GI/Liver

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Biologics in Pregnancy Patients With Autoimmune Disease

Jack Cush, MD

A large cohort, claims data study shows that among pregnant women receiving biologic therapies for autoimmune conditions, 72% continued their biologics pregnancy, more so among inflammatory bowel disease (IBD) patients than those with rheumatoid arthritis (RA), psoriasis (PsO) or psoriatic

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Single center study of 2741 ANA tests: 65% ANA negative, 31% ANA+ w/ nuclear staining patterns, & 2.0% ANA+ w cytoplasmic staining. Cytoplasmic - most were reticular, dense fine speckled next. Reticular assoc w/ primary biliary cholangitis (w/ Abs against M2). Dense fine https://t.co/SfBY9BShax
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Vitamin D Headlines (5.9.2025) Dr. Jack Cush reviews the news, journal reports and lupus highlights from the past week on RheumNow. Triple positivity, the gut and CRPS, and hope for better outcomes with Vitamin D therapy. https://t.co/i9OJrYR59T https://t.co/PQ3fAR5teR

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Vitamin D Headlines (5.9.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal reports and lupus highlights from the past week on RheumNow.com. Triple positivity, the gut and CRPS, and hope for better outcomes with Vitamin D therapy. 

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67 systemic sclerosis pts w/ mod-to-severe lower GI Sxs were Rx in phase 2, RDBPCT of placebo or fecal transplants at wks 0 and 2, with no signif change in GI sxs by week 12 (bloating or diarrhoea). https://t.co/vWq2c8d4Kn https://t.co/PpPsAQbj5M

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67 systemic sclerosis pts w/ mod-to-severe lower GI Sxs were Rx in phase 2, RDBPCT of placebo or fecal transplants at wks 0 and 2, with no signif change in GI sxs by week 12 (bloating or diarrhoea). https://t.co/vWq2c8d4Kn https://t.co/EZGgVYpxAl

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Pairwise Network Metanalysis suggests that JAKi use may NOT be assoc w/ Gastrointestinal perforation (GIP), as suggested by the PI. 23 RCTs, (20,023 pts) followed for 24 wks. Incidence of JAKi GIP=0.19%. compared to csDMARDs this was not signif increased (RR 1.02; CI: 0.41-2.56). https://t.co/lLD9Tj6a9F
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Rheumatology: Believe It or Not (4/25/2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Should we believe the reviews and metanalyses?

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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/uAfInA5MAq https://t.co/3AjMRQnmts

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Anti-muscarinic 3 Abs are assoc w/ severe GI Dz in systemic Sclerosis. 132 SSc pts (enrich for GI Sxs) - 39% had anti-M3R Abs; 25% high-titer M3R+. Hi titer M3R+ pts had more diffuse Dz (44% vs 23%), GI severity (91% vs 70%), RNPC3+ (18% vs 6%), U1RNP+(21 vs 2%) https://t.co/j8ZWFY4fgx
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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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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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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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morbidity,covid,heart,lung,brain

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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ERA, APPs, & Alpha GAL (3.21.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.  Listen in for 2 new case questions - Ask Cush Anything.

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The FDA has approved guselkumab(Tremfya) for both subcutaneous (SC) and intravenous (IV) induction therapy treatment of adults with moderately to severely active Crohn’s disease (CD). It is the only IL-23 inhbitor available for SC and IV use in CD https://t.co/ekXRVOwNnS https://t.co/6zveRR5WjD

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Alpha-gal syndrome (AGS) is a (Lone Star) tick-borne allergy to the galactose-α-1,3-galactose carbohydrate, found in mammalian meat/products; Sxs (hives, itching, swelling, and GI issues) present 2-8 hrs after meat & be life-threatening. Time to Dx has dropped considerably, w/… https://t.co/p1M9Qaf1jz https://t.co/jTJzq7YtVJ
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A Case of IgA Vasculitis Presenting as Duodenal Perforation Presentation by Dr. Audrey Liu, at the Rheumatology Winter Clinical Symposia - Feb 2025 https://t.co/kZWgy1S0Wh https://t.co/9mJAzVRVpl

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syringe, pill, DMARD, Treatment, therapy

Are Combination Biologics Safe?

Jack Cush, MD

Although package inserts commonly warn against combining the use of biologic or targeted therapies, there is growing interest in such combination therapy for patients with problematic immune-mediated inflammatory diseases (IMID).
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Crohn’s Microbiome may Predispose to Axial Spondyloarthritis Researchers at Weill Cornell Medicine found that people with Crohn’s disease and related joint inflammation have distinct gut bacteria, with Mediterraneibacter gnavus as a potential biomarker. https://t.co/SI03wAJ3UU https://t.co/dlt3VxBDLw

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Crohn’s Microbiome may Predispose to Axial Spondyloarthritis

EurekAlert!

People with Crohn’s disease and related joint inflammation linked to immune system dysfunction have distinct gut bacteria or microbiota, with the bacterium Mediterraneibacter gnavus being a potential biomarker, according to new study by Weill Cornell Medicine researchers.

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From Bellyache to Bloodstorm - a Mesenteric Sclerosis case with Macrophage Activation Syndrome Presentation by Dr. Anjali Nidhaan at the Rheumatology Winter Clinical Symposia - Feb 2025 https://t.co/pXwav5f2BI https://t.co/0Faao7zhbV

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UK MRCP exam makeup: Cardio 15% Pharm 15% Resp 10% GI 10% Neuro 10% ID 8% Endo 8% RHEUM 6% Heme 5% Renal 5% Derm 4% Eye 2% Psych 2% https://t.co/WG7X3B8a0Y https://t.co/9VF5LkLJjs

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Do infections lead to Kawasaki Dz (KD)? Swedish registry study of 1774 KD vs 17 731 controls. +Hx of Infx incr risk of KD (OR 2.3; 2.0 to 2.5) - mostly Resp, skin, GU & GI Infx. Infxns usually clustered before KD Dx (OR 5.1 15–28d; OR 1.3 6-12 mos prior KD. More infx = more KD… https://t.co/V9zbcmJdKv https://t.co/Evl3rtCxUO
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Recent Blogs

Best of 2022: The Contribution of the Gut Microbiome and Diet to Joint Inflammation in PsA

Christopher Ritchlin, MD, MPH
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Interactions of the gut microbiota in humans promote the release of a variety of metabolites with profound effects on human health and immune regulation. Read Post

Best of 2022: Methotrexate in PsA

Philip Mease, MD
Methotrexate
Until the publication of the SEAM trial, evidence in the medical literature for the efficacy of the most commonly used drug for psoriatic arthritis worldwide, methotrexate, has been lukewarm at best. Yet we all employ it commonly, either as monotherapy or in combination with biologic or targeted synthetic DMARD treatment. It is inexpensive and widely available, and only modestly toxic. Read Post
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