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Lupus

Urine-soluble CD163 as a biomarker in #SLE: usCD163 significantly higher w/ active lupus nephritis & correlates w/ UPCR, disease activity, anti-dsDNA Ab levels and a higher chronic kidney disease stage. https://t.co/Mxe53pCnEF https://t.co/BOspodqpSE
Dr. John Cush @RheumNow( View Tweet )
Aug 15, 2022
Intensity and longevity of SARS-CoV-2 vaccination response in patients with immune-mediated inflammatory disease: a prospective cohort study https://t.co/1fiNgBQUbr looks like lower ab response and drops over 6 mths - boosters important in our patients

Peter Nash @drpnash( View Tweet )

Aug 15, 2022
NEJM - Lupus Pernio in Sarcoidosis - 71 yoM w/ red nodules on his nose, ears, fingers, and toes. The lungs were clear on auscultation. Angiotensin-converting enzyme level of 102. https://t.co/Vy9XQlRVKl https://t.co/wlyx3D9FzC
Dr. John Cush @RheumNow( View Tweet )
Aug 14, 2022
Utility of Repeat ENA Antibody Testing Repeat serologic testing is not uncommon, but is it warranted? A retrospective study shows that repeated testing for autoantibodies to extractable nuclear antigens rarely changes the result or adds a new diagnosis.https://t.co/ncXqSMz0Qo https://t.co/FxHKjJsga3
Dr. John Cush @RheumNow( View Tweet )
Aug 14, 2022
Of 38 childhood SLE (12-25yrs) pts, 65% were non-adherent to meds. Those taking MMF, 33% had MPA drug level < 1 (nonadherent). 17% non-adherent by pharmacy refills rate. 46% pts c/o side effects; 33% remembering & 25% could not afford. https://t.co/vL6LtYzJWe https://t.co/RAwwg40Lfz
Dr. John Cush @RheumNow( View Tweet )
Aug 12, 2022
NEJM - Lupus Pernio in Sarcoidosis - 71 yoM w/ red nodules on his nose, ears, fingers, and toes. The lungs were clear on auscultation. Angiotensin-converting enzyme level of 102. https://t.co/BUvO9Y0rzs https://t.co/AhK6VMVBlD
Dr. John Cush @RheumNow( View Tweet )
Aug 11, 2022
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Less Organ Damage with Remission in SLE

Aug 10, 2022

A cohort study of SLE patients shows that remission and low disease activity (LDA) are associated with less damage accrual over time.



Patients from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort were serially assessed with different measures of

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Utility of Repeat ENA Antibody Testing

Aug 10, 2022

Repeat serologic testing is not uncommon, but is it warranted? A retrospective study shows that repeated testing for autoantibodies to extractable nuclear antigens (ENA) rarely changes the result or adds a new diagnosis. 



This study from a single, multicentre tertiary health network

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Do not take antacids or PPI with mycophenolate. Magnesium & aluminium hydroxide antacids (Maalox) will lower MMF Cmax 33% & AUC 17% if given simultaneously. PPI also lowers AUC by ~33% https://t.co/IoWISgL3SY https://t.co/JV1Yv5Pg9d https://t.co/b8UoQ4zMUV https://t.co/VwNgVQ5End
Dr. John Cush @RheumNow( View Tweet )
Aug 08, 2022
Plasmacytoid Dendritic Cell Inhibitor in Cutaneous Lupus Litifilimab, a humanized monoclonal antibody against BDCA2, targets the BDCA2 receptor on plasmacytoid dendritic cells. https://t.co/nmadPUhlyH https://t.co/4UbNPMtxIh
Dr. John Cush @RheumNow( View Tweet )
Aug 07, 2022
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The Great Unknowns (8.5.2022)

Aug 05, 2022

Dr. Jack Cush reviews the news, FDA approvals, journal articles from the past week on RheumNow; plus viewer questions. This week great hopes for vitamin D, the great unknows of CSA and the great big mess that is the gout.




  1. 521 clinically suspect arthralgia (CSA) pts were

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ACR guidance

ACR Updated Guideline on Vaccinations for Rheumatic Patients

Aug 04, 2022

The ACR has posted a new ACR Clinical Practice Guideline Summary providing recommendations on the use of vaccinations for children and adults with rheumatic and musculoskeletal diseases (RMDs).



This guideline builds on past

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DLE discoid lupus

Plasmacytoid Dendritic Cell Inhibitor in Cutaneous Lupus

Aug 01, 2022

Litifilimab, a humanized monoclonal antibody against BDCA2, targets the BDCA2 receptor on plasmacytoid dendritic cells. When administered to patients with cutaneous lupus erythematosus (CLE) was shown reducing disease activity in CLE patients.

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Belimumab (Benlysta) has been FDA approved for use in pediatric patients with active lupus nephritis who are receiving standard lupus therapy. The approval in kids is for the IV formulation only; SC belimumab is for SLE and LN in adults https://t.co/TKyNDwIUQH https://t.co/6VaMOMfwYi
Dr. John Cush @RheumNow( View Tweet )
Jul 31, 2022
Japanese SLE registry looked at infection risk with Prednisolone (PSL). Among 509 SLE pts (47 yrs); 77% used immunosuppressants & 52 had hospitalized infxns. Signif higher SIE w/ PSL 5.0–7.5 mg (aHR 6.8) & PSL 7.6-15 mg (aHR 7.6) vs 0-2.5 mg/d https://t.co/xZ5Yx4X1uw https://t.co/FSfsTENeUx
Dr. John Cush @RheumNow( View Tweet )
Jul 29, 2022
Study of 245 active SLE pts followed x 2 yrs shows low disease activity (LLDAS) achieved in 63%. By multivariate analysis, negative predictors of LLDAS were nephritis, heme involvement & low C3/C4. Early LLDAS predicted future LLDAS-50 https://t.co/IQaDFRtrZy https://t.co/G6MdBOMftX
Dr. John Cush @RheumNow( View Tweet )
Jul 29, 2022
Belimumab (Benlysta) has been FDA approved for use in pediatric patients with active lupus nephritis who are receiving standard lupus therapy. The approval in kids is for the IV formulation only; SC belimumab is for SLE and LN in adults https://t.co/LCUFDpZM6j https://t.co/R2kA2DbxKy
Dr. John Cush @RheumNow( View Tweet )
Jul 28, 2022
Lungs ILD

Approach to ILD in Myositis Syndromes

Jul 28, 2022

Mehta et al have published a full read review of managing interstitial lung disease (ILD) in patients with inflammatory myopathies, a heterogeneous group of syndromes connected by ILD and and increased morbidity and mortality risk.



They divide myositis-ILD into three main prognostic

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Fever,temp,man,HA,thermometer

Rheumatic Causes for Fever of Unknown Origin

Jul 27, 2022

Fever of unknown origin (FUO) represents a diagnostic challenge to many physicians and while cancer and infectious causes need to be excluded, rheumatic disorders are amongst the most common causes of FUO.



A recent metanalysisi of the medical literature from 2002 to 2021, included

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Have you checked out our new sister-site, Still's Now? A new site for Still's disease, autoinflammatory & febrile disorders.https://t.co/oWEugnOB6k https://t.co/5jwiP2Xqrz
Dr. John Cush @RheumNow( View Tweet )
Jul 26, 2022
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Nintedinib’s Durable Efficacy in Systemic Sclerosis

MedPage Today
Jul 26, 2022

Patients with interstitial lung disease (ILD) related to systemic sclerosis continued to see less progression when treated with nintedanib (Ofev) in the pivotal 100-week SENSCIS trial, researchers said.



Among participants who remained on the drug until the protocol had them stop,

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mitochondrial,DNA

Mitochondria as Master Regulators of Inflammation

Jul 25, 2022

Mitochondrial constituents and metabolic products may give rise to immune activation; this is especially true for mitochondrial DNA, which can function as damage-associated molecular patterns (DAMPs) leading to inflammasome activation.



DAMPs and pathogen-associated molecular patterns

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11.5% of Crohns pts have TNFi use contraindications (either MS, CHF, neoplasia, infx risk, TNFi AE, comorbidities, SLE. Alternatively GI survey respondents use ustekinumab (76%), vedolizumab (249%), or tofacitinib (0.5%) https://t.co/6ApUz93iS0 https://t.co/PTmnsTd2Wh
Dr. John Cush @RheumNow( View Tweet )
Jul 25, 2022
213 #SLE pts were screened for Cryoglobulinemia (2013 -2017); CG is frequent in SLE (66%), but mostly asymptomatic. Mean levels 40mg/L (0-228). Cryo Vasculitis in 15% w/ purpura, ulcers, digit ischemia, arthritis, GN (5%) or CNS (19%) https://t.co/jRVXCj4MlV https://t.co/gamOOwkJ5R
Dr. John Cush @RheumNow( View Tweet )
Jul 25, 2022
Leflunomide versus azathioprine in lupus nephritis? Study of 215 bx proven LN given either LEF or AZA - Renal flares were equal (15.7% v 17.8%), as was time to flare (16 mo vs AZA 14 mo); 24-hr proteinuria, creatinine, C3 and C4 improved similarly. https://t.co/2TWmweS2wy https://t.co/0YzlU4vfXP
Dr. John Cush @RheumNow( View Tweet )
Jul 23, 2022
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