Infection

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
Dr. John Cush @RheumNow( View Tweet )
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
Dr. John Cush @RheumNow( View Tweet )
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 )
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/TGgKDQ0D7F
Dr. John Cush @RheumNow( View Tweet )
DANFLU-2 RCT of 332 438 elderly (43 881 w/ diabetes) tested high (HD-IIV) vs standard dose SD-IIV) flu vaccine. HD-IIV signif. reduced cardioresp., CV, CHF, influenza, hospitalizations vs SD-IIV, irrespective of DM status. Similar results previously seen in a Canadian RA pop. https://t.co/GGZPThoHrs
Dr. John Cush @RheumNow( View Tweet )
Best of 2025: Distinguishing Septic and Gouty Arthritis A single center, retrospective review of patients undergoing knee joint fluid aspirations for presumed crystalline arthritis (CA) showed that synovial WBC may provide a useful diagnostic marker for SA with an optimal https://t.co/G31CazbqmR
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/PTJPhcvnzC
Dr. John Cush @RheumNow( View Tweet )
Review of IL-1 family cytokines in inflammation and immunity - including, IL-1, IL-18, IL-33, IL-36, IL-37, IL-38, IL-1Ra, etc. Full read -- Good Reference!! https://t.co/01o05qYPjU https://t.co/M02xrvxKre

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Dr. John Cush @RheumNow( View Tweet )
joint.tap_.septic.monarthritis.jpg

Best of 2025: Distinguishing Septic and Gouty Arthritis

Jack Cush, MD

A single center, retrospective review of patients undergoing knee joint fluid aspirations for presumed crystalline arthritis (CA) showed that synovial WBC may provide a useful diagnostic marker for SA with an optimal threshold of 50,000 cells/mm3.

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Japanese retrospective study-194 #RA pts Rx w/ JAK inhib (74 vaccinated w/ recombinant zoster (RZV) & 120 Not-Vax). H.zoster lower w/ RZV (4.8/100PY) vs UnVax (7.8/100PY) w/ overall efficacy of 59.1%. RSV Vax pts who got HZ had signif lower lymphocyte #s, higher SDAI & CDAI. https://t.co/vJJRflJ23x
Dr. John Cush @RheumNow( View Tweet )
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Telling You Where to Go (12.19.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com. Who would've thunk - a PsA FMF connection? Labs to diagnose SSc-ILD? IgA-RF may be important or RZV may not work in JAK inhibitor treated patients?

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Lyme disease is endemic in Massachusetts. EHR study shows Lyme dz incidence declined from 211 per 100 000 patients in 2012 to 86 per 100 000 in 2024 (P< .001), but this decr. was driven by 1 large practice group implemented a new initiative to reduce Lyme Dx & Rx in pts w/ https://t.co/lMCUA9o4Uc
Dr. John Cush @RheumNow( View Tweet )
Japanese retrospective study-194 #RA pts Rx w/ JAK inhib (74 vaccinated w/ recombinant zoster (RZV) & 120 Not-Vax). H.zoster lower w/ RZV (4.8/100PY) vs UnVax (7.8/100PY) w/ overall efficacy of 59.1%. RSV Vax pts who got HZ had signif lower lymphocyte #s, higher SDAI & CDAI. https://t.co/4VMWPhzXeL
Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

A Brief History of Rheumatoid Arthritis Mimics

Robert Schoen, MD, MBA
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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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The Impact of Obesity on Psoriatic Arthritis

Sponsored by Lilly Medical Affairs
A person indoors raises one arm in a flexed pose while holding the elbow with the opposite hand, with a sofa and light curtains in the background
Image alt text: A person indoors raises one arm in a flexed pose while holding the elbow with the opposite hand. Is obesity common in your patients with PsA? Learn more about the intersection of disease pathogenesis between PsA and obesity and how weight intervention can affect PsA outcomes.
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