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Osteoarthritis Risky Business (4.18.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and Journal reports from this week on RheumNow.com.  Osteoarthritis patients have unique risks and synovial fluid WBC numbers can tell you when to worry about septic arthritis in gout and pseudogout patients.

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Distinguishing Septic and Gouty Arthritis

Jack Cush, MD

A single center, retrospective review of patients undergoing knee joint fluid aspirations for presumed crystalline arthritis (CA) showed that synovial WBC may provide a useful diagnostic marker for SA with an optimal threshold of 50,000 cells/mm3.

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EMR Messaging Woes (4.11.2025)

Jack Cush, MD

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

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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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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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ERA, APPs, & Alpha GAL (3.21.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.  Listen in for 2 new case questions - Ask Cush Anything.

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CDC's Committee on Immunization (ACIP) met and recommended: 1. Expand strains for meningococcal vax 2. Lower age for RSV vax > 50y 3. Rec. chikungunya vax for certain travelers - Flu & Covid Vax to be up next mtg 6/25 https://t.co/jInnR5JSxS https://t.co/PXg0HDLgnL https://t.co/4pfZSRrEzi

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In a murine model of Kawasaki Dz vasculitis- depleting gut microbiota reduces KD like vasculitis. CV lesions were assoc w/ decrease in Akkermansia muciniphila and Faecalibacterium prausnitzii. Replacement attenuated these findings. https://t.co/uAfInA5MAq https://t.co/3AjMRQnmts

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Dr. John Cush RheumNow ( View Tweet)
In a murine model of Kawasaki Dz vasculitis- depleting gut microbiota reduces KD like vasculitis. CV lesions were assoc w/ decrease in Akkermansia muciniphila and Faecalibacterium prausnitzii. Replacement attenuated these findings. https://t.co/Hnij8TWkYy https://t.co/wEuVcuAZ5j

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Dr. John Cush RheumNow ( View Tweet)
Is High Dose Aspirin Needed in Kawasaki Disease (KD)? Does aspirin add any advantage to intravenous immunoglobulin (IVIG) alone in children with KD? A randomized clinical trial IVIG alone was not inferior to IVIG plus aspirin, suggesting that high-dose aspirin during initial https://t.co/vThkP4AH6x
Dr. John Cush RheumNow ( View Tweet)
FDA reports higher rate of allergic/hypersensitivity type reactions w/ certainlots of Immune Globulin Intravenous (IGIV) and Immune Globulin Subcutaneous (IGSC) ; these have voluntarily withdrawn by the manufacturers https://t.co/j0yVBodLtW https://t.co/k7s4LtLnyu

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Dr. John Cush RheumNow ( View Tweet)
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 https://t.co/zzRIVG0Sq3
Dr. John Cush RheumNow ( View Tweet)
FDA reports higher rate of allergic/hypersensitivity type reactions w/ certainlots of Immune Globulin Intravenous (IGIV) and Immune Globulin Subcutaneous (IGSC) ; these have voluntarily withdrawn by the manufacturers https://t.co/N73Cc8rfAS https://t.co/OTROyomvv8

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Dr. John Cush RheumNow ( View Tweet)
Metanalysis showed no increased risk of serious infx (SIE) w/ JAK inhibitors use in pts w/ immune-mediated inflammatory skin diseases -- 32 RCTs, 11,917 pts found SIE in 0.62% on JAKi vs 0.51% controls. Meta-analysis found no significant increase in risk of serious infection https://t.co/ugH72nk8bZ
Dr. John Cush RheumNow ( View Tweet)
Shanghai hospital retrospective cohort study of 249 pts w/ post-Unilat TKA & lat knee pain. 144 Rx w/ IA steroids vs 105 Rx w/ PO meds. Infection rate w/in 6 mos post-TKA found no signif difference (2.1% vs 2.9%); Injx pts had signif better pain relief, QOL & knee function (KSS) https://t.co/ULVO6KU7pn
Dr. John Cush RheumNow ( View Tweet)
185 children with SLE (cSLE) were analyze for long-term outcomes. 38 (20.54%) had serositis. Pts w/ serositis were younger, had more Dz activity, acomorbidities, & mortality. Having both serositis and ESRD increased risk of poor 20 Yr survival. https://t.co/fw8wcuS48E https://t.co/LgS3Sxy7gd

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Dr. John Cush RheumNow ( View Tweet)
185 children with SLE (cSLE) were analyze for long-term outcomes. 38 (20.54%) had serositis. Pts w/ serositis were younger, had more Dz activity, acomorbidities, & mortality. Having both serositis and ESRD increased risk of poor 20 Yr survival. https://t.co/tnYgg6MNXp https://t.co/zJor1oTFfD

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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)
Systematic review 21 studies showed potential of RTX with IVIg in autoimmune Dz - 10 studies on pemphigus (85 pts) - all Positive outcomes except 1 paraneoplastic pemphigus. Infections (eg, P. jirovecii pneumonia) seen in 3. 11 studies (24 pts) Rx'd neuropathies, CND lupus& https://t.co/o0RRUBIqmS
Dr. John Cush RheumNow ( View Tweet)
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