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Infection

Insights on Postinfectious ME/CFS

The medical community is challenged by myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS - its origins, pathogenesis outcomes and treatment.  JAMA has reviewed a recent Nature paper wherein an NIH led team of multidisciplinary experts performed an inpatient study of

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Ides of March (3.15.2024)

Dr. Jack Cush has advice for Caesar and the superstitious, and covers pregnancy, platelets, dialysis and vaccinations in Lupus.





  1. Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory

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MMWR: Vaccination and Multisystem Inflammatory Syndrome in Children

CDC

Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition typically occurring 2–6 weeks after SARS-CoV-2 infection and characterized by fever and multiorgan involvement.  The current MMWR report shows that MIS-C case numbers have decreased by 98% since 2021.

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Depression and RA (3.8.2024)

Dr. Jack Cush reviews the news, journal reports and regulatory approvals from the past week.

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Lyme Disease 2022

The CDC has updated its Lyme disease surveillance report based on a new case definition. Compared to 2017–2019, the number of cases in 2022 rose by 69%.

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Can Mycophenolate be Stopped in Stable SLE?

In patients with clinicall stable systemic lupus erythematosus (SLE) and lupus nephritis, the withdrawal of mycophenolate mofetil was not significantly inferior to mycophenolate maintenance, but MMF withdrawal had numerically more reactivations, while MMF maintenance had more infections.

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COVIDs Extended Risk for Rheumatic Disease

EurekAlert!

Annals of Internal Medicine reports a large, binational study finding SARS-CoV-2 infection was associated with an increased risk for autoimmune inflammatory rheumatic diseases (AIRDs) that extends up to 12 months after

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Sniffles & Arthritis (3.1.2024)

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Are these associations with infection, biomarkers and weather real or imaginary? Linked or luck? Causal or casual?  You decide....





  1. No clear link between weather & MSK symptoms

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Sinusitis Linked to 40% Heightened Risk of Rheumatic Disease

EurekAlert!

The common inflammatory condition sinusitis is linked to a 40% heightened risk of a subsequent diagnosis of rheumatic disease, particularly in the 5 to 10 years preceding the start of symptoms, finds research published in the open access journal RMD Open.

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Immunosuppression Increasing (2.23.2024)

Dr. Jack Cush reviews the news and journal reports from the past 2 weeks on RheumNow.com; but begins with a discussion of what constitutes "immunosuppression" and how it applies to our patients.





  1. 2021 NHIS Survey data suggests the prevalence of immunosuppression in the USA

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PJP prophylaxis in GPA. Always a trade off but these things are not created equal. PJP or sepsis are much worse on average than the AEs @anisha_dua @RheumNow #RNL2024 https://t.co/9sECd7fSRk
Richard Conway @RichardPAConway( View Tweet )
Dr. Winthrop avoid JAKi and TNFi in pts with chronic lung infections like MAI. #RNL2024 @rheumnow https://t.co/TfMa7hktL9
TheDaoIndex @KDAO2011( View Tweet )
For pts on JAKi needing vaccines; to avoid diminishing vaccine efficacy, Dr. Winthrop noted he treats a JAKi like he would MTX in that he holds the JAKi a week after vaccinating. #RNL2024 @rheumnow

TheDaoIndex @KDAO2011( View Tweet )

#RNL2024 @RheumNow Winthrop on Shingrix: Good data at 10 yrs Diminished response in immunocompromised (chemo) Very limited data with autoimmune patients https://t.co/cJitGOWZQt
Eric Dein @ericdeinmd( View Tweet )
The 10 year Shingrix data showing continued humoral responses in "normal" patients, with continued long-term efficacy (drops to only 70+%) suggesting we may need to boost at some point. In our rheumatology patients, the efficacy does drop and needs to be evaluated. Dr. Kevin… https://t.co/eHfjtsPv2O https://t.co/K1i5R3ZScV
Dr. Rachel Tate @uptoTate( View Tweet )

Best Treatments for COVID-Related MIS-C

The RECOVERY trial focused on pediatric MIS-C patients treated with immunomodulators and anti-cytokine therapy demonstrated the benefits of first-line therapy with intravenous methylprednisolone or second-line tocilizumab in children refractory to initial treatment. Neither IV

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Hepatitis B Virus Reactivation is possible w/ immunosuppression- most (>10%) w/ w/ Rituximab & stem cell transplants. If HBsAg positive, pts should recv anti-viral prophylaxis; HBsAg− individuals should be evaluated on a case-by-case basis https://t.co/7JKorgWbYr https://t.co/RdW65u5KDR
Dr. John Cush @RheumNow( View Tweet )

Methotrexate Nodulosis (1.19.2024)

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. How good (or not) are rheumatologists and what to do about MTX nodulosis?





  1. Network meta-analyses of 153 trials & 8713 patients w/ chronic pain from TMJ disorders; Most effective (

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Tic-Borne Disorders Causing Chronic Arthritis?

Findings from a population based cross-sectional study suggests that while up to 20% of patients have antibodies to tick-borne exposures, only a minority reported musculoskeletal symptoms. 



Lyme disease is one of many tick-borne diseases (TBDs) that may include spotted fever

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New Year's Resolutions (1.5.2024)

Dr. Jack Cush imparts his new New Year's Resolutions for 2024 and also reviews the news and journal reports from the past week on RheumNow.com.

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RheumNow Podcast – Bill of Rights (12.15.2023)

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Two major reports on fatigue and fibromyalgia misfired, and "ankylosing spondylitis" is sent to the Rheumatology dead word cemetery. 

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ICYMI: ACR Plenaries: Changing the Practice of Rheumatology

Over the years of navigating the annual meeting, I found the sessions with the most impact to my practice were the Plenary Sessions. During these sessions, the latest research is presented, new ideas are floated, and old myths debunked. Here are the top ACR2023 Plenary abstracts I found

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CBT or Naltrexone in Fibromyalgia (12.8.2023)

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.  Be sure to catch the early registration break for 2024 RheumNow Live.





  1. Palmoplantar pustulosis (PPP) is difficult to treat; w/ few reports of JAKi

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Is MTX Safe in the Elderly? (12.1.2023)

Dr. Jack Cush reviews this past week's news and journal reports from RheumNow.com. Good news is that nearly 99% of adult rheumatology positions matched! But the challenge is that 45% of pediatric fellowship programs and 39% of pediatric rheum slots were unfilled in the 2024 NRMP match.

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Large French study on infection risk of PsA biologics 12k pts over 6 years When compared to Humira, only Enbrel and Stelara had lower infection risk Concurrent steroid use associated with increased infection 1.85HR @RheumNow #ACR23 Abs#2566 https://t.co/Os1esuodfl
Robert B Chao, MD ( View Tweet )