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Telling You Where to Go (12.19.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com. Who would've thunk - a PsA FMF connection? Labs to diagnose SSc-ILD? IgA-RF may be important or RZV may not work in JAK inhibitor treated patients?

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APPs in the News (12.5.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from RheumNow.com, including info on scleroderma, dermatomyositis and malignancy, rheumatologist and APP salary concerns.

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Managing Perioperative DMARDs with Arthroplasty

Jack Cush, MD

Postoperative complications with arthroplasty may be related to chronic inflammation and immunosuppressive therapy. Yet a recent retrospective study total ankle arthroplasty in end-stage RA patients shows that early postoperative wound complications are unaffected by the continued use of their preoperative medications including DMARDs.

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Japanese retrospective study-194 #RA pts Rx w/ JAK inhib (74 vaccinated w/ recombinant zoster (RZV) & 120 Not-Vax). H.zoster lower w/ RZV (4.8/100PY) vs UnVax (7.8/100PY) w/ overall efficacy of 59.1%. RSV Vax pts who got HZ had signif lower lymphocyte #s, higher SDAI & CDAI. https://t.co/vJJRflJ23x
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Lyme disease is endemic in Massachusetts. EHR study shows Lyme dz incidence declined from 211 per 100 000 patients in 2012 to 86 per 100 000 in 2024 (P< .001), but this decr. was driven by 1 large practice group implemented a new initiative to reduce Lyme Dx & Rx in pts w/ https://t.co/lMCUA9o4Uc
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Japanese retrospective study-194 #RA pts Rx w/ JAK inhib (74 vaccinated w/ recombinant zoster (RZV) & 120 Not-Vax). H.zoster lower w/ RZV (4.8/100PY) vs UnVax (7.8/100PY) w/ overall efficacy of 59.1%. RSV Vax pts who got HZ had signif lower lymphocyte #s, higher SDAI & CDAI. https://t.co/4VMWPhzXeL
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Taiwanese retrospective study (2001-2022) of 2,383 PsA pts Rx w/ 1+ DMARDs. Comparing 1,190 bDMARDs vs 1,193 cDMARD Rx pts, bDMARDs assoc. w/ signif lower risk of MACE (HR 0.65), all-cause mortality (0.44), CV mortality (0.54), but more infx related Hosp (1.45) https://t.co/eu7fSVkjZl
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Korean claims study of 60 315 adult #RA pts (matched 1:5 controls), found risk for nontuberculous mycobacteria pulmonary disease was 3 fold higher in RA (0.23% vs 0.06%; 0.54 vs 0.14/1000PYs). Mostly in seropositive RA (OR 3.77), also males, obese, EtOH use. https://t.co/xPPHvtwxIB
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Korean claims study of 60 315 adult #RA pts (matched 1:5 controls), found risk for nontuberculous mycobacteria pulmonary disease was 3 fold higher in RA (0.23% vs 0.06%; 0.54 vs 0.14/1000PYs). Mostly in seropositive RA (OR 3.77), also males, obese, EtOH use. https://t.co/hJgoD8mnhv
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Taiwan Health Insurance study of 5749 #RA pts Rx w/ b/tsDMARD, followed >2.5 yrs - 268 (4.7%) had serious infx (1.3 SIE/100PYs); 51% pneumonia, 25% UTI, 10% TB). 60% had b/tsDMARDs dose reduction- not assoc w/ increase SIE (3.4% v 4.2%), but D/C increased SIE (35% v 26%) https://t.co/6J8rB3IyFR
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10 yr European retrospective study of haemophagocytic lymphohistiocytosis found 3345 deaths due HLH from 29 countries. Crude mortality rate = 5.3 per 10million PYs (range: 1.1-11.3). From 2011 to 2021, increasing from 3.9 to 6.6/10millPYs, varying by country, sex, age. https://t.co/58gCQ72saF
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Zantac is Back! Ranitidine has been off the market for 5yrs, withdrawn over concerns about N-nitrosodimethylamine (NDMA) impurity affecting shelf-life. The FDA has approved reformulated ranitidine tablets - the drug has the same prior efficacy and safety label. https://t.co/ktTz5EO2Ja
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Australian Vaccine study (2019 - 2021) - w/in 12 mos of b/tsDMARD initiation 73% (11,225/15,460) recv influenza vaccination. High-dose Flu vax used in 28% in 60–69 yo, but > 80% older than 70yo. Only 9.7% recv pneumococcal & 2.4% zoster Zostavax or Shingrix) vax w/in 6 months of https://t.co/xoGTWMUi1L
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In 2024, 77 pts referred to Rheum for possible PMR were ultimately Dx w/ B19 viral infx. 96% had arthralgia & 7% had PMR-like features (5/5 w/ BL shoulder/neck. prolonged AM stiff, fever & Hi CRP/ESR - none had hip pain. 4/5 were male, w/ mean age of 55 yrs. None were RF/CCP+ https://t.co/SsLVEyL8X8
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Having #RA does not increase mortality in CA pts Rx w/ immune checkpoint inhibitors (ICI). 301 Veterans w/ RA & 2114 nonRA controls were compared: all-cause mortality was similar (HR 1.09; 0.94, 1.25). Most deaths from cancer (90% & 91%), but rarely from infection (<1%) https://t.co/gsXie6HpTu
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Western Australia study of 1854 SLE pts (median 40 yrs old). Interstitial lung disease was seen in in 3.8% of SLE, 26 fold more than controls. Risk factors for ILD included older age, smoking and serositis. SLE-ILD pts had higher mortality rates (MR 52.0, CI 37.0–71.1).
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Biologic use in 5008 IBD pts finds higher serious infxn (SIE) rates (vs, RA or PsO). In UC the SIE rate was 5.5/100PY w/ vedolizumab & 7/100PY w/ other biologics. In Crohns the SIE rate was 7.9/100PY w/ vedolizumab vs 6.5/100PY w/ other biologics (adj HR 1.15; 0.95–1.40) (P .16) https://t.co/R7YC220NnO
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