Infection

Article

Mixed Drinks, Mixed Results (10.30.2026)

Jack Cush, MD

Dr. Cush reviews the news and journal reports from this past week on RheumNow. This week on the podcast: hopeful guidelines for PMR; certainty about good & bad beverages in gout; mixed results in Sjogren's; non-lupus drugs saves lupus lives; and big hips sink ships in psoriatic arthritis

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Two crystals in one joint? Cryptococcus risk doubled with JAK inhibitors? And early damage in Sjögren’s linked to a 12–14-fold increase in lymphoma risk? Dr. Jack Cush breaks down the findings behind the numbers in this week's RheumNow roundup: - JAK inhibitors: Cryptococcal https://t.co/4RkznhyoIt
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(about vaccines….) “If you don’t fear the problem you won’t value the solution” -Dr. William Schaeffer
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Cryptococcus is rare, but twice as likely with JAK inhibitors. Retrospective TriNetX analysis of RA pts (>30k/grp) starting JAKi vs TNFi; JAKi vs non-TNFi; & TNFi vs non-TNF. Crypto seen in <0.2% in all groups; but signif higher HR for JAKi (HR 2.2 & 2.15) https://t.co/1J4SjcqF8u
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REVEAL study enrolled 418 early microscopic polyangiitis pts - High baseline (Pre-Rx) neutrophil-to-lymphocyte ratio (NLR > 10) was assoc w/ signif higer Dz activity (BVAS), alveolar hemorrhage, poor renal function, reduced survival & higher infection-related mortality (P = https://t.co/wYBOz00GGB
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REVEAL study enrolled 418 early microscopic polyangiitis pts - High baseline (Pre-Rx) neutrophil-to-lymphocyte ratio (NLR > 10) was assoc w/ signif higer Dz activity (BVAS), alveolar hemorrhage, poor renal function, reduced survival & higher infection-related mortality (P = https://t.co/vXuRwXP9gc
Article

Review of HLA-B27

Jack Cush, MD

HLA-B27 remains the dominant genetic link to spondyloarthritis (SpA) across the age spectrum, but B27 related clinical expression diverges between children and adults. New mechanistic data on autoreactive T cells, HLA-B27 misfolding, and gut-joint trafficking point to new plausible, targetable

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Dutch single center study of ANCA tests (n 5518) betw 2012-2023; 286 (5.2%) were positive: 63% did not have AAV. ANCA+ Non-AAV pts had other CTD, neoplasia, infxn, or used specific drugs. IIF and ELISA 1st test - good negative predictive values. Performing a second test increased https://t.co/0oAhOg10VL
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Korean retrospective study compared NIDDM pts Rx w/ SGLT2 inhibitor (n 552,065) vs sulfonylurea (1,480,092) showed SGLT2 inhibitors were assoc w/ a signif 11% lower risk of incident autoimmune rheumatic disease (HR 0.89). Diff of −6.50 per 100K PYs over median ~9 mos F/U. https://t.co/uTiCjejkjL
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Japanese study of 101 864 children shows fertility treatments (ovulation induction, intrauterine insemination, invitro fertilization) increases the risk of Kawasaki Dz. Incidence rates per 100K PYs - 274 for spont conception vs 391 for assisted conception (adj HR 1.42; https://t.co/Ro0beSXAAq
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Retrospective Medicare comparison 450 paired #PMR cohorts Rx w/ IL-6 inhib or csDMARDs. At 1 yr, IL-6i pts (vs csDMARD) had signif more GC D/C (adj HR 1.28) or minimal GC use (<3mg/d) (aHR 1.28). Hosp. infxn 2X higher in IL-6i (12.2 vs 5.7 per 100 PY) in year 1, but not year 2 https://t.co/G4eIusHDPa
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Retrospective Medicare comparison 450 paired #PMR cohorts Rx w/ IL-6 inhib or csDMARDs. At 1 yr, IL-6i pts (vs csDMARD) had signif more GC D/C (adj HR 1.28) or minimal GC use (<3mg/d) (aHR 1.28). Hosp. infxn 2X higher in IL-6i (12.2 vs 5.7 per 100 PY) in year 1, but not year 2 https://t.co/YgqLjD9nvM
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US TriNetX EHR study of of seropositive RA:  31,932 without ILD; 115 RA-ILD on antifibrotic Rx & 1885 RA-ILD not Rx w/ antifibrotics. MTX was used more in RA w/o ILD (52%) vs RA-ILD (12%) on antifibrotics. RA-ILD was assoc w/ heterogeneous antifibrotic use. https://t.co/eBJBXbnQLN
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CDC warns of an association betw severe CNS arboviral disease, w/ neurologic sequelae in pts receiving anti-CD20 mAbs (rituximab, ocrelizumab, ofatumumab, obinutuzumab, etc). West Nile virus was the most common arbovirus, but there are others; mortality up to 40%. Most arbovirus https://t.co/7eMoNgWbB4
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