Infection

Full read review & update on Rhabdomyolysis. 26K cases/Yr in USA. Muscle damage leading to weakness, myalgias, swelling, myoglobinuria, electrolyte probs, AKI. Causes: 1) exogenous toxins (46%); 2) trauma; 3) myopathies/metabolic muscle dz (10%), infxn. AKI in 46%, & death in https://t.co/E2LcLeMls0
Dr. John Cush @RheumNow( View Tweet )
RT @gibson_rheumPAC Given rising resistance, effective first-line regimens and adequate duration (14 days) are critical. PPI-based quadruple regimens remain highly effective when patients can adhere. #RNL26 https://t.co/bxqMbPFegt
Dr. John Cush @RheumNow( View Tweet )
RT @ericdeinMD #RNL26 Prosthetic joint infection vs flare? - PJI risk 50-80% higher in RA (OR 1.47-1.8) - Immunosuppressants, intra-artic injections, RA activity, BMI incr risk - Delay in diagnosis https://t.co/XTozafDQyf
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RT @ericdeinMD #RNL26 Inflammatory arthritis pts getting TKA: - increased risk of RBC transfusion (OR 1.39), infection (1.64) and readmission (1.46) - THA: also risk of mechanical complications (like dislocation) OR 1.3 https://t.co/ovW2C2EuXF
Dr. John Cush @RheumNow( View Tweet )
RT @gibson_rheumPAC Helicobacter pylori Update: H. Pylori remains the most common chronic bacterial infection worldwide, acquired in childhood and lifelong if untreated. Its clinical impact spans far beyond dyspepsia—from ulcers to malignancy. #RNL26 tis

Dr. John Cush @RheumNow( View Tweet )

RT @richardPAconway We have improved RA mortality in many areas but respiratory (mainly ILD) and infectious issues remain stubbornly elevated. #RNL26 https://t.co/ViucOIOOzY https://t.co/3kIqPMeKKX

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Dr. John Cush @RheumNow( View Tweet )
RT @richardPAconway Disease activity is a strong risk factor for RA-ILD. Particularly for moderate/high disease activity but there appears to be a linear relationship (at least above a certain threshold) #RNL26 https://t.co/ot8ttdmu5G
Dr. John Cush @RheumNow( View Tweet )
RT @ericdeinmd RA-ILD #RNL26 Jeff Sparks MTX and ILD - Rare MTX-induced pneumonitis. 7 cases in n=4786 (0.3% cases) vs <0.1 on PBO, rare diff from ILD - No increase in incident ILD - meta-analysis of 7 studies show OR 0.49 https://t.co/k2XeAzBsYB
Dr. John Cush @RheumNow( View Tweet )
RT @richardPAconway UIP is predominant radiologic pattern in RA-ILD. Contrast with our other diseases. But by no means exclusive - up to 50% of RA-ILD have a more inflammatory pattern. Important treatment implications! #RNL26 https://t.co/HmW1mz429i
Dr. John Cush @RheumNow( View Tweet )
RT @ericdeinmd Mucosal Hypothesis RA #RNL26 Demoruelle Mucosal origins of RA? Key sites of immune-environment interaction initiate local inflamm, becomes systemic Link of lung inflamm/immune dysregulation - ass w/ smoking, ILD NETs in lung drive RA path? Gut/oral microbes drive

Dr. John Cush @RheumNow( View Tweet )

Japanese nationwide survey of 1943 RMD pts taking Azathioprine (AZA) 34% had adverse events: hepatobiliary (149%), GI (10%), blood/lymphatic (9%), infections (5%), & skin (2.4%). AEs lead to 71% D/C AZA. Serious AEs (Gr ≥3) higher w/ older (OR 2.5), & SLE (OR 2.3) https://t.co/lVNYVQATfx
Dr. John Cush @RheumNow( View Tweet )
IXCHIQ - a live-attenuated chikungunya virus vaccine: 10-30% have mild-moderate adverse effects, w/ headache, fatigue, & myalgia. <3% have severe AEs. Rare reports of encephalitis in elderly post Ixchiq, due to type I IFN-neutralizing autoantibodies (same w/ yellow-fever Vax) https://t.co/3VlZCd4sGc
Dr. John Cush @RheumNow( View Tweet )
🧬 PAPA Syndrome: When Sterile Inflammation Mimics Infection (Pyogenic Arthritis, Pyoderma gangrenosum, Acne) •A rare monogenic autoinflammatory disease •Caused by gain-of-function mutations in PSTPIP1 🧠 Pathophysiology •Mutant PSTPIP1 → increased interaction with pyrin https://t.co/tJ4INdgfky

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Ravi Kumar @RheumattDoc( View Tweet )
death

Trends in Rheumatoid Arthritis Mortality

Jack Cush, MD

A recent study examines trends in rheumatoid arthritis (RA)-related mortality among U.S. postmenopausal women (aged 55 and older). They found RA mortality rates have declined, yet disparities in who is most affected persist, especially for white women, and those over 85 yrs of age.

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Turkish study of 128 Psoriatics (62 PSO, 66 PsA) found more periodontitis in PsA vs PSO (47% vs 31%; P=.058). Signif. higher levels of Dz activity seen for PSO (CPDAI: OR 1.38; P = .001) & enthesitis (MASES: OR 1.39; P < .001) if periodontitis present in PsA patients. https://t.co/d8OfarFWeG
Dr. John Cush @RheumNow( View Tweet )
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Emergencies, Independence & Hemorrhage (1.23.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and reports from the past two weeks on RheumNow.Com

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French Retrospective study (2011-22) of 36129 adult psoriasis pts on biologics who recv antibiotics (9366/26% @ baseline, 61% during FU). Abx treatment assoc w/ 12% greater risk biologic D/C (HR 1.12); more for multiple Abx courses (HR 1.29; 95% CI, 1.24-1.35) https://t.co/2Jv5xCibyd
Dr. John Cush @RheumNow( View Tweet )
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/K1fLo5iHpd
Dr. John Cush @RheumNow( View Tweet )
Retrospective study of recombinant zoster vaccine Rheumatic (RMD) pts on DMARDs (32% JAKi) (114) vs 65 normals. HZoster reactivation: no controls vs 1in RMD. 1 Dz flare requiried steroids. Minor AE (ISR, HA, myalgia) seen in 17.5% & 21.5% w/ 1st & 2nd dose. RZV is safe in RMD https://t.co/Mu3OyA4EOD
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A 2 yr. old female pt reported w/ a a novel P435S gain-of-function variant in TLR7 (thought pathogenic in SLE) - pt dx w/ juvenile SLE, recurrent infection, and neuroinflammatory features. A review of 12 other TLR7 GOF variants revealed similar SLE associations. https://t.co/NU553QwCtj
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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
Dr. John Cush @RheumNow( View Tweet )
US Overdose Deaths have dropped in 2024 & 2025!. Overdose (opioids, heroin, fentanyl) deaths peaked at ~110,000 in 2022, fell a little in 2023, but plummeted (27%) to 80,000 in 2024. Reported deaths highes in the N. East & Atlantic states. https://t.co/P3mgrOzGhr https://t.co/eGOBhIx7ZB

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Dr. John Cush @RheumNow( View Tweet )
Retrospective study of recombinant zoster vaccine Rheumatic (RMD) pts on DMARDs (32% JAKi) (114) vs 65 normals. HZoster reactivation: no controls vs 1in RMD. 1 Dz flare requiried steroids. Minor AE (ISR, HA, myalgia) seen in 17.5% & 21.5% w/ 1st & 2nd dose. RZV is safe in RMD https://t.co/Hf7HaGOLXd
Dr. John Cush @RheumNow( View Tweet )
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
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.
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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.
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A Guide to Self Care of (Mild) COVID19

Kathryn H. Dao, M.D.
morbidity,covid,heart,lung,brain
There is guidance published on how to manage moderate to severe cases, but very few blueprints detail what to do with “mild” infection.  The first day, I developed congestion and cough, with a sore throat.  As the day progressed, I started to have chills, low grade fevers, and myalgias.  The postnasal drainage was overwhelming, and when I tried to swallow, it felt like swallowing broken glass.  Isolating in my room, I was left to deal with my symptoms.
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