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Infection

Immunosuppression Increasing (2.23.2024)

Feb 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 is

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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 )
Jan 28, 2024
Dr. Winthrop avoid JAKi and TNFi in pts with chronic lung infections like MAI. #RNL2024 @rheumnow https://t.co/TfMa7hktL9
TheDaoIndex @KDAO2011( View Tweet )
Jan 27, 2024
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 )

Jan 27, 2024
#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 )
Jan 27, 2024
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 )
Jan 27, 2024

Best Treatments for COVID-Related MIS-C

Jan 24, 2024

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 immunoglobulin

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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 )
Jan 20, 2024

Methotrexate Nodulosis (1.19.2024)

Jan 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 (pain

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Tic-Borne Disorders Causing Chronic Arthritis?

Jan 16, 2024

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 group

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New Year's Resolutions (1.5.2024)

Jan 05, 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)

Dec 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

Dec 13, 2023

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)

Dec 08, 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 efficacy.

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Is MTX Safe in the Elderly? (12.1.2023)

Dec 01, 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 )
Nov 15, 2023

Day 2 Report - ACR Plenaries: Changing the Practice of Rheumatology

Nov 14, 2023

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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#Infection rates are equal in #RWD #real #world #data using #biosimilars compared to previous use of #originators. BC database #0970 #ACR23 ⁦@RheumNow⁩ ⁦@ACRheum⁩ #arthritisresearchcanada #ARC https://t.co/eVSPgVfmQG
Janet Pope ( View Tweet )
Nov 14, 2023
Abst #1584 TMP-SMX⬇️PJP ⬇️SIE,⬇️outpt infx in GPA on RTX. 919 patients: 31% had TMP-SMX, 40% on pred >20 mg/day followed median 496 days. SIE (aHR 0.5, 95%CI 0.3-0.8), outpt infx (aHR 0.7, 95%CI 0.5-0.9), & PJP. Thirteen PJP (all not on TMP-SMX). #ACRbest #ACR23 @rheumnow

TheDaoIndex @KDAO2011( View Tweet )

Nov 13, 2023
To remind us. Glory be! GLORIA a #RCT in elderly active #RA: MTX+10 mg daily #prednisolone which was better than MTX alone. But more infections and no comparison of inexpensive Rx such as adding #HCQ. Still debated as to benefit vs risk of this strategy @RheumNow #ACR23 @ACRheum https://t.co/slOmESbIOW

Janet Pope ( View Tweet )

Nov 13, 2023
Ab#0848 @RheumNow #ACR23 Biomarkers to Differentiate Flare from Bacterial Ifn in SLE CD14 and CD64 modest increase in infections v flare, better than IL-6 and MRP8/14 One marker not enough to differentiate, but in combo w/ complements, procal, dsDNA improves composite scores https://t.co/MeMYbkMTQH
Eric Dein ( View Tweet )
Nov 12, 2023
To finish the #ACR23 Review Course, one of my favourites: the erudite @LCalabreseDO on the complicated web between viral infections and autoimmunity. Complex interactions both ways. Isn't the immune system amazing? (& ref the @CleClinicMD service led by @CCalabreseDO) @RheumNow https://t.co/spLQQfBVdr
David Liew @drdavidliew( View Tweet )
Nov 11, 2023
A masterclass by @LCalabreseDO on the management of viral infections and rheumatic disease. Don’t forget to screen for HBV, HCV, HIV prior to immunosuppressive treatment #ACR23 @RheumNow https://t.co/psLXSuhnHk
Dr. Antoni Chan ( View Tweet )
Nov 11, 2023
ID testing for pts with inflammatory eye disease: syphilis, TB, Lyme (where appropriate). Low yield is toxoplasma, toxocara and viral dz - Dr L Kopplin #ACRReview @RheumNow #ACR23 https://t.co/UyQ8Bc2cEy
TheDaoIndex @KDAO2011( View Tweet )
Nov 11, 2023

Incidence, Microbiological Studies, and Factors Associated With Prosthetic Joint Infection After Total Knee Arthroplasty

Nov 07, 2023

A study of nearly 80,000 US veterans who underwent primary knee joint arthroplasty (TKA) showed  the incidence of prosthetic joint infection (PJI) was highest in the first 3 months and remained elevated through 12 months compared with 12 months or more after surgery. Gram-negative organisms

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