 3.5%; not much better w/ Pred D/C https://t.co/q4TceeFByc
Dr. John Cush RheumNow ( View Tweet)
Diagnosing PMR is easy before Pred initiation; but after steroids NO SO. Before Pred, PMR Dx from non-PMR (median probabilities 7.8 vs 2.8) w/ 86% sensitivity/83% specificity. After Pred Dx probability of PMR dropped to 1.0 w/ sensitivity 3.5%; not much better w/ Pred D/C https://t.co/RRIYY6xleN
Dr. John Cush RheumNow ( View Tweet)
Adrenal Dysfunction after Steroids in PMR and GCA Patients JAMA has published a study of PMR and GCA patients who stopped glucocorticoid (GC) therapy and noted a low (1.2%) risk of GC-induced adrenal insufficiency after planned cessation. https://t.co/zQSa8ex9na https://t.co/gkKxHFPuNe

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Dr. John Cush RheumNow ( View Tweet)
Adrenal Dysfunction after Steroids in PMR and GCA Patients JAMA has published a study of PMR and GCA patients who stopped glucocorticoid (GC) therapy and noted a low (1.2%) risk of GC-induced adrenal insufficiency after planned cessation. https://t.co/ZTaIQxs0ex https://t.co/LA5qji8Zj5

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Dr. John Cush RheumNow ( View Tweet)
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