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MGUS,SPEP,Gamma

Review: Monoclonal Gammopathy of Undetermined Significance

Jack Cush, MD

NEJM has reviewed the common hematologic/immunologic finding of "monoclonal gammopathy of undetermined significance" (MGUS) - a common premalignant plasma-cell proliferative disorder found in approximately 5% of those over age of 50 years.

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Tramadol not effective at chronic pain

EurekAlert!

The strong opioid painkiller, tramadol, is not that effective at easing chronic pain for which it’s widely prescribed, finds a pooled data analysis of the available research, published online in BMJ Evidence Based Medicine.

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dna

Sequencing DNA to find new lupus treatments

EurekAlert!

Medical University of South Carolina geneticist Betty Tsao, Ph.D., will lead a five-year project to identify rare mutations associated with childhood-onset systemic lupus erythematosus (SLE), or lupus, with more than $3.5 million in funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Tsao holds the Richard M. Silver Endowed Chair for Inflammation Research in the Division of Rheumatology and Immunology at MUSC.

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Associations in Rheumatology (10.3.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal reports and important associations in rheumatology from the past week on RheumNow.com.

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Rheumatoid arthritis begins long before symptoms

EurekAlert!

Scientists have discovered that rheumatoid arthritis (RA) doesn’t start when the pain begins. It silently starts years earlier.The new research reveals that people at risk for RA experience dramatic immune system changes long before they feel symptoms.   

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CART

CAR-T Product Shows Early Promise in Lupus

Five patients with systemic lupus erythematosus (SLE) in China have been treated with a potentially groundbreaking form of chimeric antigen receptor (CAR) T-cell therapy, researchers reported, with encouraging results after 3 months.

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What is IPAF? Idiopathic Interstitial Pneumonia with Autoimmune Features - or IPAF - describes patients with interstitial pneumonia with autoimmune features, but they don’t meet a diagnosis of a CTD. https://t.co/ThU4pq27MU https://t.co/AOa5PALJst

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Dr. John Cush RheumNow ( View Tweet)
Definitions for Interstitial Lung Disease: A Consensusfrom the Fleischner Society https://t.co/2r9oS1Eb9k https://t.co/GqKq5E0bmp

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Dr. John Cush RheumNow ( View Tweet)
Controversies in ILD This deep dive into controversies in interstitial lung disease explored complex topics including IPAF, methotrexate, systemic autoimmune rheumatic disease vs. connective tissue disease distinctions, and the evolving role of anti-fibrotic therapy. Panelists: https://t.co/ekP1Gg73yj
Dr. John Cush RheumNow ( View Tweet)
Evidence of immune ageing detected at the earliest stages of RA. Study of 69 controls, 32 CSA, 44 undiff. arthritis (UA), 23 early RA, & 56 DMARD naive RA. UA & CSA had reduced naive CD4 T cells. Th17, Tregs &7 senescent T cells, were only seen once RA was established. https://t.co/c1wiA5gvM5
Dr. John Cush RheumNow ( View Tweet)
In lupus patients presenting with demyelinating symptoms, consider a probable disease overlap between NPSLE and NMOSD. >>>> serum AQP4 is highly specific for NMOSD. @RheumNow #APLAR25 @rheumarhyme @marklagacmd https://t.co/2Z8rbJ3a1c

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sheila RHEUMarampa ( View Tweet)
Different B cells depletion strategies in SARDs highlighted by Georg Schett From low and short lived depletion achieved w/ drugs to sustained deep tissular depletion with CAR T cells leading to potential immune reset @RheumNow #APLAR25 https://t.co/t35lrzEomF

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Aurelie Najm AurelieRheumo ( View Tweet)
Juvenile Lupus: some new mechanistic data Circulating Treg population are expanded in SLE and in particular in Lupus Nephritis compared to HC Naive Treg display specific molecular features in particular over expression of FCRL3 and TLR5 showing new pathways to explore in https://t.co/RuMtWRkpYB

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Aurelie Najm AurelieRheumo ( View Tweet)
Hyperferritinemia is common in Hyperinflammatory syndromes but is a hallmark of Macrophage activation syndrome and Sepsis; and is a poor prognostic sign too. MAS is excessive activation of T-lymphocytes & macrophages leading to cytokine storm & multi-organ damage. https://t.co/MUKXC0Tw3M
Dr. John Cush RheumNow ( View Tweet)
A new player in AIRD ThA age associated T helper cells Displaying both Cytotoxic & APC functions Correlation with disease activity in RA and SLE More research is needed to better characterize function but could be a promising therapeutic target @RheumNow #APLAR25 https://t.co/4SnY65tXpJ

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Aurelie Najm AurelieRheumo ( View Tweet)
Controversies in ILD Join leading experts as they tackle complex topics: IPAF, MTX, SARD vs. CTD, and anti-fibrotic therapy. 📅 Sep 16, 2025 | ⏰ 7 PM ET Jeffrey Sparks, MD | Janet Pope, MD | Elena Joerns, MD Moderator: Jack Cush, MD 👉 Register: https://t.co/O4FQNyGeTr https://t.co/jIfjuWWNvp

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Dr. John Cush RheumNow ( View Tweet)
🆕 Intro to ILD (Part I): the essentials 🫁 Definition & basics 🔬 Key pathology patterns 🧑⚕️ Clinical approach 📋 What rheums need to know ⬇️ Download & learn more: https://t.co/Fn76PiGsPl Created by @MithuRheum | via @RheumNow for our Rheum to Breathe: ILD Campaign https://t.co/MalDKUjonR

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Dr. John Cush RheumNow ( View Tweet)
Elevated serum levels of interleukin-18 discriminate Still's disease from other autoinflammatory conditions. Sera from 53 mSAID, 220 guSAID, 49 controls show IL-18 signif increased in Still's Dz; free IL-18 levels were selectively higher in Still's disease. https://t.co/8IWXWZmWgE
Dr. John Cush RheumNow ( View Tweet)
Elevated serum levels of interleukin-18 discriminate Still's disease from other autoinflammatory conditions. Sera from 53 mSAID, 220 guSAID, 49 controls show IL-18 signif increased in Still's Dz; free IL-18 levels were selectively higher in Still's disease. https://t.co/oAd3JwDR5D
Dr. John Cush RheumNow ( View Tweet)
Review of cancer-associated myositis (CAM) & assoc myositis-specific or myositis-associated autoantibodies. 2017 meta-analysis 5 studies & 4538 pts w/ DM or PM, the cancer risk (SIR) for DM = 4.66, but PM = 1.75. Cancer risk ^^ w/ Low serum KL-6, TIF1γ, NXP2, HMGCR Abs https://t.co/xsOt4wPIXB
Dr. John Cush RheumNow ( View Tweet)
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