Infection

Infections cause high morbidity & mortality in our immunocompromised rheum patients: vaccinations are essential to keep them healthy. Best time to administer vaccines? 1. Before immunosuppression 2 during periods of dz control 3. >1 vaccines need pt input @LCalabreseDO #CCRW25 https://t.co/oBgXlIk1TY

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Covid lung pneumonia corona (keep)

Did Hydroxychloroquine Reduce COVID-19 Mortality?

Jack Cush, MD

A multicenter study investigated the association between hydroxychloroquine (HCQ) dosage and COVID-19 mortality among hospitalized patients from multiple medical centers in China. The analysis focused on dose effects of HCQ on mortality.

This retrospective cohort includes 2,387 COVID-19

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SARD-ILD and serious infection risk: The elephant in the room Interstitial lung disease (ILD) remains one of the largest unmet clinical needs across many systemic autoimmune rheumatic diseases (SARD). ILD is highly prevalent across systemic sclerosis, mixed connective tissue https://t.co/oxIteGfUTd
Dr. John Cush @RheumNow( View Tweet )
CDC 2025–26 Updates to Influenza Vaccination. - Most are trivalent inactivated (IIV3s) or vaccines (RIV3), few live virus(LAIV3) - FDA approved FluMist (LAIV3) for self-administration (ages 2-49) - If <18yrs, Flu vax should thimerosal free 2023/24 Flu vax prevented 7900 deaths, https://t.co/hjLBGKWNDr
Dr. John Cush @RheumNow( View Tweet )
RA-associated interstitial lung disease or bronchiectasis is assoc w/ increased risk of total and cause-specific mortality. retrospective cohort study using the Mass General Brigham Biobank 221 RA-LD cases (151 RA-ILD, 70 RA-BR). RA-LD higher mortality (34 vs 13/1000PY; HR

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When Myositis Hits the Lungs: What Every Rheumatologist Should Know About ILD When idiopathic inflammatory myopathies (IIM) affect the lungs, the consequences can be serious. Interstitial lung disease (ILD) is not only common in IIM, but also one of the leading causes of death, https://t.co/qRoTr3r84x
Dr. John Cush @RheumNow( View Tweet )
Retrospective study of 201 IPAF (Interstitial pneumonia w/ autoimmune feat.) pts w/ F/U 5.6 yrs. ANA+ 80%, RF+ 25%, CCP+ 14%, 88% Rx w/ IS or antifibrotics. 24% died, 7.5% transplant. Comorbidies were common; mean CCI 3.2; IPAF mortality worsened by

Dr. John Cush @RheumNow( View Tweet )

Nitazenes — a class of highly potent synthetic opioids — are rapidly emerging as a major contributor to the overdose crisis; they are over 20 times more potent than fentanyl. Nitazenes are an illegal Schedule I drug that are rapidly spreading in the illicit drug market

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There is no criteria for infection-induced Antiphospholipid syndr (APS). aPL & aCL abs have been reported w/ COVID, HCV, HIV, EBV, varicella-zoster, & CMV. infections may induce transient aPL positivity without over APS, but may precipitate APS or catastrophic APS (CAPS).

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JAK Janus

Equal Safety of JAK Inhibitors and TNF Inhibitors

Jack Cush, MD

JAMA has published a systematic review and meta-analysis of head-to-head studies showing there was no meaningful difference in safety events observed when taking either JAK inhibitor (JAKi) vs TNF antagonist (TNFi) therapies for the treatment of immune-

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yellow box among blue

SARD-ILD and serious infection risk: The elephant in the room

Jeffrey Sparks, MD, MMSc

Interstitial lung disease (ILD) remains one of the largest unmet clinical needs across many systemic autoimmune rheumatic diseases (SARD). Clinicians are already keenly aware of the complexity of patients with SARD-ILD. The “elephant in the room” for all these issues: serious infection.

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QD Clinic: Progressive RA-ILD Management Dr. Richard Conway, a rheumatologist in Dublin, discusses a case about managing progressive rheumatoid arthritis-interstitial lung disease, as part of RheumNow's Rheum to Breathe: ILD campaign, presented throughout the month of September https://t.co/dLCXeXwl7w
Dr. John Cush @RheumNow( View Tweet )
Hyperferritinemia is common in Hyperinflammatory syndromes but is a hallmark of Macrophage activation syndrome and Sepsis; and is a poor prognostic sign too. MAS is excessive activation of T-lymphocytes & macrophages leading to cytokine storm & multi-organ damage. https://t.co/MUKXC0Tw3M
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QD Clinic Video: RA and Bronchiectasis Dr. Jeffrey Sparks, Boston, talks about rheumatoid arthritis and bronchiectasis as part of RheumNow's Rheum to Breathe: ILD campaign, presented throughout the month of September 2025. https://t.co/Y2u3m4rFfj https://t.co/KgrIxXlQo4

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Dr. John Cush @RheumNow( View Tweet )
9 yr. study of anti-Ro52 & ILD pts -- 1,026 pts 15% Ro52+: interstitial pneumonia w/ autoimmune 48%, CTD-ILD 13%, idiopathic pulm fibrosis 10%, hypersens pneumonitis 6%, idiopathic ILD 24%. Ro52+ were younger w/ more autoimmune dz, +MSA Abs, ILD progression, death, & lung https://t.co/fuFfnaYIRd
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3 yr study of FDA Adverse Event Reporting on anifrolumab shows following AEs- URIs, herpes zoster, infusion reactions, and potential new risks like dyspnea and pyrexia, not in the label. https://t.co/vP2YWGT2vR https://t.co/BruGBtXEBu

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📍Smoking, obesity and low Vit D are significant risk factors for Pre-RA. 📍Subdoligranulum arthritogenic strain is a newly described infectious agent implicated in the pathogenesis of pre-RA @RheumNow #ACR25 @rheumarhyme https://t.co/ZzZZlfdKmk

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Lung Cancer in Rheumatoid Arthritis and Interstitial Lung Disease A matched cohort study from the Veterans Health Administration shows that RA patients have a >50% increased risk of lung cancer, a 3-fold higher risk of lung cancer in RA-ILD. https://t.co/Gjn2M2CNAO https://t.co/DPgDQsCWK9

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Dr. John Cush @RheumNow( View Tweet )
RheumNow Podcast square

September to Remember (9.5.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from RheumNow. This week - unemployment, diagnosing Sjogren's and a lot of ILD.

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LTBI risk in rheumatic pts is high (22%). Metanalysis 18 studies, 12,167 rheum pts shows LTBI signif. incr w/ current smoking (OR 1.50), golimumab(OR 2.90), Chloroquine (OR 1.27), age >40 (OR 1.84), prior TB OR 3.26). LTBI not increased w/ RF, ADA, ETN, BCG, Pred, smoking, DM https://t.co/0PayHJqwDn
Dr. John Cush @RheumNow( View Tweet )
Retrospective French Health Data System Immune Checkpt inhibitor (ICI) study. Of 172,363 ICI-Rx adult pts, ICI myotoxicities at 6 months ranged from 0.7% -0.9%. ICI myocarditis & myositis incidence was 0.3%- 0.6%, co-occurring in ∼13–23%. ICI myotoxicity- 1-mo fatality was https://t.co/kOGKM8lC0H
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ILD Begins (8.29.2025) Dr. Jack Cush reviews the news and journal reports from https://t.co/V10S4oVFsv. This week news on vaccines, safety of acetaminophen and more. https://t.co/YlOK3X4hkW https://t.co/9cgcDn0xab

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exterior of CDC offices

ACR Concerns on the Scientific Integrity at the CDC

ACR

On behalf of the American College of Rheumatology (ACR), we express deep concern over recent developments at the Centers for Disease Control and Prevention (CDC) that appear to undermine the agency’s longstanding commitment to science-based public health policy.

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Wait! FDA approved the Chikungunya Virus Vaccine 2 yrs ago, but just pulled the vaccine, Ixchiq, citing serious safety concerns (specifically CBER reports of >20 serious adverse events, including 21 hospitalizations, 3 deaths, w/ 1 fatality directly linked to vaccine-derived https://t.co/aaC38VX7rF
Dr. John Cush @RheumNow( View Tweet )
Recombinant zoster vaccine effective in #SLE without flare. Retrospective Medicare & commercial claims data on pts given 2 RZV doses, matched 1:4 to unVAX. 3592 pts F?u ~1.5 yrs. Vax effectiveness 70% in Medicare; 54% commercial. SLE flare rates HR 0.91& 0.94. https://t.co/WCBOQhb4Ad
Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

A Brief History of Rheumatoid Arthritis Mimics

Robert Schoen, MD, MBA
books history
Imagine that 100 years from now, your great granddaughter, an eminent rheumatologist, reviews the history of rheumatoid arthritis mimics. Read Post

Best of 2022: Freeze Tag

Kathryn H. Dao, M.D.
mask,covid,people,risk
A beloved childhood game I enjoyed was Freeze Tag. Players would run to avoid being tagged by the person who was “It”.  If you were tagged, you had to “freeze” in your spot until someone was brave enough to come un-tag you.  The game ends when everyone is frozen or if people quit. For over 2 years, I have been living in a real-life “Freeze Tag” game and able to dodge COVID19, until now. Sitting in my room symptomatic and frozen in isolation, I ruminated about my patients who had COVID19 and their experiences. I wanted to share with you three stories of three variants. Read Post
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