Infection

Post-treatment Lyme Syndrome Symptoms that persist long after Lyme disease is treated are not uncommon — a 2022 study found that 14% of patients who were diagnosed and treated early with antibiotic therapy would still develop Post Treatment Lyme Disease (PTLD). https://t.co/mmwGCnARY8
Dr. John Cush @RheumNow( View Tweet )
Post-treatment Lyme Syndrome Symptoms that persist long after Lyme disease is treated are not uncommon — a 2022 study found that 14% of patients who were diagnosed and treated early with antibiotic therapy would still develop Post Treatment Lyme Disease (PTLD). https://t.co/Qd6tqOkDBl
Dr. John Cush @RheumNow( View Tweet )
Castleman disease (CD) is a rare, non-clonal lymphoproliferative disorder w/ systemic sxs & maybe linked w/ herpesvirus 8, POEMS or TAFRO syndrome. Mimickers include lymphoma, sarcoma, IgG4-RD, Infections (EBV, HHV8, HIV, CMV, TB), Autoimmune Dz (RA, SLE, Stills) https://t.co/29M0jePXHd
Dr. John Cush @RheumNow( View Tweet )
Piperacillin effectively treats Lyme disease at 100-times lower dose than doxycycline https://t.co/vbu78RbRys https://t.co/AqSkm7XtbB https://t.co/olTi8OWsQ6

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Dr. John Cush @RheumNow( View Tweet )
Castleman disease (CD) is a rare, non-clonal lymphoproliferative disorder w/ systemic sxs & maybe linked w/ herpesvirus 8, POEMS or TAFRO syndrome. Mimickers include lymphoma, sarcoma, IgG4-RD, Infections (EBV, HHV8, HIV, CMV, TB), Autoimmune Dz (RA, SLE, Stills) https://t.co/70sROoHusy
Dr. John Cush @RheumNow( View Tweet )
Piperacillin effectively treats Lyme disease at 100-times lower dose than doxycycline https://t.co/NQXG7FRtwh https://t.co/YcIYJqorKX https://t.co/e7UCG0z4wL

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Dr. John Cush @RheumNow( View Tweet )
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Post-treatment Lyme Syndrome

EurekAlert!

Symptoms that persist long after Lyme disease is treated are not uncommon — a 2022 study found that 14% of patients who were diagnosed and treated early with antibiotic therapy would still develop Post Treatment Lyme Disease (PTLD). Yet doctors puzzle over the condition’s causes and how to

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Diabetes Prevention with Hydroxychloroquine in Sjogren’s A Taiwanese insurance claims analysis looked at HCQ use in primary Sjögren syndrome (pSS) and showed that HCQ exposure significantly reduces the risk of new onset diabetes in pSS. Conversely, higher doses of https://t.co/WQD0RNfm5Z
Dr. John Cush @RheumNow( View Tweet )
CDC's Committee on Immunization (ACIP) met and recommended: 1. Expand strains for meningococcal vax 2. Lower age for RSV vax > 50y 3. Rec. chikungunya vax for certain travelers - Flu & Covid Vax to be up next mtg 6/25 https://t.co/jInnR5JSxS https://t.co/PXg0HDLgnL https://t.co/Vro5mbjG9R

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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 threshold of 50,000 https://t.co/ye69mRooSh
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Is High Dose Aspirin Needed in Kawasaki Disease (KD)? Does aspirin add any advantage to intravenous immunoglobulin (IVIG) alone in children with KD? A randomized clinical trial IVIG alone was not inferior to IVIG plus aspirin, suggesting that high-dose aspirin during initial https://t.co/uuCgDmgNif
Dr. John Cush @RheumNow( View Tweet )
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 https://t.co/QGHxk3O8q4
Dr. John Cush @RheumNow( View Tweet )
CDC's Committee on Immunization (ACIP) met and recommended: 1. Expand strains for meningococcal vax 2. Lower age for RSV vax > 50y 3. Rec. chikungunya vax for certain travelers - Flu & Covid Vax to be up next mtg 6/25 https://t.co/jInnR5JSxS https://t.co/PXg0HDLgnL https://t.co/4pfZSRrEzi

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Dr. John Cush @RheumNow( View Tweet )
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Osteoarthritis Risky Business (4.18.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and Journal reports from this week on RheumNow.com.  Osteoarthritis patients have unique risks and synovial fluid WBC numbers can tell you when to worry about septic arthritis in gout and pseudogout patients.

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In a murine model of Kawasaki Dz vasculitis- depleting gut microbiota reduces KD like vasculitis. CV lesions were assoc w/ decrease in Akkermansia muciniphila and Faecalibacterium prausnitzii. Replacement attenuated these findings. https://t.co/uAfInA5MAq https://t.co/3AjMRQnmts

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Dr. John Cush @RheumNow( View Tweet )
In a murine model of Kawasaki Dz vasculitis- depleting gut microbiota reduces KD like vasculitis. CV lesions were assoc w/ decrease in Akkermansia muciniphila and Faecalibacterium prausnitzii. Replacement attenuated these findings. https://t.co/Hnij8TWkYy https://t.co/wEuVcuAZ5j

Links:

Dr. John Cush @RheumNow( View Tweet )
Is High Dose Aspirin Needed in Kawasaki Disease (KD)? Does aspirin add any advantage to intravenous immunoglobulin (IVIG) alone in children with KD? A randomized clinical trial IVIG alone was not inferior to IVIG plus aspirin, suggesting that high-dose aspirin during initial https://t.co/vThkP4AH6x
Dr. John Cush @RheumNow( View Tweet )
FDA reports higher rate of allergic/hypersensitivity type reactions w/ certainlots of Immune Globulin Intravenous (IGIV) and Immune Globulin Subcutaneous (IGSC) ; these have voluntarily withdrawn by the manufacturers https://t.co/j0yVBodLtW https://t.co/k7s4LtLnyu

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Dr. John Cush @RheumNow( View Tweet )
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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.

Distinguishing septic arthritis (SA)

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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 https://t.co/zzRIVG0Sq3
Dr. John Cush @RheumNow( View Tweet )
FDA reports higher rate of allergic/hypersensitivity type reactions w/ certainlots of Immune Globulin Intravenous (IGIV) and Immune Globulin Subcutaneous (IGSC) ; these have voluntarily withdrawn by the manufacturers https://t.co/N73Cc8rfAS https://t.co/OTROyomvv8

Links:

Dr. John Cush @RheumNow( View Tweet )
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EMR Messaging Woes (4.11.2025)

Jack Cush, MD

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

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Metanalysis showed no increased risk of serious infx (SIE) w/ JAK inhibitors use in pts w/ immune-mediated inflammatory skin diseases -- 32 RCTs, 11,917 pts found SIE in 0.62% on JAKi vs 0.51% controls. Meta-analysis found no significant increase in risk of serious infection https://t.co/ugH72nk8bZ
Dr. John Cush @RheumNow( View Tweet )
Shanghai hospital retrospective cohort study of 249 pts w/ post-Unilat TKA & lat knee pain. 144 Rx w/ IA steroids vs 105 Rx w/ PO meds. Infection rate w/in 6 mos post-TKA found no signif difference (2.1% vs 2.9%); Injx pts had signif better pain relief, QOL & knee function (KSS) https://t.co/ULVO6KU7pn
Dr. John Cush @RheumNow( View Tweet )
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Should Lupus Nephritis Receive PJP Prophylaxis?

Jack Cush, MD

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. 

There are no clear guidelines

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Recent Blogs

A Brief History of Rheumatoid Arthritis Mimics

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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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