Recovery Rheum

Recovery Rheum John D. Carter, MD provides comprehensive rheumatology care for those with autoimmune & inflammatory conditions.

He is a multiple year winner of Tampa’s Best Doctors, Castle Connolly and multiple other patient care awards Carter, MD provides extensive care for those suffering from rheumatic diseases and conditions, including Rheumatoid arthritis, Systemic Lupus Erythematosis (Lupus), Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease-related arthritis, Non-Radiographic Spondyloarthitis,

Gout, Giant cell arteritis (Temporal Arteritis), and Polymyalgia Rheumatica. Prior to Recovery Rheum LLC, Dr. Carter was the former Chief of Rheumatology at USF and Tampa General Hospital for 17 years.

09/09/2026

Nobody says the word out loud.
They come at it sideways. “Could this be something neurological?” “My mother had dementia.”
Then they stop and wait to see if I’ll say it for them.
I usually do. Not because I think they have it — because a fear carried silently gets larger, and
said out loud in a room with a physician it usually gets smaller.
Here’s what I’ve noticed after enough of these conversations: the people most frightened by
their brain fog are almost always the people paying closest attention to it. That vigilance is itself
reassuring, and it’s the opposite of what I see in someone whose memory is genuinely failing.
If this is sitting in the back of your mind, bring it to your next appointment. It’s a normal thing to
ask.
What’s the question you’ve been meaning to ask your doctor but haven’t?

09/09/2026

Most of what’s sold as fermented in a supermarket isn’t, in the way that matters.
Sauerkraut in a shelf-stable jar has usually been pasteurized. Heat kills the live cultures, which
is the entire point. Same with most pickles — if they’re sitting in vinegar rather than brine, no
fermentation happened at all.
Look in the refrigerated section, and look for the words live or active cultures on the label.
The Stanford trial had people eating around six servings a day by the end. That’s more than
most people will do, and I’m not asking you to. But it tells you the effect they measured came
from a real dose, not a spoonful of yogurt on a Tuesday.
Start with one thing you’d actually eat. Kefir in the morning is the easiest version of this I know.

09/08/2026

Did scientists just prove that Epstein-Barr virus causes lupus? Not so fast.

A fascinating new study found more EBV-infected B cells in people with systemic lupus erythematosus and showed a potential way these cells could help drive autoimmune inflammation.

That matters. But it does not prove that EBV causes lupus.

One major limitation: the patients in the study already had lupus. That means we still have a critical chicken-or-egg question. Did EBV help start the disease—or does lupus, along with changes in immune function and potentially immunosuppressive treatment, make it harder for the body to control EBV?

The main human comparison was also small: 11 people with lupus and 10 healthy controls. And some of the most important functional experiments used EBV-transformed cells under laboratory conditions—valuable for showing what could happen biologically, but not proof that this is what actually starts lupus in a person.

The EBV–lupus connection is real, scientifically fascinating, and deserves much more research. But there is an important difference between association, a plausible biological mechanism, and proven causation.

This is important science. But are we ready to say “EBV causes lupus”?

Not yet.

Follow Recovery Rheum for evidence-based autoimmune disease education and critical reviews of the medical research behind the headlines.

Reference:
Younis S, Moutusy SI, Rasouli S, et al. Epstein-Barr virus reprograms autoreactive B cells as antigen-presenting cells in systemic lupus erythematosus. Sci Transl Med. 2025 Nov 12;17(824)

09/06/2026

Autoimmune disease has a way of making itself the center of everything.

The fatigue. The pain. The brain fog. Bloodwork. Doctor visits. Medications. Flares. Cancelled plans. And that constant question in the back of your mind: How am I going to feel tomorrow?

Those struggles are real. They deserve to be taken seriously, investigated appropriately, and treated with excellent medical care.

But there’s something I’ve learned after decades of caring for people with autoimmune disease:

Your diagnosis deserves your attention.

It doesn’t deserve every moment of your life.

Take your medications. Keep your appointments. Ask questions. Advocate for yourself. Find physicians who listen. And keep working toward better health.

But also notice the people you love. Laugh when you can. Go outside. Take the trip. Sit by the water.

And when life with chronic illness gets particularly loud…

don’t forget the sunsets. 🌅

— Dr. Carter | Recovery Rheum

09/05/2026

Cardiovascular risk in rheumatoid arthritis isn’t fixed at diagnosis. It tracks with how active the
disease is. Sustained inflammation is what damages blood vessels, so lowering disease
activity lowers the risk that comes with it.
Which means the thing protecting your heart is the same thing protecting your joints. Not a
separate plan. The same one, done properly.
This is also the clearest argument I know against stopping medication because you feel fine.
Feeling fine is not the same as low disease activity, and the gap between them is where the
damage accumulates quietly.
Ask what your inflammatory markers are doing. Not just how you feel. Both matter, and only
one of them shows up in bloodwork.

09/04/2026

Somewhere along the way, chronic illness became something people feel they have to explain.
Not to their doctor. To everyone else. The relative who asks whether they’ve tried going gluten
free. The wellness account implying that anyone still sick simply hasn’t tried hard enough.
That message lands hardest on the people who are already doing everything right.
I have patients with beautifully controlled diets who flare anyway, and patients who eat
whatever they want and go years without one. The disease is not grading your discipline.
Food is worth taking seriously. It is not worth taking personally.
What’s the one piece of unsolicited health advice you’re most tired of hearing?

09/03/2026

Brain fog is a terrible name for it.
It sounds soft. Vague. Like something you could shake off with coffee and a better night’s
sleep. The name itself makes it easy to dismiss, and patients absorb that — which is why so
many apologize before describing it.
What people actually describe to me is precise. Standing in a room having lost the reason they
walked in. Reading the same line four times. Losing a word mid-sentence that they have used
their entire adult life.
None of that is vague. It’s specific, and it’s measurable, and it tracks with inflammation.
I think we lost something when we gave this symptom a cute name. People do not report
symptoms they think sound trivial.
What’s the sentence you use when you try to describe it to someone who doesn’t have it?

09/02/2026

For years, CAR-T therapy has generated extraordinary hope in autoimmune disease—with early studies suggesting the possibility of deep, treatment-free remission in conditions such as lupus, systemic sclerosis, myositis and rheumatoid arthritis.

But this week is an important reminder that extraordinary potential can come with extraordinary responsibility.

Novartis has paused eight autoimmune and neurologic CAR-T trials after three patients treated with rap-cel died following serious cases of immune effector cell-associated hemophagocytic syndrome (IEC-HS)—a severe inflammatory complication of immune-effector therapies. Bristol Myers Squibb has separately paused enrollment in autoimmune studies of its CAR-T therapy after observing inflammatory events, although no deaths have been reported in the BMS program related to this pause.

This does not mean CAR-T therapy has failed in autoimmune disease. Yet, it absolutely failed for these three patients. It does mean we need to talk about the entire treatment—not just the remarkable remission stories.

CAR-T is not simply an infusion that “resets” the immune system. Current autoimmune CAR-T protocols can involve collecting and genetically modifying a patient’s T cells, lymphodepleting chemotherapy, CAR-T infusion, and careful monitoring for potentially serious immune complications.

The goal shouldn’t simply be to cure—or achieve prolonged remission from—autoimmune disease at any cost. The goal is to someday achieve a durable immune reset as safely as possible.

These events may ultimately help researchers build a safer next generation of cell therapy. For patients living with autoimmune disease, I sincerely hope they do.

Science advances when we celebrate breakthroughs—but also when we confront complications honestly.

09/01/2026

The hardest sentence to hear in a rheumatology appointment is “that’s just part of your
disease.”
Sometimes it’s true. Often it’s a stopping point rather than an answer.
Fatigue is hard to measure. There’s no swollen joint to point at, no image that shows it. So it
becomes the symptom that gets absorbed into the diagnosis and stops being investigated.
But the four causes in this video are all measurable. They cost almost nothing to check. And
three of them are correctable within a few months.
If you’re bringing this to your doctor, one phrasing helps more than any other: “I know fatigue
comes with this, and I’d still like to rule out the treatable causes.” It moves the conversation
from complaint to plan.
You are allowed to ask twice.

09/01/2026

Almost every patient I meet has tried removing something from their diet before they’ve tried
adding anything.
Nightshades. Dairy. Lectins. The list grows every year, and it usually comes from a
post rather than a study.
Subtraction is measurable in a way addition isn’t. You can feel yourself giving something up.
You can’t feel your omega-3 level rising. So the harder path starts to feel like the more serious
one.
The evidence sits almost entirely on the addition side. Olive oil. Fatty fish. Beans. Fiber. Those
have trials behind them. Most elimination protocols have testimonials.
If cutting something out genuinely helps you, keep doing it. You know your body better than
any study does. Just don’t mistake difficulty for effectiveness.
The goal was never a stricter diet. It was less inflammation.

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2919 W. Swann Avenue, Suite 402
Tampa, FL
33609

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