NHANES, Numbers, & Risk (7.18.2025)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com along with interesting case questions from "Ask Cush Anything".
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Osteoarthritis (OA) degenerative or inflammatory? 296 pts w/ Knee OA (age 63 yrs, 2/3 had poor oral hygien, K&L grade 2, pain >40). Periodontitis in 62.5% & signif assoc w/ Xray K&L grade 4 (OR 5.39), poor oral hygiene (OR 34), dental visits (OR 8.54), brushing time (OR 21.9) https://t.co/xXIr2qxtt4
Dr. John Cush @RheumNow( View Tweet )
MTX lowers risk of serious infxn (SI) - UK Observational study of 17 472 newly Dx RA (2018–2023); 10K on MTX, 4,540 other csDMARDs; 13680 corticosteroids (GC). 1307 SI (3/100 PY) w/ reduced adj HR 0.72 (95% CI: 0.63–0.82). 311 SI-related mortality (IR 0.69;0.61–0.77) https://t.co/iuxAivtrYZ
Dr. John Cush @RheumNow( View Tweet )
Short full read review of the history, safety and use of Corticosteroids in Respiratory Medicine (including use in community-acquired pneumonia (CAP), ARDS, septic shock, ILD, COPD/asthma, COVID-19, Cancer, Sarcoid & IPF. https://t.co/aKMAT8IhLm https://t.co/RopoNnYJ6Z
Dr. John Cush @RheumNow( View Tweet )
Sulfasalazine as a preventative against Pneumocystis (PJP). 594 RA pts & 848 Rx episodes - 181 on SSZ, 667 controls. W/ 850 Pt-Yrs F/U, 21developed PCP, 3 died of PCP. SSZ significantly lowered PJP risk (p = 0.003, rate ratio = 0.05; 95% CI 0.00–0.34). https://t.co/PAgBaJGldR https://t.co/PuTxGXTeRS
Dr. John Cush @RheumNow( View Tweet )
MTX lowers risk of serious infxn (SI) - UK Observational study of 17 472 newly Dx RA (2018–2023); 10K on MTX, 4,540 other csDMARDs; 13680 corticosteroids (GC). 1307 SI (3/100 PY) w/ reduced adj HR 0.72 (95% CI: 0.63–0.82). 311 SI-related mortality (IR 0.69;0.61–0.77) https://t.co/YhJV3vyAmB
Dr. John Cush @RheumNow( View Tweet )
Sulfasalazine as a preventative against Pneumocystis (PJP). 594 RA pts & 848 Rx episodes - 181 on SSZ, 667 controls. W/ 850 Pt-Yrs F/U, 21developed PCP, 3 died of PCP. SSZ significantly lowered PJP risk (p = 0.003, rate ratio = 0.05; 95% CI 0.00–0.34). https://t.co/PAgBaJGldR https://t.co/VV3MvVEGal
Dr. John Cush @RheumNow( View Tweet )
Martinque, Afro-Caribbean population (n 354 800) study(2004-2022) of 33 AOSD pts (71%F; 79% systemic; 21% chr articular); 91% met Yamaguchi criteria; features as expected but more Pulmonary Dz(51%; 94% w/ a systemic pattern). Half Dx < age 35 yrs. Prevalence 7.6 /100 000 mean https://t.co/QWyfNuvhkl
Dr. John Cush @RheumNow( View Tweet )
Study of 176 anti-MDA5-DM patients and 55 controls found anti-IFN-α Abs in 18% of MDA5-DM pts, higherin those >60 yrs. IFN-α Ab-positivity assoc w/ RP-ILD (68% vs. 41%) & pulmonary infxn (74% vs. 46%, esp fungi), Mortality (p = 0.006). https://t.co/6w6S3nozPI https://t.co/FoXEIuLBEk
Dr. John Cush @RheumNow( View Tweet )
Hmmm Really? (7.11.2025)
Dr. Jack Cush reviews the news and journal reports from this past week - some obvious, other new thoughts and some - hmmm, reallly?
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Diffuse idiopathic skeletal hyperostosis (DISH)is a structural cause of dysphagia due to anterior cervical osteophytes. Retrospective study 208 dysphagia pts w/ head/neck CT. DISH was Dx in 39%; predicted by low serum albumin, COPD, & chronic pain https://t.co/zrn4dnCtLc https://t.co/svE6khmUEm
Dr. John Cush @RheumNow( View Tweet )
#RA linked to 40% incr risk of serious dental Infx. National Inpatient Sample (2016-2022) retrospective study of ~15 million adult inpatient records, 10.7K (0.07%) had oral Infx Hosp. Risk factors included RA (1.9%; OR 1.4, male (1.79), Black (1.23), smoking (1.33) https://t.co/pr4Uf6ywJ7
Dr. John Cush @RheumNow( View Tweet )
ICYMI: Should Lupus Nephritis Receive PJP Prophylaxis?
A current review article suggests that the need for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in patients with systemic lupus erythematosus (SLE) and lupus nephritis will need to be individualized based on therapies and risk factors.
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Case series of 22 PsA pts treats w/ combination bioDMARDs & JAKi,TYK2i or APR
IL17i + JAKi 10.5 PY = 1 mild infectious stomatitis
IL23i + JAKi 3.7 PY = no AE
IL-17i + TYK2i 8.5 PY = 2 mild upper respiratory infections
IL-23i + TYK2i 8.3 PY = 2 mild URIs, 1 folliculitis
TNFi + https://t.co/hxhTxmJpbN
Dr. John Cush @RheumNow( View Tweet )
ICYMI: AGA Guideline: Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals
The American Gastroenterology Association has published its revised clinical practice guidelines for the prevention and treatment of hepatitis B virus (HBV) reactivation in at-risk patients, particularly those with immune-mediated disease, receiving immunomodulatory therapy and steroids.
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Remission in Axial Spondyloarthritis Unrelated to Gut Inflammation
Most patients with early, active axial spondyloarthritis (axSpA) who quickly received a tumor necrosis factor (TNF) inhibitor experienced remission, and it didn't matter whether or not they had intestinal https://t.co/Sa10k6neRP
Dr. John Cush @RheumNow( View Tweet )
FDA adds new warning for "myocarditis" to the Pfizer and Moderna COVID-19 vaccines (prev mainly assoc w/ Moderna) - risk is 8 per 1 million people for those on 2023-2024 COVID shots, most common in males ages 12 to 24. Generally good outcomes seen. https://t.co/QZbTRaKGH1 https://t.co/1cAUw73eqF
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Dr. John Cush @RheumNow( View Tweet )
PCR: Prevalence, Cost, & Risk (6.27.2025)
Dr. Jack Cush reviews the news and journal reports from last week on RheumNow.com
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UK study of 17472 newly Dx #RA pts (10997 MTX, 4,540 csDMARDs; 13680 steroids-CS) w/ 1307 Serious Infx (SI) (3/100PY) & 311 SI deaths. MTX signif decr. SI (adj HR 0.72) & CS no effect HR 0.99. SI assoc w/ age, smoker, comorbidity, seropositive, high DAS28. 1 DAS unit incr SI https://t.co/Zmsuaf7Rw3
Dr. John Cush @RheumNow( View Tweet )
Vector borne diseases that result in arthritis will rise with climate change/ flooding risk
- Chikungunya
- Dengue
- Zika
- West-Nile Virus
@RheumNow #EULAR2025 @bella_mehta https://t.co/CCOYqTjaXE
Dr. John Cush @RheumNow( View Tweet )
Steroids, Not JAKi, Are the Real Infection Risk
Dr. David Liew reporting at EULAR 2025 in Barcelona, Spain.
https://t.co/rLpyo1UNjd https://t.co/bDfdLTEM1N
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Dr. John Cush @RheumNow( View Tweet )
Safety of Recombinant Zoster Vaccine in Rheumatic Patients
New work presented at EULAR focuses on the RZV, which contains recombinant glycoprotein E – the major target of CD4+T-cells. The abstract describes the tolerability and safety of RZV in patients with inflammatory https://t.co/NS3h9CdGIU
Dr. John Cush @RheumNow( View Tweet )
Management of AAV:
1.High dose GC f/b reduced dose taper ‼️caution in pts w/severe renal dz and RTX induction.
2. RTX effective for induction and maintenance, best for relapses.
3.PLEX: in RPGN pts if accesible ⚠️ risk for infection.
4.Avacopan: for faster GC weaning. No https://t.co/kfZ4gM38KG
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Adela Castro @AdelaCastro222( View Tweet )
#ClinicalPearls
For
#cartilage #swelling in #relapsing #polychrondritis
Ask for #pics
#Levamisole in #cocaine
#infection - uncommon - from piercing
Acute #bacterial v chronic
#lymphoma
#malignancy
#vasculitis
#Trauma
Hx, duration, fever can be helpful
#EULAR2025
@RheumNow https://t.co/X2b6VHYsYa
Links:
Janet Pope @Janetbirdope( View Tweet )
Vector borne diseases that result in arthritis will rise with climate change/ flooding risk
- Chikungunya
- Dengue
- Zika
- West-Nile Virus
@RheumNow #EULAR2025 https://t.co/HtHyADsOSX
Bella Mehta @bella_mehta( View Tweet )
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