TNF inhibitor

TNFi mAbs, JAKi, –IL-17 are protective against Anterior Uveitis (AU) in AxSpA. Metanalysis of 44 RCTs shows AU IR: - TNF mAbs: 4.1 - etanercept 5.4 - IL-17i: 2.8 - JAKi: 1.5 - placebo: 10.8 https://t.co/qN9UL16YPO https://t.co/5WOjAq9ty6

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Dr. John Cush @RheumNow( View Tweet )
This study examined the risk of neuroinflammatory disease after initiation of b/tsDMARDs Overall risk of neuroinflammatory events among new users of TNF inhibitors did not differ substantially as compared to new users of other b/tsDMARDs In AC&R https://t.co/8rGgZmpq9c https://t.co/5gxuWBctBL

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ACR_Journals @ACR_Journals( View Tweet )
#RNL2024 @RheumNow @AlexisOgdie Many therapies for SpA - but ONLY TNFi, IL17i, and JAKi for AxSpA Check out https://t.co/3918uYvdFj to help guide treatment decisions: Prior therapies? enthesitis? concomitant IBD/uveitis? comorbidities? Pt preferences? https://t.co/6ugueBPMTy

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Dr. John Cush @RheumNow( View Tweet )

#RNL2024 @RheumNow @_AprilArmstrong Choosing a biologic in Psoriasis TNF - great in PsA, pregnancy. Avoid in demyelinating, hep B IL-17 - robust skin, PsA (axial too). Avoid in IBD IL-23 - robust skin, PsA evidence, fewer injections https://t.co/42kUaIZxKs

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Dr. John Cush @RheumNow( View Tweet )

April Armstrong RNL

ICYMI: Co-management of Psoriatic Disease

Richard Conway, MBBChBAO, PhD

It is a common clinical scenario to see someone with both severe psoriatic arthritis and skin psoriasis. In an ideal world this would involve a combined clinic with our local friendly dermatologist. For many of us, however, this is not practical for many reasons. The excellent Saturday morning

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vedolizumab-induced enthesitis @lihi_eder #RNL2024 @RheumNow 11/90 (12.2%) of pts on VDZ for IBD w/ develop new-onset enthesitis Is this true drug rxn or previously masked by prior meds (TNF)? Usually unilateral +/- oligo, dactylitis Most respond to NSAID or injxn, 27% change Rx

Dr. John Cush @RheumNow( View Tweet )

Staph. aureus bacteremia (SAB) is assoc w/ poor outcomes & Osteoarticular infection. Danish study of 18 274 SAB pt (367 w RA). 90d SAB risk in RA was 23% vs 12.5% in non-RA (HR 1.93). Higher w/ Jt implants (29%) & TNFi use (42%). 90d Mortality was 35% https://t.co/hjaPnTbE0E https://t.co/7t7omiUVYf

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Dr. John Cush @RheumNow( View Tweet )
Oral Surveillance study revisited: the risk of Venous thromboembolism & Pulmonary emboli were higher with tofacitinib (10>5 mg BID) versus TNFi and were generally consistent over time. VTE & PE risk incr by age, BMI, and VTE Hx https://t.co/v7ISjw5Rvd https://t.co/10oE7MiAAj

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Dr. John Cush @RheumNow( View Tweet )
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1/600 Falls May Die (4.5.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and Journal reports from this past week on RheumNow.com -  including problems w/ falls, pain and treatment of Dupuytren’s contractures.

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soluble Fms‐like tyrosine kinase‐1 (sFlt-1)/placental growth factor (PlGF) ratio, biomarkers of placental function and adverse pregnancy outcomes. Study of 158 RA pts, 1/2 on TNFi during Preg. TNFi assoc w/ incr birthweight; no effx on sFlt‐1 & PlGF https://t.co/JFvDxrTAfr https://t.co/CRxSEbm2Ru

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Dr. John Cush @RheumNow( View Tweet )
Korean biologics registry study 526 Ank Spondylitis pts on TNFi > 1yr and tapered; 24.1% experienced flares. Predictors of flare included B27+, inflammatory LBP, psoriasis, SpA Fam Hx, DM, ≥50% TNFi tapering, Dz activity (ASDAS-CRP, BASFI) at tapering https://t.co/jjyMX3borT https://t.co/u0lbtfCyz1

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Dr. John Cush @RheumNow( View Tweet )
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Activity & Pain Tolerance (3.29.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com, including where you should sit in clinic and why you should worry about secondary Sjogren's in RA.

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Naysayers & Disrupters (3.22.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week - including a few contrary reports on infection, seropositivity and plasmapheresis.

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2023 EULAR Psoriatic Arthritis Recommendations

Jack Cush, MD

EULAR has updated its treatment recommendations from the prior 2019 guidelines, since which there have been several newly developed agents. The updated guidance includes 7 overarching principles and 11 recommendations regarding treatment strategy and pharmacological therapies.

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Expert Panel Guidance on Managing Psoriatic Arthritis and Comorbidities

Jack Cush, MD

An expert panel has published their consensus guidelines for the management of psoriatic arthritis (PsA) and it's comorbidities in the journal Rheumatology. 

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Japanese study of 672 autoimmune pts on TNFi & tocilizumab - 1.6% (n=9) developed non-tuberculous Mycobacteria (NTM) infx post biologics. 2 disseminated NTM, 2 died. NTM pts had higher mortality [(22% vs 2.6%) & took more steroid (17 vs 3 mg, P=0.004).https://t.co/fGGafrTeiL https://t.co/DkmiC2hVEA

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Dr. John Cush @RheumNow( View Tweet )
JAK-pot: 46913 Rx courses on JAKi, TNFi, other MOA. Rx D/Cs for AEs: - TNFi = JAKi (HR 1.0) - Other MOA > JAKi (HR 1.11) - TNFi < tofacitinib (0.81) - TNFi > baricitinib (1.15) - TNFi < JAKi; if >65yrs w/ CV risk (0.79) https://t.co/jCtLG3SNvP https://t.co/FN5U5Z1M9M

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Dr. John Cush @RheumNow( View Tweet )
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Ides of March (3.15.2024)

Jack Cush, MD

Dr. Jack Cush has advice for Caesar and the superstitious, and covers pregnancy, platelets, dialysis and vaccinations in Lupus.





  1. Dutch study of 586 RA pts on bDMARDs found more nonserious infections (NSIE) (77/100PYs) than serious infx (SIE)(1.3/100Pys). Upper respiratory

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DMARD,trends,2021

US Trends in RA DMARD Use 2017-2021

Jack Cush, MD

A trend analysis of DMARDs shows that only half of rheumatoid arthritis (RA) patients are taking DMARDs, and that the COVID-19 pandemic substantially affected DMARD use. Despite numerous DMARD advances and evolving treatment guidelines since 1990, older therapies are still commonly used and

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Depression and RA Dr. Jack Cush reviews the news, journal reports and regulatory approvals from the past week. https://t.co/nJZD4D2ByC https://t.co/ET3Xp9cK62

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Dr. John Cush @RheumNow( View Tweet )
Have a Rheumatology question or case for Jack Cush? Record it here and we'll feature it on an upcoming podcast. Tell us your name and where you practice rheumatology. https://t.co/a3XeAa2lcG https://t.co/dTZa2uQF97

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Dr. John Cush @RheumNow( View Tweet )
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Many with Psoriatic Arthritis Fail to Achieve Minimal Disease Activity

Jack Cush, MD

Despite the availability of numerous advanced therapies for psoriatic arthritis (PsA), there remains a substantial burden and unmet need for improved therapies, according to a newly published Canadian study.

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DMARDs, MTX & TNFi can lower CV risk in RA pts. #RWCS24 https://t.co/Un457RYL8R
Dr. John Cush @RheumNow( View Tweet )
Combo IL-23 and TNFi synergistic benefit in UC in the proof-of-concept VEGA trial. More data to come! #RWCS24 @RWCSmtg @RheumNow https://t.co/FgLTR2PBYJ

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Dr. Rachel Tate @uptoTate( View Tweet )
Dr. J. Giles reviews adipose tissue as a source of inflammatory cytokines like TNF, IL-6, IL-1, IL17, etc. #RWCS24 @RWCSmtg @RheumNow https://t.co/AYD9PpwNE6

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Dr. Rachel Tate @uptoTate( View Tweet )

Recent Blogs

Infections Rheums Should Worry About

Cassandra Calabrese, DO
TB.EMimage.CDC_.jpg
With the increasing development and use of new biologics and oral targeted therapies to treat RA and other immune mediated inflammatory diseases, an awareness of infection risk and prevention has become of increasing interest as well. While our patients may be susceptible to many different types of infections depending on immunosuppressive regimen, age and co-morbidities, I’ll highlight a few of the “usual suspects”. Read Post

Hard Conversations: DMARDs and Malignancy

Michael Putman, MD, MSCI
Risk Option Decision
Cancer is the most difficult DMARD risk to discuss with patients. Few warnings could scare people away from a drug faster than the words “may increase risk of cancer,” yet the risks (even when substantiated) have all been low and may be counterbalanced by the benefits of disease control. Read Post

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