Panacea of Prednisone & Cannabis (5.16.2025)
Dr. Jack Cush reviews the news, journal and regulatory reports from this week on RheumNow.com. Interesting trends and results with prednisone in lupus, cannabis in RA and opioid deaths too!
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Lupus in an empty house
The full house immunofluorescence pattern is the classic histopathologic finding of lupus and lupus nephritis. Glomerular deposits staining for IgG, IgA, IgM, C3 and C1q can help confirm a suspected diagnosis of systemic lupus erythematosus (SLE). This https://t.co/Zcywc5r9q9
Dr. John Cush @RheumNow( View Tweet )
IL2 low dose in #SLE
seems to + alter immune regulation
Multiple targets to explore in #lupus
Unravelling pathophysiology in SLE
CD40L
TLR7,8
#rapamycin type drugs
CAR-T w novel CARS
Etc
#LUPUS2025
@RheumNow https://t.co/jeycgg4ZhT
Links:
Janet Pope @Janetbirdope( View Tweet )
We are not (yet) in #SLE
Getting
👇
Correct drug
In right pt
At right time
At correct individual dose
Even more problematic is in a renal bx - 2 glomeruli beside each other have v different cytokine expressions
Unravelling #LUPUS2025
@RheumNow https://t.co/yGBvhFkPKY
Links:
Janet Pope @Janetbirdope( View Tweet )
Here’s who flares in #SLE
least to most
Persistently neg antiDNA
Persistently + antiDNA
conversion of neg to + antiDNA
So are we over ordering antibodies in 1st 2 groups 🤷♀️
Unravelling #LUPUS2025
@RheumNow https://t.co/1Feau7f199
Janet Pope @Janetbirdope( View Tweet )
Who with +ANA will become #SLE
Mostly similar cytokine signature
But ⬆️IFN and
more innate immune changes
👇
In those who developed #lupus
? prediction & Prevention model in +#ANA people 🤷♀️
yr in review E Vital’s paper
#LUPUS2025 @RheumNow @ZahiTouma https://t.co/khpqRlH8Nk
Janet Pope @Janetbirdope( View Tweet )
Is Lupus Just a B Cell Disorder?
https://t.co/0kwxE6KLeI https://t.co/pORHkg9HY6
Dr. John Cush @RheumNow( View Tweet )
CAR-T and cellular depletion therapies gone wild! Currently there are over 85 different therapeutic candidates aiming to reset the immune system in >380 clinical trials. Review article looks at indications, targets, modalities & outlook. https://t.co/yleR4B48IY https://t.co/WwSPzIPomk
Dr. John Cush @RheumNow( View Tweet )
Lupus in an empty house
The full house immunofluorescence pattern is the classic histopathologic finding of lupus and lupus nephritis. Glomerular deposits staining for IgG, IgA, IgM, C3 and C1q can help confirm a suspected diagnosis of systemic lupus erythematosus (SLE). This https://t.co/DQWwRJmdqM
Dr. John Cush @RheumNow( View Tweet )
Smoking & Autoantibodies in Rheumatoid Arthritis
Investigators from the Netherlands have published their findings that smoking is a risk factor in rheumatoid arthritis (RA), led by the induction of local autoimmune responses at mucosal sites (in the lungs) and exemplified by https://t.co/SQa3PrRnOI
Dr. John Cush @RheumNow( View Tweet )
Deep remission in SLE – what is it, and can we achieve it?
Recent reports on lupus patients treated with CAR-T cells targeting CD19+ B lymphocytes have sparked excitement. This is due to the patients experiencing ongoing clinical remission without further treatment after two https://t.co/rdBkIhfWWd
Dr. John Cush @RheumNow( View Tweet )
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
Dr. John Cush @RheumNow( View Tweet )
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/JI7iGvw8xp
Dr. John Cush @RheumNow( View Tweet )
Soluble CD13 (sCD13) has pro-inflammatory effects & is elevated in severe COVID-19. sCD13 is chemotactic, angiogenic, & arthritogenic. In COVID-19, sCD13 was assoc w/ sCD13 severity, ethnicity, inflammation markers, NETosis, & vascular injury/thrombosis. https://t.co/2bKY9NtnCD
Dr. John Cush @RheumNow( View Tweet )
Smoking & Autoantibodies in Rheumatoid Arthritis
Investigators from the Netherlands have published their findings that smoking is a risk factor in rheumatoid arthritis (RA), led by the induction of local autoimmune responses at mucosal sites (in the lungs) and exemplified by RA-specific autoantibodies.
RA is characterized by the
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Soluble CD13 (sCD13) has pro-inflammatory effects & is elevated in severe COVID-19. sCD13 is chemotactic, angiogenic, & arthritogenic. In COVID-19, sCD13 was assoc w/ sCD13 severity, ethnicity, inflammation markers, NETosis, & vascular injury/thrombosis. https://t.co/dTT9X49DIt
Dr. John Cush @RheumNow( View Tweet )
Hyperpigmentation in SLE
Young complex SLE patient develops blue-grey/slate colored hyperpigmentation on her arms and legs - From?
Features Dr. Jack Cush
https://t.co/yoKU7rJp8y https://t.co/Kh0tZLJ8SX
Dr. John Cush @RheumNow( View Tweet )
Retrospective study of 131 childhoold SLE pts found lymphopenia (in 53%) significantly correlated w/ higher anti-dsDNA and increased disease activity. (r = −0.63). Lymphopenia assoc w/ more nephritis (72%), HTN (24%), leukopenia (36%) & neuropsychiatric SLE https://t.co/F1NALw86hu
Dr. John Cush @RheumNow( View Tweet )
Full read review of Neuropsychiatric SLE. NPSLE criteria includes 12 central & 7 peripheral findings (psych, cognitive, Sz, CVA/TIA, neuropathy, MS-like). NPSLE AutoAbs are many: Abs against APL, LAC, RP, NMDA, NMO/AQP4, EC, SBSN, UCH-L1, TP1, GAPDH, MAP2, U1RNP https://t.co/HvDX8wSuoB
Dr. John Cush @RheumNow( View Tweet )
US guided lymph node Bx compared 25 controls, 14 ACPA (+) & 45 ACPA (-) RA pts. ACPA+ LN Bx showed upregulated adaptive imm. genes, but ACPA neg LN Bx showed higher innate imm genes - especially w/ higher neutrophil presence & incr CD15 + PMNs irrespective of ACPA status https://t.co/C42QMd2zap
Dr. John Cush @RheumNow( View Tweet )
US guided lymph node Bx compared 25 controls, 14 ACPA (+) & 45 ACPA (-) RA pts. ACPA+ LN Bx showed upregulated adaptive imm. genes, but ACPA neg LN Bx showed higher innate imm genes - especially w/ higher neutrophil presence & incr CD15 + PMNs irrespective of ACPA status https://t.co/h8trTxt5t1
Dr. John Cush @RheumNow( View Tweet )
2024 Management of Familial Mediterranean Fever Recommendations
A EULAR/PReS combined task force has developed recommendations for the management of Familial Mediterranean fever (FMF), the most common monogenic autoinflammatory disease worldwide. These evidence-based recommendations update the 2016 recommendations developed for rheumatologists and other HCPs
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Vitamin D for Prevention of Disease
JAMA has published a clinical guideline on the use of vitamin D to prevent disease in children and adults. Guideline committee experts, included adult and pediatric endocrinology, internal medicine, obstetrics/gynecology, nutrition, and epidemiology) advise that healthy nonpregnant persons
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Post-treatment Lyme Syndrome
EurekAlert!
Symptoms that persist long after Lyme disease is treated are not uncommon — a 2022 study found that 14% of patients who were diagnosed and treated early with antibiotic therapy would still develop Post Treatment Lyme Disease (PTLD). Yet doctors puzzle over the condition’s causes and how to
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