Autoinflammatory

Stills,continuum

Treating Refractory Still's Disease

Jack Cush, MD

A full read systematic review article examined treatment options for difficult to manage systemic juvenile idiopathic arthritis, or Still’s disease. It classified these refractory disease patients as those with either (1) persistent arthritis, (2) recurrent or difficult-to-treat

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Organ Involvement with Behçet’s A review of patient data from the International AutoInflammatory Disease Alliance (AIDA) Network registry identifying those with mucocutaneous Behçet’s disease (BD) may progres to major organ involvement (MOI)m especially at later stages. https://t.co/jqM4IZuobe
Dr. John Cush @RheumNow( View Tweet )
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Vitamin D and Lupus Outcomes (11.21.2025)

Jack Cush, MD

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

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bechets.jpg

Organ Involvement with Behçet’s

Jack Cush, MD

A review of patient data from the International AutoInflammatory Disease Alliance (AIDA) Network registry identifying those with mucocutaneous Behçet’s disease (BD) may progres to major organ involvement (MOI)m especially at later stages.

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Retrospective review of 113 AOSD pts, median age 45yrs, ferritin 4626 (IQR 1169–14,239). Advanced Rx (IVIG, IL-1, IL-6) required in 15 (13.3%), NOT predicted by ferritin levels, either measured continuously or by quartiles. Ferritin is not a reliable biomarker in AOSD. https://t.co/pHEPeIf9u2
Dr. John Cush @RheumNow( View Tweet )
Robinson et al has published that Epstein-Barr virus infects and reprograms autoreactive B cells to drive the systemic autoimmune response in SLE https://t.co/vjpvILrJOt https://t.co/HepyZrYW5L

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Dr. John Cush @RheumNow( View Tweet )
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IL-1 Inhibition in CPPD

Jack Cush, MD

Controlled clinical trials in patients with calcium Pyrophosphate Deposition Disease (CPPD) are scant. Now a metanalysis provides evidence that anakinra, an interleukin-1 inhibitor, is a promising alternative for patients with acute CPPD flares.

The purpose of this analysis is
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20-40% of Autoimmune hepatitis (AIH) is associated with other autoimmune diseases - lead by autoimmune thyroiditis, type 1 DM, ulcerative colitis, Crohn disease, & celiac (but less so for RA, PBC, SLE, Sjögren syndrome, vitiligo). AIH Dx Abs include ANA, ASMA, LKM1. https://t.co/I3ZPHiRgqZ
Dr. John Cush @RheumNow( View Tweet )
Cush and Kavanaugh

ACR 2025 Rheumatology Round Up

Jack Cush, MD

Drs. Jack Cush & Arthur Kavanaugh, two of rheumatology’s most trusted voices, provide a breakdown of the latest breakthroughs and hottest topics in rheumatology from the 2025 ACR Convergence meeting in Chicago.

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Hospitalization in Stills: Is it "Still" an infection? Dr. Janet Pope discusses abstract 0163, "Trends in hospitalization and outcomes among patients admitted with Adult-onset Still’s disease in the United States: INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE (2016-2022)," https://t.co/3Z0U9XN3nx
Dr. John Cush @RheumNow( View Tweet )
@CarolineDiorio @ChildrensPhila @RheumNow Indeed, there are a lot of familiar HLH/MAS friends in the post-CAR-T CRS mix... (indeed, rheum friends from many places) @CarolineDiorio @ChildrensPhila in the #ACR25 BCRC pre-meeting @RheumNow https://t.co/OzWu3MV1FA

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David Liew @drdavidliew( View Tweet )
I've always (very) simplistically considered post-CAR-T CRS and HLH/MAS in the same bucket, and there certainly are substantial similarities. It raises the obvious question - can we borrow therapies? @CarolineDiorio @ChildrensPhila in the #ACR25 BCRC pre-meeting @RheumNow https://t.co/2HkHxpl89u

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David Liew @drdavidliew( View Tweet )
What dictates how severe CRS is following CAR-T? (Often the critical question, and will especially be in the autoimmune space, where CAR-T is largely less time-critical) @CarolineDiorio @ChildrensPhila in the #ACR25 BCRC pre-meeting @RheumNow https://t.co/u0w4lx7YVn

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David Liew @drdavidliew( View Tweet )
CAR-T Cell Therapies Show Promise for Autoimmune Disease Two pioneering studies presented at #ACR25 spotlight the potential of CAR-T cell therapies to transform treatment for SLE and other autoimmune diseases. These early findings suggest a new frontier in immune modulation and https://t.co/KdNWmVc4Qc
Dr. John Cush @RheumNow( View Tweet )
kids w 👇 Undifferentiated #systemic #autoinflammatory #disease Rx #IL1i N=33 =boys &girls 3.5 yrs Sx Abst#2151 #ACR25 @ACRheum @RheumNow There are many periodic fever syndromes 🤔some mutations are not yet discovered Access to &use of Anakinra canukinumab Rilonacept https://t.co/IyTx0nFxKC

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Janet Pope @Janetbirdope( View Tweet )
The next VEXAS, but also maybe we can treat it? IDH1/2 Another clonal hematopoesis known to cause heme malignancy, but also some inflamm sequelae (autoinflamm-like e.g. PMR/GCA) & you can directly inhibit it Wow. We will hear more #ACR25 LB21 @RheumNow https://t.co/WL2ai5zb8Q https://t.co/Yi31xkhLO9

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David Liew @drdavidliew( View Tweet )
#ACR25 Abstr#LB21 Are they novel somatic variants beyond #VEXAS in driving inflammation in undiagnosed SAID?Unbiased enrichment analysis in 265 UBA1-negative adults identified IDH1/2 hotspot mutations. Cd be used to screen esp those with cytopenia. Sorry pix not allowed @RheumNow

Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )

The Power of Gamma Delta T Cell for Autoimmunity https://t.co/wIMu5r7b3D More on T Cell engagers , this time with gama delta T cell ( tiny but mighty ). Kate Roslin talks about advantages of this protocol. (No cytokines thus less toxicity). @Yuz6Yusof @RheumNow #ACR25

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Nouf Al hemmadi @NoufAhmedAlham2( View Tweet )

How does DADA2 present? Ten studies provided data on a total 225 patients 1) skin findings 2) fever 3) stroke 4) cytopenias @RheumNow #ACR25 Abst 1615 https://t.co/xZuTk6YFdJ

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Brian Jaros, MD @Dr_Brian_MD( View Tweet )
When MAS is suspected. Soluble IL2 receptor alpha and CXCL9 may be useful (however t cell lymphomas and viral infections like hepatitis may also have them) #ACR25 @RheumNow Key takeaways below https://t.co/wJv1dvwU88

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Bella Mehta @bella_mehta( View Tweet )
Soluble IL2 receptors help assess macrophages behavior. Ferritin also asses the same in Macrophage activation syndrome. ADA2 is the newer biomarker for hemophagocytic syndromes. #ACR25 @RheumNow Interferon gamma also a newer important target in MAS https://t.co/7sWwninBTM

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Bella Mehta @bella_mehta( View Tweet )
Simultaneous measurements if S100, Ferritin and IL-18 increase diagnostic utility of these biomarkers in Stills disease. @RheumNow #Acr25 https://t.co/3wmijNcpVY

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Bella Mehta @bella_mehta( View Tweet )
Low percentage of glycosylated Ferritin was more specific for Stills disease but not used frequently in clinical practice. @RheumNow #ACR25 https://t.co/wTK1eIcSKX

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Bella Mehta @bella_mehta( View Tweet )
Biomarkers in Stills disease and MAS. #ACR25 @RheumNow IL 6 may not be helpful compared to CRP, and IL 1 beta is difficult to measure IL-18 seems to be the best one. https://t.co/u3oBTd4eaP

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Bella Mehta @bella_mehta( View Tweet )
IL- 18 go together sometimes with glycolytic enzymes such as aldolase Also MAS may not be a switch on and off mechanism. Lastly MAS with Stills may have increased IL18 levels but not in other disease like SLE #ACR25 @RheumNow https://t.co/BW1fD7usBT

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Bella Mehta @bella_mehta( View Tweet )

Recent Blogs

Best of 2022: Five Mistakes When Diagnosing Still’s Disease

Jack Cush, MD
Thermometer
Adult-onset Still's presents an interesting and diagnostic challenge when encountered. Here are 5 tips to improve your diagnostic acumen for this febrile disorder. Read Post

Best of 2022: Myths & Misconceptions with Febrile Disorders

Rachel Tate, DO
Myth vs reality
Still’s disease and autoinflammatory disorders are rare conditions unified by recurrent fevers and inflammation of skin, joints, and other organs. While labs often support the diagnosis, these conditions are best diagnosed by genetic testing, or by specific criteria (in the absence of a genetic test). The following is a table that lists common misconceptions (myths) and their clarifying explanations. Read Post
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