Cardio/Pulmonary

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Keys to Mastery (5.2.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, articles and drug approvals from the past week on RheumNow.com. This podcast marks the beginning of our Lupus Campaign called "Lupus Unlocked: Keys to Mastery". This month's campaign on Lupus is sponsored by Aurinia.

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Study of 104 RA-ILD pts found that (31.7%) RA-ILD patients were ANCA positive (29/31 were p-ANCA+). compared to ANCA neg, ANCA+ RA-ILD had more respiratory Sxs, ANA positivity, worse PFTs, more acute exacerbations of ILD, more bronchietasis & honeycombing https://t.co/vZODUW9tSX https://t.co/zTrdtcc78O

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Study of 104 RA-ILD pts found that (31.7%) RA-ILD patients were ANCA positive (29/31 were p-ANCA+). compared to ANCA neg, ANCA+ RA-ILD had more respiratory Sxs, ANA positivity, worse PFTs, more acute exacerbations of ILD, more bronchietasis & honeycombing https://t.co/vZODUW9tSX https://t.co/6WUbSoOyOm

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2001–2015 Danish national health registry study of 1.8 million adults, including 290,781 w/ knee or hip #OA & 1.5 million age-, sex-, education-matched controls. Women w/ knee or hip OA had 44% higher risk of CV Dz (HR 1.44), while men w/ HOA/KOA lesser incr (HR 1.24) CV risk https://t.co/C3ZHZiM38T
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2001–2015 Danish national health registry study of 1.8 million adults, including 290,781 w/ knee or hip #OA & 1.5 million age-, sex-, education-matched controls. Women w/ knee or hip OA had 44% higher risk of CV Dz (HR 1.44), while men w/ HOA/KOA lesser incr (HR 1.24) CV risk https://t.co/P9V7m9rqAa
Dr. John Cush @RheumNow( View Tweet )
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Osteoarthritis Risky Business (4.18.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and Journal reports from this week on RheumNow.com.  Osteoarthritis patients have unique risks and synovial fluid WBC numbers can tell you when to worry about septic arthritis in gout and pseudogout patients.

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In a murine model of Kawasaki Dz vasculitis- depleting gut microbiota reduces KD like vasculitis. CV lesions were assoc w/ decrease in Akkermansia muciniphila and Faecalibacterium prausnitzii. Replacement attenuated these findings. https://t.co/Hnij8TWkYy https://t.co/wEuVcuAZ5j

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Is High Dose Aspirin Needed in Kawasaki Disease?

Jack Cush, MD

Does aspirin add any advantage to intravenous immunoglobulin (IVIG) alone in children with Kawasaki disease (KD)? A randomized clinical trial IVIG alone was not inferior to IVIG plus aspirin, suggesting that high-dose aspirin during initial IVIG treatment did not reduce coronary artery

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EMR Messaging Woes (4.11.2025)

Jack Cush, MD

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

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KORAIL (Korean RA-ILD) prospective cohort study of CT and biomarkers showed 35% ILD progressed over 3 yrs. Higher baseline KL-6 (HR 1.37) & hSP-D (1.51) levels assoc w/ progression. Increasing KL-6 at 1 yr showed the greatest progression (∆KL-6: HR 2.0) https://t.co/efowyCp1qu https://t.co/JVd7sRKzVF

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Korean insurance claims study (2008–2021) 183,212 psoriasis & PsA pts, found Biologic Rx assoc w/ lower risk of new-onset & recurrent MACEs vs phototherapy (adj HR, 0.45 & 0.34). Nonbiologic systemic Rx lowered MACE risk (v photoRx) only in pts w/ prior Hx MACE (0.79) https://t.co/08wNm1AbpC
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Danish registry study of 1431 AAV pts ((median age: 69 yrs, 52M; F/U 4.8 yrs) shows AAV had more LVH (17% vs 12%), ST-T (10% vs 7%), aFib (9.6% vs 7.5%), QTc prolong (6% vs 3.6%). Only AAV w/ major ECG abnls had incr risk of CV mortality [HR 1.99; 1.49-2.65) https://t.co/OB8b9pC6kw
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JAK-pot Collaboration of 15 registries looked at MACE risk in RA pts and found NO incr CV risk during 1st 2 yrs of JAKi (vs TNFi) use. 51233 pts; 828 incident MACE; in 73008 Rx courses (16K JAKi, 35K TNFi, & 21K OMA bDMARDs). JAK adj IRR: 0.89;0.63 to 1.25 (vs TNFi); bDMARD-OMA https://t.co/MAZrGfCNrU
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Matched cohort study of 83,811 #RA pts showed RA had a 12% increased risk of avoidable hospitalizations (CHF, pulmonary edema; (IRR 1.12). Predictors of ACSC hosp. were age, Steroids, ambulatory comorbid Dxs. ambulatory care access & ^ primary care may reduce this risk. https://t.co/AxQVoXoxxx
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An Epidural Letdown (4.4.2025)

Jack Cush, MD

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

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Cardiac-MSK Patients at Highest Risk for Falls and Death A study by Peking University and Chinese PLA General Hospital found that multimorbidity, having multiple chronic diseases, is linked to worsening falls and higher mortality in middle-aged and older adults in China. https://t.co/R47w77zSwP
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Korea National Health Insurance Database review shows that risk of mortality in Behcets patients is 28% higher than gen. population; highest in 1st 12 mos (OR 2.66). Major causes were CA, CVD, GI (viscus rupture), respiratory, & infections. Higher in younger pts. https://t.co/vWJrUN9C0H
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Cancer Survival with TNF Inhibitors (3.28.2025)

Jack Cush, MD

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

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Cardiac-MSK Patients at Highest Risk for Falls and Death

EurekAlert!

A new study by researchers at Peking University and the Chinese PLA General Hospital has found that multimorbidity—living with multiple chronic diseases—is closely associated with worsening fall conditions and mortality among middle-aged and older adults in China. The findings,

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Predicting Premature Death with Multimorbidity

Jack Cush, MD

Machine learning (ML) models were used to predict premature death in inflammatory bowel disease (IBD) patients with multimorbidity, the co-occurrence of 2 or more chronic conditions. 

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Veterans Admin (VA) EHR study of #RA-associated ILD (n 1047), matched 237 RA-ILD pts who Rx w/ TNFi vs 237 Rx w/ non-TNF biologics (mean age 68y; 92% male). Death & Resp hospitalisation were similar (adj HR 1·21, 1·27), as was mortality (1·15), Resp mortality (1·38) https://t.co/03LV5B4FSV
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Targeting Obesity in Rheumatic Disease Patients

Jack Cush, MD

Sattar et al. has published an informative overview of the effect of obesity on rheumatic and musculoskeletal diseases (RMDs). They estimate that nearly 70% of RMD patients are overweight or obese.

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Increased Mortality In Arthritis Patients with COPD A new study published in the January 2025 issue of Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, a peer-reviewed, open-access journal, finds that people with chronic obstructive pulmonary disease… https://t.co/6WCtfcrSaq https://t.co/ydVtBxqy37
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Retrospective review of 781#RA pts; 78 Dx w/ILD (77 subclinical, most UIP on HRCT). w/ mean 10 yrs F/U, death rate was 1.5 vs. 7.1 per 100PY (without v with ILD) SMR equal betw RA & gen pop. but 2x higher in RA w/ ILD. Mortality higher w/ ILD (HR~3), age and low BMI… https://t.co/Vj0acewmK8 https://t.co/N1wHTjMfTr
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Still's Dz Afro-Caribbean study of 58 pts (57% AOSD). Sex differed betw kids F 36% vs F71% in adults. Kids had signif more typical skin rashes (100 vs 29%), coronary artery dilation (16 vs 0%), & MAS (52 vs 9%). Adults signif more polyarthalgia (91 vs 32%) & lung dz (51 vs 4%).… https://t.co/AYKNazgio5 https://t.co/1yQgeMiwku
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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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