Panacea of Prednisone & Cannabis (5.16.2025)
Dr. Jack Cush reviews the news, journal and regulatory reports from this week on RheumNow.com. Interesting trends and results with prednisone in lupus, cannabis in RA and opioid deaths too!
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We are not (yet) in #SLE
Getting
👇
Correct drug
In right pt
At right time
At correct individual dose
Even more problematic is in a renal bx - 2 glomeruli beside each other have v different cytokine expressions
Unravelling #LUPUS2025
@RheumNow https://t.co/yGBvhFkPKY
Links:
Janet Pope @Janetbirdope( View Tweet )
Here’s who flares in #SLE
least to most
Persistently neg antiDNA
Persistently + antiDNA
conversion of neg to + antiDNA
So are we over ordering antibodies in 1st 2 groups 🤷♀️
Unravelling #LUPUS2025
@RheumNow https://t.co/1Feau7f199
Janet Pope @Janetbirdope( View Tweet )
An excellent presentation from Dr Pankti Mehta @PanktiMehta24
Re #Jaccoud’s
With
#IFN signature
if #erosive IA - often + CCP / RF
Vs
nonerosive often +RNP
@RheumNow #LUPUS2025 https://t.co/y6z4KbhCdy
Janet Pope @Janetbirdope( View Tweet )
Subclinical #arthritis in #SLE
Do we look for it?
Should we care?
Certainly seems to exist on #MRI hands
More changes of course if tender joints
Not sure of clinical relevance
Optical imaging and POCUS was compared
#LUPUS2025 @RheumNow
ANCA Askanase presents
Janet Pope @Janetbirdope( View Tweet )
Who with +ANA will become #SLE
Mostly similar cytokine signature
But ⬆️IFN and
more innate immune changes
👇
In those who developed #lupus
? prediction & Prevention model in +#ANA people 🤷♀️
yr in review E Vital’s paper
#LUPUS2025 @RheumNow @ZahiTouma https://t.co/khpqRlH8Nk
Janet Pope @Janetbirdope( View Tweet )
Impt predictors of
#neuropsychiatric #SLE
#LUPUS2025 @RheumNow
No major predictors
But if explanation of other conditions ex
Past #cvA
#ischemic events
Doesn’t have to have
➡️Active systemic ##Lupus
➡️ ?ribosomalP
+Abs described in #CNS lupus
A real headache! https://t.co/iuWfB454EN
Janet Pope @Janetbirdope( View Tweet )
Level up 🆙
#hydroxychloroquine #levels in #SLE
When
to determine adherence - too low
To see if levels are supratherapeutic
Who
SLE Pts who have risks for #HCQ toxicity#CKD, liver dx, age, overdosing
Why
Safety
Adherence
@RheumNow #LUPUS2025 https://t.co/l8FPcqmTki
Janet Pope @Janetbirdope( View Tweet )
Is Lupus Just a B Cell Disorder?
https://t.co/0kwxE6KLeI https://t.co/pORHkg9HY6
Dr. John Cush @RheumNow( View Tweet )
Assessing neuropsychiatric SLE by 3-T, 3D contrast-enhanced vessel wall imaging. 47 w/ NPSLE vs 42 without (just SLE) showed the NPSLE had 2 fold more 1ntracranial contrast-enhanced vessel wall imaging (CE-VWI) w/ AUC 0.78 for CE-VWLs, & sensitivity 60% , specificity 87%.
Dr. John Cush @RheumNow( View Tweet )
Neutrophil alkaline phosphatase (NAP) elevated in active AOSD. 141 AOSD compared to Bcell lymphoma, SLE, aPL & controls. NAP pos. correl w/ Systemic Dz activity score (R=0.71), & 0.59 for CRP/ANC/ferritin. NAP scores higher in pre-MAS, but lower w/ MAS (w/lower WBC). NAP responds https://t.co/YbYPaJUEbz
Dr. John Cush @RheumNow( View Tweet )
Lupus in an empty house
The full house immunofluorescence pattern is the classic histopathologic finding of lupus and lupus nephritis. Glomerular deposits staining for IgG, IgA, IgM, C3 and C1q can help confirm a suspected diagnosis of systemic lupus erythematosus (SLE). This https://t.co/DQWwRJmdqM
Dr. John Cush @RheumNow( View Tweet )
Retrospective cohort study 112 biopsy-proven Lupus nephritis pts (65% class IV; F/U 8.3 yrs). (64.3%), alone or in combination. Renal damage incr betw 5 & 10 yrs F/U. 13.4% progressed to renal function impairment, and 11.6% to ESRD. Early Dx & Rx of LN, esp w/ highproteinuria, https://t.co/N1BL9Bri3M
Dr. John Cush @RheumNow( View Tweet )
Smoking & Autoantibodies in Rheumatoid Arthritis
Investigators from the Netherlands have published their findings that smoking is a risk factor in rheumatoid arthritis (RA), led by the induction of local autoimmune responses at mucosal sites (in the lungs) and exemplified by RA-specific autoantibodies.
RA is characterized by the
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Retrospective study of 131 childhoold SLE pts found lymphopenia (in 53%) significantly correlated w/ higher anti-dsDNA and increased disease activity. (r = −0.63). Lymphopenia assoc w/ more nephritis (72%), HTN (24%), leukopenia (36%) & neuropsychiatric SLE https://t.co/ONUm84jThE
Dr. John Cush @RheumNow( View Tweet )
Vitamin D Headlines (5.9.2025)
Dr. Jack Cush reviews the news, journal reports and lupus highlights from the past week on RheumNow.com. Triple positivity, the gut and CRPS, and hope for better outcomes with Vitamin D therapy.
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Carpal Tunnel Syndrome as a Harbinger of Rheumatoid Arthritis
Rates of carpal tunnel syndrome (CTS) were significantly greater in patients later diagnosed with rheumatoid arthritis (RA), according to a large, long-running observational study.
https://t.co/JiYvjhsKEp https://t.co/szmG5vrvcd
Dr. John Cush @RheumNow( View Tweet )
Retrospective study of 131 childhoold SLE pts found lymphopenia (in 53%) significantly correlated w/ higher anti-dsDNA and increased disease activity. (r = −0.63). Lymphopenia assoc w/ more nephritis (72%), HTN (24%), leukopenia (36%) & neuropsychiatric SLE https://t.co/F1NALw86hu
Dr. John Cush @RheumNow( View Tweet )
Using 16S rRNA gene amplification, Gut bacterial taxa from 53 CRPS pts compared to 52 controls. Differences were seen in microbiome and plasma short-chain fatty acid levels between CRPS patients and controls, w/ >90% accuracy https://t.co/TO7CCmmtD5 https://t.co/Gn9loJPNfM
Dr. John Cush @RheumNow( View Tweet )
Full read review of Neuropsychiatric SLE. NPSLE criteria includes 12 central & 7 peripheral findings (psych, cognitive, Sz, CVA/TIA, neuropathy, MS-like). NPSLE AutoAbs are many: Abs against APL, LAC, RP, NMDA, NMO/AQP4, EC, SBSN, UCH-L1, TP1, GAPDH, MAP2, U1RNP https://t.co/1m7SXMA68Z
Dr. John Cush @RheumNow( View Tweet )
D-Lay Trial: High-Dose Vitamin D Retards Multiple Sclerosis
A randomized clinical trial with oral high-dose cholecalciferol ( vitamin D3) was shown to prevent or delay the onset of clinically isolated syndrome (CIS), typical for multiple sclerosis (MS).
Vitamin D plays an important role in immune
Using 16S rRNA gene amplification, Gut bacterial taxa from 53 CRPS pts compared to 52 controls. Differences were seen in microbiome and plasma short-chain fatty acid levels between CRPS patients and controls, w/ >90% accuracy https://t.co/TO7CCmmtD5 https://t.co/zM1wKxjGBX
Dr. John Cush @RheumNow( View Tweet )
Triple positivity (anti-CarP Abs, RF, ACPA) assoc w/ increased Dz activity in RA. Single center, 138 RA pts. Triple pos. pts had signif more TJC (10 v 7.7), Pain (6.3 v 5.1), DAS28-CRP (4.7 vs. 4.0), ESR (33 v 23), ACPA (395 v 369), but lower RF (164 v 453). NO diff in Bone https://t.co/DexENW4W2T
Dr. John Cush @RheumNow( View Tweet )
Circulating miR-126-3p is a mechanistic biomarker for knee osteoarthritis. Study of 145 pts w/ #OA undergoing knee or hip arthroplasty or arthroscopy. miR-126-3p highest in subchondral bone, fat pad &synovium, not cartilage. IV or IA miR-126-3p given to mouse model of kneeOA https://t.co/DzudhYAK8E
Dr. John Cush @RheumNow( View Tweet )
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/06Ltm0FycI
Dr. John Cush @RheumNow( View Tweet )
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