Cardio/Pulmonary

2025

The 2025 Rheumatology Year in Review

Jack Cush, MD

The year 2025 presented numerous advances in rheumatology and related inflammatory and autoimmune disorders ranging from several new groundbreaking FDA approvals/indications, drug developments, game-changing guidelines and practices that will impact patient care for rheumatic diseases.

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Diffuse Alveolar Hemorrhage in Rheumatic Disease A retrospective, cross-sectional, single-center study of adult rheumatic disease patients with diffuse alveolar hemorrhage (DAH), demonstrates a high proportion have coexistent pulmonary infection and significant mortality risk. https://t.co/vpzF8Dnspr
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Systematic review of cardiovascular death in systemic immune-mediated Dz (SIDs): 39 studies, 171,748 pts - SIDs assoc w/ signif. higher CV mortality (HR 1.26; 1.09-1.47; p = 0.002), especially for RA, SLE, GPA & females. 92% of CV deaths from acute coronary syndrome (ACS) https://t.co/ogLhqKMwON
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Retrospective single center --103 EGPA pts finds 36 (35%) w/ cardiac involvement, having cardiac Sxs & biomarkers. Most common: pericarditis (77%), cardiomyopathy w/ CHF (55%), myocarditis (36%), cardiogenic shock (14%), cardiac arrest (6%), coronary v.asospasm (8%) https://t.co/JNdVNlVWvA
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alveolar hemorrhage acute

Diffuse Alveolar Hemorrhage in Rheumatic Disease

Jack Cush, MD

A retrospective, cross-sectional, single-center study of adult rheumatic disease patients with diffuse alveolar hemorrhage (DAH), demonstrates a high proportion have coexistent pulmonary infection and significant mortality risk. 

DAH is an uncommon but

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DANFLU-2 RCT of 332 438 elderly (43 881 w/ diabetes) tested high (HD-IIV) vs standard dose SD-IIV) flu vaccine. HD-IIV signif. reduced cardioresp., CV, CHF, influenza, hospitalizations vs SD-IIV, irrespective of DM status. Similar results previously seen in a Canadian RA pop. https://t.co/GGZPThoHrs
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Anti-mitochondrial M2 Ab (AMA-M2) in 987 IIM pts-- 55 (6%) were AMA-M2 positive. AMA-M2+ had signif. higher rates of polymyositis (56% vs 23.5%), GGT, alk phos levels, & 3 fold more cardiac involvement (60 vs 13%) (arrhythmias, CHF, pulm HTN (31-56%), but no effect on survival https://t.co/8fQzgRfHr4
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Shortened Leukocyte telomere length (PBL-TL) is assoc w/ systemic sclerosis–ILD. Study of PBL-TL in 244 SSc vs 314 controls, found signif shorter PBL-TL in SSC. Short PBL-TL was assoc w/ ILD & Pulm HTN, more lung related hospitalizations, but not w/ Raynauds, skin or vascular dz

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Anti-mitochondrial M2 Ab (AMA-M2) in 987 IIM pts-- 55 (6%) were AMA-M2 positive. AMA-M2+ had signif. higher rates of polymyositis (56% vs 23.5%), GGT, alk phos levels, & 3 fold more cardiac involvement (60 vs 13%) (arrhythmias, CHF, pulm HTN (31-56%), but no effect on survival https://t.co/WYWeDpiYOh
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Best of 2025: ERS/EULAR guidelines for CTD-related interstitial lung disease The ERS and EULAR have published clinical practice guidelines for the evaluation and management of CTD associated ILD in two simultaneous publications in the European Respiratory Journal and Annals of https://t.co/ceGCQjkmJV
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Definitions for Interstitial Lung Disease: A Consensusfrom the Fleischner Society https://t.co/gEqmkdJLDh https://t.co/Q0TKznTWdV

Links:

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Best of 2025: ERS/EULAR guidelines for CTD-related interstitial lung disease

Jack Cush, MD

The European Respiratory Society (ERS) and European Alliance of Associations for Rheumatology (EULAR) have published clinical practice guidelines for the evaluation and management of connective tissue diseases (CTD) associated interstitial lung disease (ILD) in two simultaneous publications in

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Best of 2025: 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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Best of 2025: Antifibrotics - A New Class of Therapies in Rheumatology? Recent large-scale clinical trials have broadened therapeutic options for SARD-ILD beyond immunosuppressants, offering new hope for patients with these serious conditions. https://t.co/RLlOdEWTOa https://t.co/UI9cdJ5Ovd

Links:

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Intro to ILD (Part I): the essentials 🫁 Definition & basics 🔬 Key pathology patterns 🧑⚕️ Clinical approach 📋 What rheums need to know ⬇️ Download & learn more: https://t.co/Fn76PiGsPl Created by @MithuRheum | via @RheumNow for our Rheum to Breathe: ILD Campaign https://t.co/JpyE3T7Atj

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Nerandomilast FDA Approved for Progressive Pulmonary Fibrosis The FDA has approved nerandomilast (Jascayd), a PDE4b inhibitor, to treat adults with progressive pulmonary fibrosis (PPF). Nerandomilast was approved to treat idiopathic pulmonary fibrosis (IFP) in October 2025. https://t.co/G2SS0qJTfl
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Nerandomilast FDA Approved for Progressive Pulmonary Fibrosis

Jack Cush, MD

The FDA has approved nerandomilast (Jascayd), a PDE4b inhibitor, to treat adults with progressive pulmonary fibrosis (PPF). Nerandomilast was approved to treat idiopathic pulmonary fibrosis (IFP) in October 2025.  

PPF is a a life-threatening, progressive lung condition, leading to

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FDA has approved nerandomilast (Jascayd) for the treatment of progressive pulmonary fibrosis (PPF) in adults, based on the results of the phase 3 FIBRONEER trial. Nerandomilast is PDE4 inhibitor,, in Oct 2026 it was approved for use in diopathic pulmonary fibrosis (IPF) https://t.co/WVrGj7q7hB
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Study of 177 #SSc pts (116 w/ SSc-ILD vs 61 without ILD). SSc-ILD had more dcSSc, Raynaud’s & GI Dz. SSc-ILD predicted by triad of elevated NLR, PT, anti-SCL-70 (AUC of 0.879; sensitivity 82.6%; specificity 85.0%). NLR: neutrophil to lymphocyte ratio; PT: prolonged prothrombin https://t.co/iI6ZnZgJE7
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TriNetX retrospective cohort study of 1402 propensity matched Systemic Sclerosis pts on vs off SGLT2 inhib (2013-2025) & found SGLT2i significantly lowered all-cause mortality (HR 0.54), stroke (HR 0.64), & hospitalizations (HR 0.76), moreso in SSc without Hx of CHF (HR 0.62) https://t.co/CVkRJegei9
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TriNetX retrospective cohort study of 1402 propensity matched Systemic Sclerosis pts on vs off SGLT2 inhib (2013-2025) & found SGLT2i significantly lowered all-cause mortality (HR 0.54), stroke (HR 0.64), & hospitalizations (HR 0.76), moreso in SSc without Hx of CHF (HR 0.62) https://t.co/t6GVrN6zoQ
Dr. John Cush @RheumNow( View Tweet )
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Turkey Tryptophan (11.28.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and reports from this past week on RheumNow.com, including reports on FDA resurrections, FM seasonal worsening, and do you fight switch or swap biologics in PsA TNFi nonresponders?

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Subclinical Cardiac Dysfunction in Gout. ECHO study of 202 hyperuricemic (100 gout vs 102 asympt [asymSUA]) pts. VS. asymSUA, Gout pts had signific more LV Diastolic Dysfunc (31% vs 11%), lower LV ejection Fx (60 vs 65); questioning need for tailored CV monitoring in ^SUA pts https://t.co/gCOKKk7H05
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Study of 2280 dermatomyositis (DM) & polymyositis (PM) pts looked at short term (ST: <3 mos) vs long term (LT) steroid (GC) use. Vs ST, LT GC use assoc w/ higher risks of heart failure (adj OR 1.8), osteoporosis (1.9), all-cause & PM/DM-related admission (3.8) & higher costs https://t.co/Q9xt06yzew
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Chronic pain may dramatically raise your blood pressure

Science Daily

Widespread chronic pain may stealthily drive up blood pressure, partly through its ties to depression and inflammation.

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Recent Blogs

rheumthought

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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