Labs/Biomarkers

US guided lymph node Bx compared 25 controls, 14 ACPA (+) & 45 ACPA (-) RA pts. ACPA+ LN Bx showed upregulated adaptive imm. genes, but ACPA neg LN Bx showed higher innate imm genes - especially w/ higher neutrophil presence & incr CD15 + PMNs irrespective of ACPA status https://t.co/C42QMd2zap
Dr. John Cush @RheumNow( View Tweet )
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Keys to Mastery (5.2.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, articles and drug approvals from the past week on RheumNow.com. This podcast marks the beginning of our Lupus Campaign called "Lupus Unlocked: Keys to Mastery". This month's campaign on Lupus is sponsored by Aurinia.

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Secondary Benefits to SGLT2 Inhibitor Use in SLE

Jack Cush, MD

An emulation trial of sodium–glucose cotransporter 2 inhibitors (SGLT2i) in systemic lupus erythematosus patients yielded a significantly reduced risk of several cardiorenal complications among patients with SLE and type 2 diabetes.

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2023 report from US NHANES study says #Gout affects 12.1 million in the USA. Gout prevalence incr from 3.6% in 2011/12 to 5.1% in 2017/2018. Recent increases do to doubling in Asian Americans from 3.3% to 6.6%. https://t.co/IBa3fOt83c https://t.co/aVHkg54IKp

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Procalcitonin > 0.9 ng/mL can be a critical marker for identifying bacterial infection in #SLE. Single center study of 116 juv. SLE pts dx bacterial infx in 17%. Procalcitonin was signif better than others: NLR, PLR, ESR, CRP, LC4R, ferritin (cut offs need to be defined) https://t.co/3ujTDIucFM
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RHEUMATOLOGIST Survey: What are your contraindications tor renal Bx?

Dr. John Cush @RheumNow( View Tweet )

RHEUMATOLOGIST SURVEY: Which Lupus patients should undergo renal Bx?

Dr. John Cush @RheumNow( View Tweet )

US guided lymph node Bx compared 25 controls, 14 ACPA (+) & 45 ACPA (-) RA pts. ACPA+ LN Bx showed upregulated adaptive imm. genes, but ACPA neg LN Bx showed higher innate imm genes - especially w/ higher neutrophil presence & incr CD15 + PMNs irrespective of ACPA status https://t.co/h8trTxt5t1
Dr. John Cush @RheumNow( View Tweet )
Study of 104 RA-ILD pts found that (31.7%) RA-ILD patients were ANCA positive (29/31 were p-ANCA+). compared to ANCA neg, ANCA+ RA-ILD had more respiratory Sxs, ANA positivity, worse PFTs, more acute exacerbations of ILD, more bronchietasis & honeycombing https://t.co/vZODUW9tSX https://t.co/zTrdtcc78O

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RHEUMATOLOGIST SURVEY: Which Lupus patients should undergo renal Bx?

Dr. John Cush @RheumNow( View Tweet )

RHEUMATOLOGIST SURVEY: Which Lupus patients should undergo renal Bx?

Dr. John Cush @RheumNow( View Tweet )

RHEUMATOLOGIST SURVEY: Which Lupus patients should undergo renal Bx?

Dr. John Cush @RheumNow( View Tweet )

Study of 104 RA-ILD pts found that (31.7%) RA-ILD patients were ANCA positive (29/31 were p-ANCA+). compared to ANCA neg, ANCA+ RA-ILD had more respiratory Sxs, ANA positivity, worse PFTs, more acute exacerbations of ILD, more bronchietasis & honeycombing https://t.co/vZODUW9tSX https://t.co/6WUbSoOyOm

Links:

Dr. John Cush @RheumNow( View Tweet )
Incr. neutrophils in RA synovium correlates w/ higher Dz activity and poorer Rx responses. Study of 55 #RA pts, 1/3 (17) enriched for synovial PMNs - these correlated w/ DAS28--CRP, synovial inflammation, and CD3+/CD68+ cell counts https://t.co/zz59w8MMUU https://t.co/R7Ruyab0wj

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Stills,continuum

Unmet Needs in Still’s disease

Jack Cush, MD

In February 2023, an expert consensus panel of pediatric and adult rheumatologists met to address challenges in Still’s disease (SD), including systemic juvenile idiopathic arthritis and adult-onset SD. They addressed four main topics: (1) early recognition and diagnosis of SD; (2) pathogenetic

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2025 BSR Guideline for Treatment of Axial Spondyloarthritis

Jack Cush, MD

The British Society of Rheumatology has published its 2025 Guidelines for the Treatment of Axial Spondyloarthritis (axSpA); addressing axial and extra-musculoskeletal manifestations including acute anterior uveitis, psoriasis and IBD.  They address the effectiveness and safety of

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Ultrasound lesions of dactylitis associ w/short-term development of PsA. Study of 64 PsO +arthralgia pts. IUS PD synovitis & B mode enthesitis predicted PsA Dx (p < .001) w/ an accuracy of 89.1 %, a sensitivity of 86.7 % and a specificity of 89.8 %. https://t.co/KoXMmoxXhP https://t.co/tj2NxKDkqh

Links:

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Genetic Sequencing in Rheumatology Genetic sequencing as a research and diagnostic tool has expanded in medicine and rheumatology. An interesting review in Arthritis and Rheumatology suggests that despite currently modest use, there will be an expanded role for genetic

Dr. John Cush @RheumNow( View Tweet )

Predictors of Developing RA A prospective cohort study of seropositive arthralgia patients demonstrated that baseline characteristics and labs can be used to predict which arthralgia patients are at highest risk of developing RA. These studies underscore the influence of https://t.co/wpSHDfwCL7
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Genetic Analysis of Asymptomatic Antinuclear Antibody Positive Patients A large scale genomic population study found antinuclear antibodies (ANA) in up to 14% of the population; most with ANA are asymptomatic, and ANA production is not associated with significant genetic risk. https://t.co/Ltqf1yaaoy
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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DNA,genetics,sequencing

Genetic Sequencing in Rheumatology

Jack Cush, MD

Genetic sequencing as a research and diagnostic tool has expanded in medicine and rheumatology. An interesting review in Arthritis and Rheumatology suggests that despite currently modest use, there will be an expanded role for genetic sequencing in the field of rheumatology. 

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AutoAbs & protein signatures evolve as pts go from Preclinical to established RA. Pts vs controls distinguished w/in 5 yrs of Dx best by iCCP3, RFIgA, RFIgM; and 104 proteins differentially expressed & gene analyses showed 21 pathways enriched ≤5 years of Dx. https://t.co/u8abvqNtnX
Dr. John Cush @RheumNow( View Tweet )
AI,genes

Genetic Analysis of Asymptomatic Antinuclear Antibody Positive Patients

Jack Cush, MD

A large scale genomic population study found antinuclear antibodies (ANA) in up to 14% of the population; most with ANA are asymptomatic, and ANA production is not associated with significant genetic risk. 

Asymptomatic individuals who were either

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Genomics and Future Drug Targets for Osteoarthritis

EurekAlert!

A Nature article details the results of an osteoarthritis, genome-wide association study meta-analyses across up to 489,975 cases and 1,472,094 controls, establishing 962 independent associations, 513 of which have not been previously reported. Results were published this week in the journal

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Unpopular opinion: spinach can be bad for you

Lara El Khoury, MD
pro con unsure opinion thumbs debate
PMR might be one of the most rewarding diagnoses to make in real practice: the patient comes to you in severe debilitating pain, and you prescribe steroids, giving them their lives back! As much as this impressive response makes your intervention appear almost magical, there is the often-forgotten story about the implications of such a diagnosis and treatment on patients' daily lives.  Read Post

Focus on the Fasting Lipid Profile

Dr Paul Anthony John Russo
Blood labs
How best do we communicate CV risk associated with RA to other members of the treating team, most particularly the primary care physicians? After some experimentation, I have come up with an approach that seems to work and which does not take up much time. Read Post
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