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When Myositis Hits the Lungs: What Every Rheumatologist Should Know About ILD
When idiopathic inflammatory myopathies (IIM) affect the lungs, the consequences can be serious. ILD is not only common in IIM, but also one of the leading causes of death, contributing to up to 80% of mortality in this patient group. For rheumatologists, two subsets stand out: anti-synthetase syndrome (ASyS) and anti-MDA-5 positive dermatomyositis (MDA5-DM). These patients present with distinct clinical clues, very different disease trajectories, and unique treatment challenges. Recognizing ILD early and acting decisively can make the difference between stabilizing a chronic course and facing a rapidly progressive, often fatal decline.
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STOP-RA: Hydroxychloroquine Fails in ACPA+ Arthralgia
Deane et al has published the results of the STOP-RA trial, demonstrating that 12 months of hydroxychloroquine (HCQ) did not prevent the development of clinical RA at 36 months.
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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)
Target trial emulation looked at CV (MACE) events in 18,120 propensity score–matched adults with gout starting allopurinol who were given NSAIDs or colchicine for prophylaxis. MACE & CV death were signif. higher w/ NSAIDs vs Colchicine (HRs of 1.56 and 2.50), respectively. https://t.co/0T8slmPBng
Dr. John Cush RheumNow ( View Tweet)
Hospital for Special Surgery (HSS) reports that ear acupuncture applied during hip replacement surgery reduces pain and lessens opioid use over the weeks to follow. https://t.co/lOrwb1DzW5 https://t.co/6rkHNTwaAl
Dr. John Cush RheumNow ( View Tweet)
RCT of 800 adults w/ Chronic LBP, acupuncture (AP) was compared usual care or AP +/- added maintenance found that acupuncture improved pain-related disability at 6 months and 12 months, with no statistically discernible benefit of additional maintenance sessions. https://t.co/suy09fGxxI
Dr. John Cush RheumNow ( View Tweet)
SLE and Osteoporosis
Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease that can present with a variety of signs and symptoms and organ involvement. Comorbidities further complicate the disease course that may lead to poor health-related quality of life and https://t.co/8ZmtLjzbqA
Dr. John Cush RheumNow ( View Tweet)
SMART study - Single vs. Split Dose Methotrexate in RA
Split dose weekly, oral methotrexate (MTX) was shown to be superior to single dose MTX in treating active rheumatoid arthritis (RA) patients.
https://t.co/JN5wPGNjao https://t.co/lizsrtVHwf
Dr. John Cush RheumNow ( View Tweet)
Future Perspectives of Rheumatoid Arthritis
Dr. Kuni Yamaoka, shares highlights from the Future Perspectives of Rheumatoid Arthritis session at the APLAR 2025 Congress in Fukuoka, Japan.
https://t.co/LGLqe48R2L https://t.co/Kwp3cFPtyw
Dr. John Cush RheumNow ( View Tweet)
QD Clinic: Progressive RA-ILD Management
Dr. Richard Conway, a rheumatologist in Dublin, discusses a case about managing progressive rheumatoid arthritis-interstitial lung disease, as part of RheumNow's Rheum to Breathe: ILD campaign, presented throughout the month of September https://t.co/dLCXeXwl7w
Dr. John Cush RheumNow ( View Tweet)
What are the Pros and Cons of autologous CAR T cell therapy?
Summary slide from Georg Schett who also mentioned the exciting in vivo CAR approach using nanoparticules in myeloma, something to stay tuned for
@RheumNow #APLAR25 https://t.co/kWjrx6N9Dv
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Aurelie Najm AurelieRheumo ( 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
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
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
Aurelie Najm AurelieRheumo ( View Tweet)
PAH, when associated with ILD in CTD, worsens prognosis, and poses challenges for treatment
Summary of when PAH should be assessed in patients with ILD and when to perform a right heart catheterization by Prof Kuwana
@RheumNow #APLAR25 https://t.co/g4x4ENzc9k
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Aurelie Najm AurelieRheumo ( View Tweet)
Dr. Alberta Hoi graphically presents the difference bet acute confusional states & chronic cognitive changes in #lupus patients presenting with NP symptoms.
NPSLE continues to pose a diagnostic challenge bec pts may present with more than one syndrome complex
@RheumNow #APLAR25 https://t.co/4nYTo1fzVz
sheila RHEUMarampa ( View Tweet)
How to treat CTD ILD?
A comparative slide summarizing ACR/BSR and EULAR treatment guidelines
Emphasis on combination of Immunosuppressant and Antifibrotics
@RheumNow #APLAR25 https://t.co/gLSht6QKh5
Aurelie Najm AurelieRheumo ( View Tweet)
“Listen to the patient, he is telling you the diagnosis”. – Sir William Osler
Dr. John Cush RheumNow ( View Tweet)
A framework for treatment stratified approach in CTD-ILD, by Dr Low Hsiu Ling
Based on
-ILD extent
-Risk of progression
-Biology: fibrosis/inflammation
-Safety
-Other manifestations
@RheumNow #APLAR25 https://t.co/ma5KugzBHy
Aurelie Najm AurelieRheumo ( View Tweet)
‼️More reasons why we should avoid steroids in #lupus patients
@RheumNow #APLAR25 https://t.co/a5IeutJ5mi
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sheila RHEUMarampa ( View Tweet)
