Cardio/Pulmonary

ILD damage fibrosis path

More on Methotrexate and ILD Risk

Jack Cush, MD

To assess the progression of the interstitial lung disease related to Methotrexate (MTX) exposure, and to evaluate the lung involvement in RA non-ILD patients with MTX exposure, a systematic review was performed to assess whether RA patients receiving methotrexate (MTX) are at greater

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Nerandomilast for ILD Dr. Mike Putman reports on abstract 1662 (Efficacy and Safety of Nerandomilast in Patients with Autoimmune Disease-Related Progressive Pulmonary Fibrosis: Subgroup Analysis of the FIBRONEER-ILD trial). #ACR25 https://t.co/J0e4SbVgFE https://t.co/dlOM700yVQ

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Dr. John Cush @RheumNow( View Tweet )
GLP-1 Receptor Agonists: Impacts Beyond Metabolism? Across multiple abstracts, investigators have used a large real-world dataset, the TriNetX network, to explore how GLP-1 receptor agonists (GLP-1RAs) might influence cardiovascular, renal and immune-mediated outcomes in our https://t.co/Xl6M3xSvlq
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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Upadacitinib is a Double Edged Vascular Sword in GCA Dr. David Liew discusses abstracts O751, O738, and O734 presented at #ACR25. https://t.co/eTmVehP2Cd https://t.co/vxehwRWM2D

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Dr. John Cush @RheumNow( View Tweet )
#2662 Using Medicare data to emulate real-world RA-ILD trials, investigators compared RTX vs ABA, TOC, JAKi & TNFi No sig differences in mortality, resp, hospitalisation or lung transplant across groups, suggesting other b/tsDMARDs may be as safe as RTX for RAILD @RheumNow #ACR25

Mrinalini Dey @DrMiniDey( View Tweet )

#2661 In >5000 veterans with RA-ILD, 8 distinct FVC trajectories were identified. >1/2showed a progressive decline (≥0.7%/yr). These progressive patterns predicted higher mortality & respiratory hospitalisations, underscoring major disease heterogeneity. @RheumNow #ACR25

Mrinalini Dey @DrMiniDey( View Tweet )

Inflammation skews lipid levels in RA: the “lipid paradox” Using data from CERTAIN and VARA, inflammation (hsCRP)-adjusted TC & LDL better predicted ASCVD events than standard lipids. Are we missing RA pts who need statins? @RheumNow #ACR25 A#2681

Jiha Lee @JihaRheum( View Tweet )

#2681 Tackling the “lipid paradox” in RA: inflammation-adjusted TC & LDL (using hsCRP correction) improved ASCVD risk prediction and flagged more high-risk patients than standard lipids. A smarter way to guide statin use in RA. @RheumNow #ACR25

Mrinalini Dey @DrMiniDey( View Tweet )

Observational study from VCRC AAV patinet, >70% had pulm involvement at some point As expected, nodules favor GPA (63% vs 12% MPA) & DAH favors MPA (61% vs 31%) More ILD in MPA (11% vs 1%) & more endobronchial in GPA (12% vs 2%) Helpful pearls! @RheumNow #ACR25 Abstr#0721 https://t.co/Iu5MdiTABR

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Mike Putman @EBRheum( View Tweet )
Not all RA meds are equal for the heart. In >10K older adults w/ RA, advanced therapies lowered MACE risk (HR 0.63) vs csDMARDs, while GCs ↑ risk (HR 1.54) and undertreatment ↑ it 13-fold. Control inflammation, protect the heart. @RheumNow #ACR25 Abstract #2642

Jiha Lee @JihaRheum( View Tweet )

Sleep Apnea in Psoriatic Arthritis – A Wake Up Call Fatigue is one of the most disabling symptoms in psoriatic arthritis (PsA), yet its causes are often underexplored. At #ACR25, Abstract #0549, a possible hidden contributor was studied: obstructive sleep apnea (OSA). In a https://t.co/E3cy1Uss73
Dr. John Cush @RheumNow( View Tweet )
Lung Disease in ANCA-associated Vasculitis Dr. Mike Putman discusses abstract 0721, "Pulmonary Manifestations of Granulomatosis with Polyangiitis and Microscopic Polyangiitis", presented at #ACR25. https://t.co/A5uKT4jG1I https://t.co/7E4k7QdiNK

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Dr. John Cush @RheumNow( View Tweet )
Lung Ultrasound in CTD-ILD Prospective cohort 146 pts CTD-ILD 30 preclinical ILD 76 limited ILD 40 extensive ILD Median LUS scores higher if Extensive ILD LUS scores correlation w/ fibrosis severity, DLCO & FCV Agreement between LUS and HRCT severity 0.74 Excellent inter https://t.co/R9zGmCTT8Q

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Aurelie Najm @AurelieRheumo( View Tweet )
#1748 Higher air pollution, esp PM2.5, linked to ⬆️RA disease activity and more flares in >1000 Korean patients. Each rise in PM2.5 significantly boosted DAS28, CDAI & joint counts. Does cleaner air mean calmer joints? @RheumNow #ACR25

Mrinalini Dey @DrMiniDey( View Tweet )

US Electronic Health Record cohort 2000+pts Incidence Heart Failure over 10 yrs 6.8% HF asso w/ Older Male Lower eGFR Hypertensive medication Diabetes TTMTS MTX, TNFi Higher CRP Probably surrogates for High Disease Activity... How do we detect it? Maybe not by using the https://t.co/s9SjEyk3WF

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Aurelie Najm @AurelieRheumo( View Tweet )
#1751 In early RA, higher disease activity, inflammation & older age linked to more ILD changes on machine-learning chest CT. Even subtle QCT abnormalities correlated with reduced lung function pointing to early inflammatory pathways in RA-ILD. @RheumNow #ACR25

Mrinalini Dey @DrMiniDey( View Tweet )

Serrano-Combarro et al. Abatacept in RA-ILD. 343 patients. Progressive ILD in 23%. Similar to the numbers progressing on baricitinib by same group. Previous MTX treatment appears to REDUCE risk (OR 0.45). Disease activity increases risk (OR 1.29). @RheumNow #ACR25 Abstr#2265 https://t.co/0tl0kGgm5p

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Richard Conway @RichardPAConway( View Tweet )
Data from this retrospective cohort study by Alomari et al show that SLE pts on SGLT2is ⬇️rates of PulHPN (OR 0.79) ⬇️all-cause mortality (0.49) ⬇️hospitalizations (OR 0.56) ⬇️LN (OR 0.4) vs non-SGLT2i users(p<0.001) Impt role of SGLT2i as adjunct tx #ACR25 @RheumNow Abs2438 https://t.co/NQJTzQwRCt

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sheila @RHEUMarampa( View Tweet )
#1747 Serious infections ~2× more common in RA-LD, esp RA-ILD. Pulmonary, bacterial, viral & fungal infections all increased, underscoring need for tailored prevention and vaccination. @RheumNow #ACR25 https://t.co/soyzqLk7Vj

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Mrinalini Dey @DrMiniDey( View Tweet )
#1746 In large US RA cohort, elevated GDF-15 & pentraxin-3 levels linked to prevalent RA-ILD; high GDF-15 predicted future ILD risk. Other fibrosis-related mediators from IPF or heart failure were not associated, suggesting RA-ILD has distinct pathogenic pathways @RheumNow #ACR25

Mrinalini Dey @DrMiniDey( View Tweet )

Mulcaire-Jones et al. Changes in PFTs over 1 year in early RA. Improved 31%, worsened 25%. No difference based on baseline disease activity, or MTX use. Those with baseline ILD were MORE likely to improve. ?due to effect of treatment @RheumNow #ACR25 Abstr#2235 https://t.co/bJeLYN9oN7

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Richard Conway @RichardPAConway( View Tweet )
EGPA relapse in MANDARA including OLE Majority of relapses are asthma / sinonasal in nature Of non-airway: - arthralgia/myalgia - sensory peripheral neuropathy @RheumNow #ACR25 Abst1769 https://t.co/cPjjzl4RWS

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Brian Jaros, MD @Dr_Brian_MD( View Tweet )
Serrano-Combarro et al. Baricitinib in RA-ILD. Observational, 42 patients. Progressive ILD in 26%. More frequent in women. @RheumNow #ACR25 Abstr#2229 https://t.co/ZXfgxKoau7

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Richard Conway @RichardPAConway( View Tweet )
Benson et al. Clinical features that predict CV risk in PsA. Median 3.53 year follow up. 56 CV events. 766 patients. Dactylitis emerged as key predictor in adjusted models. @RheumNow #ACR25 Abstr#2317 https://t.co/5O3G7vGYbq

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Richard Conway @RichardPAConway( View Tweet )

Recent Blogs

Overlap Syndrome with ILD

Jack Cush, MD
Cush RheumThought ILD

How would you manage a patient with Overlap (anti-synthetase) syndrome, ILD, polyarthritis and myositis?

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Best of 2023: New ACR RA-ILD Treatment Guidelines – What Were They Smoking!?

Richard Conway, MBBChBAO, PhD
Lungs ILD
Rheumatoid arthritis related interstitial lung disease (RA-ILD) is common, with symptomatic RA-ILD affecting approximately 8% of RA patients. There is a very limited evidence base supporting treatment and therefore the recent release of ACR guidelines is to be welcomed. However, the published guidelines appear discordant with the best available evidence base.  Read Post
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