Top Four and More (4.10.2026)
Dr. Jack Cush reviews the news and journal reports from RheumNow.com this week - including his top four favorite subjects.
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Claims data 2,751 #AAV patients - 6.2% developed #PJP infx. w/ predictors: age, max GC dose, rituximab, CTX, & PJP prophylaxis had Good concordance (0.70) @2mos & 0.66@1yrs. W/ monthly risk of 1.0%, prophylaxis yielded 34 potentially preventable PJP cases https://t.co/c2ObDnmfYp https://t.co/0JRd1k0R2R
Dr. John Cush @RheumNow( View Tweet )
5 yr Italian study of hospitalized autoimmune pts(2018-23) 4,896 IMID pts compared to 301,126 non-IMIM. IMID had signif higher risk cancer (adj OR 1.32) highest 1st yr. Decreased from 1.83 @ yr 1 to 1.2 @5+ yrs. IMID had more lung & bladder CA, leukemia lymphoma & melanoma https://t.co/UXqDHQtzv0
Dr. John Cush @RheumNow( View Tweet )
Claims data 2,751 #AAV patients - 6.2% developed #PJP infx. w/ predictors: age, max GC dose, rituximab, CTX, & PJP prophylaxis had Good concordance (0.70) @2mos & 0.66@1yrs. W/ monthly risk of 1.0%, prophylaxis yielded 34 potentially preventable PJP cases https://t.co/c2ObDnmfYp https://t.co/Ljr5maHZcr
Dr. John Cush @RheumNow( View Tweet )
Korean Insurance claims nested case–control study of 27,410 RA pts - 5482 w/ > comorbid Dsx Vs 21,928 w/ < 10 comorbd Dz. Having >10 signif incr Serious infx (OR 1.44), opportunistic (21.9)& Hzoster (1.18); mainly skin & soft tissue infx - NOT fatal infx. https://t.co/qDrU3BXYzd
Dr. John Cush @RheumNow( View Tweet )
Myocarditis causes 17,000 deaths/Yr worldwide. Causes include A) iatrogenic/autoimmune: checkpoint inhibitors & gene therapy; B) High income countries: parvo B19, herpesvirus 6; C) low income: dengue, HIV, malaria and Trypanosoma cruzi (Chagas disease) https://t.co/0FjPyXygpz https://t.co/04J23AiqtK
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FDA has issued a drug safety warning for avacopan (Tavneos), dentifying 76 cases of drug-induced liver injury, including 7 cases of rare vanishing bile duct syndrome (VBDS). There were 8 deaths https://t.co/WkBhs1rNpf https://t.co/ZXdHsAJUOQ
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Review: Rheumatoid Arthritis–Associated Interstitial Lung Disease
RA-ILD represents the most severe extra-articular manifestation of rheumatoid arthritis, affecting an estimated 1% of the adult population in the US and Northern Europe. Prevalence estimates vary widely (up to 58%), reflecting different diagnostic criteria, imaging modalities, and study
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Myocarditis causes 17,000 deaths/Yr worldwide. Causes include A) iatrogenic/autoimmune: checkpoint inhibitors & gene therapy; B) High income countries: parvo B19, herpesvirus 6; C) low income: dengue, HIV, malaria and Trypanosoma cruzi (Chagas disease) https://t.co/en4OnhWPda https://t.co/urwkjlVeg6
Dr. John Cush @RheumNow( View Tweet )
Italian population study of 37996 RA (prevalence 0.54%) pts w/ and 12875 incident cases (incid rate 33.1/100K), there were 1288 deaths/8yrs (MR 21.3/1K), median age=83; SMR 1.28 (1.21 to 1.35), higher <45 yrs (2.15). Leading causes CV (37%), cancer (21%) & infxn (11%) https://t.co/wPx5iqW7Nl
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phase 3 VALOR trial of 6-valent OspA-based Lyme dz vaccine (LB6V) vs placebo; 4 doses given @ Mos 0, 2, 5-9, & 12 mos later. LB6V reduced Lyme Dz risk by 73.2% @28d after 4th dose. But it was only 15.8% effective (falling short of prespecified 20%) because of fewer than expected https://t.co/TcX0GV05gY
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Outcomes of 87 VEXAS pts in the AutoInflammatory Disease Alliance (AIDA) - 75% had recurrent fever episodes. Fever episodes assoc w/ mortality, organ involvement (CV, GI, Lung), but not with complete response to biologics. https://t.co/j9vzBJNMj0 https://t.co/YGsE7LH3ml
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ILD found in 3% of #PsA pts. Metanalysis of 6 studies, 14,272 pts found ILD pooled prevalence was 3% in PsA; highers ((6%) in studies w/ CT, HRCT. Smoking was a signif. risk factor for ILD in PsA (OR 2.94, 95% CI: 1.22–7.12; I2 = 1.8%). https://t.co/9mY4Eiqc9d
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Rheumatic Immune-related Adverse Effects with Checkpoint Inhibitor Therapy
A retrospective study of patients who developed rheumatic immune-related adverse events (R-irAEs) after receiving immune checkpoint inhibitors (ICIs) at two oncology centers in Spain suggests that early https://t.co/hYf6GiR6TN
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Rheumatic Immune-related Adverse Effects with Checkpoint Inhibitor Therapy
A retrospective study of patients who developed rheumatic immune-related adverse events (R-irAEs) after receiving immune checkpoint inhibitors (ICIs) at two oncology centers in Spain suggests that early https://t.co/jKCbIvfebm
Dr. John Cush @RheumNow( View Tweet )
Full read review & update on Rhabdomyolysis. 26K cases/Yr in USA. Muscle damage leading to weakness, myalgias, swelling, myoglobinuria, electrolyte probs, AKI. Causes: 1) exogenous toxins (46%); 2) trauma; 3) myopathies/metabolic muscle dz (10%), infxn. AKI in 46%, & death in https://t.co/E2LcLeMls0
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RT @gibson_rheumPAC
Given rising resistance, effective first-line regimens and adequate duration (14 days) are critical. PPI-based quadruple regimens remain highly effective when patients can adhere.
#RNL26 https://t.co/bxqMbPFegt
Dr. John Cush @RheumNow( View Tweet )
RT @ericdeinMD
#RNL26
Prosthetic joint infection vs flare?
- PJI risk 50-80% higher in RA (OR 1.47-1.8)
- Immunosuppressants, intra-artic injections, RA activity, BMI incr risk
- Delay in diagnosis https://t.co/XTozafDQyf
Dr. John Cush @RheumNow( View Tweet )
RT @ericdeinMD
#RNL26
Inflammatory arthritis pts getting TKA:
- increased risk of RBC transfusion (OR 1.39), infection (1.64) and readmission (1.46)
- THA: also risk of mechanical complications (like dislocation) OR 1.3 https://t.co/ovW2C2EuXF
Dr. John Cush @RheumNow( View Tweet )
RT @gibson_rheumPAC
Helicobacter pylori Update: H. Pylori remains the most common chronic bacterial infection worldwide, acquired in childhood and lifelong if untreated. Its clinical impact spans far beyond dyspepsia—from ulcers to malignancy. #RNL26 tis
Dr. John Cush @RheumNow( View Tweet )
RT @richardPAconway
We have improved RA mortality in many areas but respiratory (mainly ILD) and infectious issues remain stubbornly elevated. #RNL26 https://t.co/ViucOIOOzY https://t.co/3kIqPMeKKX
Links:
Dr. John Cush @RheumNow( View Tweet )
RT @richardPAconway Disease activity is a strong risk factor for RA-ILD. Particularly for moderate/high disease activity but there appears to be a linear relationship (at least above a certain threshold) #RNL26 https://t.co/ot8ttdmu5G
Dr. John Cush @RheumNow( View Tweet )
RT @ericdeinmd
RA-ILD #RNL26
Jeff Sparks
MTX and ILD
- Rare MTX-induced pneumonitis. 7 cases in n=4786 (0.3% cases) vs <0.1 on PBO, rare diff from ILD
- No increase in incident ILD - meta-analysis of 7 studies show OR 0.49 https://t.co/k2XeAzBsYB
Dr. John Cush @RheumNow( View Tweet )
RT @richardPAconway
UIP is predominant radiologic pattern in RA-ILD. Contrast with our other diseases. But by no means exclusive - up to 50% of RA-ILD have a more inflammatory pattern. Important treatment implications! #RNL26 https://t.co/HmW1mz429i
Dr. John Cush @RheumNow( View Tweet )
RT @ericdeinmd
Mucosal Hypothesis RA #RNL26
Demoruelle
Mucosal origins of RA?
Key sites of immune-environment interaction initiate local inflamm, becomes systemic
Link of lung inflamm/immune dysregulation - ass w/ smoking, ILD
NETs in lung drive RA path?
Gut/oral microbes drive
Dr. John Cush @RheumNow( View Tweet )
Recent Blogs
Imagine that 100 years from now, your great granddaughter, an eminent rheumatologist, reviews the 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.
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There is guidance published on how to manage moderate to severe cases, but very few blueprints detail what to do with “mild” infection. The first day, I developed congestion and cough, with a sore throat. As the day progressed, I started to have chills, low grade fevers, and myalgias. The postnasal drainage was overwhelming, and when I tried to swallow, it felt like swallowing broken glass.
Isolating in my room, I was left to deal with my symptoms.
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