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3 x IL-23 = IL do Better (11.6.2026)
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Jack Cush, MD

Nov 06, 2026

Dr. Jack Cush reviews the FDA approvals and news reports from this past week on RheumNow.com. This week we discuss playing the numbers in rheumatology, playing the long game with stem cell transplants, and a=the Positive spin on seronegative RA.

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aPL vs APS in Pregnancy: Same Antibody, Different Plan -aPL but no APS: no anticoagulation; low-dose aspirin (LDASA) may reduce preeclampsia risk -Obstetric APS: LDASA + prophylactic LMWH, continued through 6 weeks postpartum -Thrombotic APS: LDASA + treatment-dose LMWH;

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Dr. John Cush

#Vaccinate your #SARD Pts esp if given strong #immune #suppression #Taiwan #College of #Rheumatology #recommendations for #vaccines Pre & Post #CAR-T Can apply for #IMMUNESUPPRESSED Pts in general who get #B #cell #depletion #ACR26 abst#2773 @RheumNow https://t.co/34xcBjsD99

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Treatment for ICI-IrAEs: •Early immunosuppression/high doses of steroids (first 2 months) associated with worse survival. •ICI-IA: TNFi and IL-6Ri mostly used •ICI-PMR: steroids/IL6Ri •ICI-myositis: steroids/IVIG mostly used. •Little data on effects of long-term

Immune-Related Adverse Events: ICI-IA: the most common rheumatic irAE-> Heterogeneous presentation. 50-78% persist >6m after stopping ICI. Usually seronegative and have elevated inflammatory markers. ICI-PMR: some pt with peripheral inflammatory arthritis, less likely comorbid https://t.co/Ad5FPGZ8nP

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Importance of genetics in rheumatic diseases #ACR26 #ReviewCourse @RheumNow https://t.co/weDtEQH0Cb

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Don't use MTX post TCZ stoppage METEORITICS randomized 52 patients to MTX vs placebo post TCZ. NO difference in time-to-relapse (see km curve) Small trial & more flares in PLBO group... but difference not worth MTX exposure/ade/etc @RheumNow #ACR26 Ab#0179 #ACRBest https://t.co/BBz7eXwZhz

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Depth of B Cell depletion matters 44 myositis pts on RTX - conventional B cells did not identify rewsponders... ...but highly sensitive flow (2 log higher sensitivity) did (93% of responders vs 31% of nonresponders) Promising biomarker but also suggests deeper b cell depleters https://t.co/LtWEg6NuyW

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The Concern about Seronegative RA A current review of seronegative RA (SNRA) by D’Onofrio, et al in npj Autoimmunity shows the diverse fate of seronegative RA - which can resolve, persist or become refractory. Clearly dedicated trials of SNRA are needed to better predict. https://t.co/6OQhYemkUX

FDA Approves Tildrakizumab for Psoriatic Arthritis Sun Pharmaceuticals announced Friday that the FDA has approved its IL-23 inhibitor, tildrakizumab (Ilumya) for use in patients with active psoriatic arthritis. https://t.co/9vJoJ35iso https://t.co/KeA3Xh8QG9

FDA Approves Tildrakizumab for Psoriatic Arthritis | RheumNow

-AZA is safe in pregnancy but can cause risk of ICP. -Monitor pts on AZA closely for ICP symptoms. #ACR26 @RheumNow https://t.co/v9mNKVNKcm

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Emergence of systemic autoimmune rheumatic diseases can occur in menopause and difficult to differentiate from "MS syndrome of Menopause" HRT: Safe in Non-SLE autoimmune disease/SLE with negative APL+ use with caution/Not recommended in APL+/APS #ACR26 @RheumNow https://t.co/6al61n1ck3

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-Biologic DMARDs are generally safe for pregnancy: ETA and CZP safer compared to others. -B cell depletion can be used in pregnancy but caution about neonatal cytopenias for first 6m if dosed in 2nd half og pregnancy. -Counsel on vaccination for biologic exposed babies. #ACR26 https://t.co/byQgPpAveT

After stopping TCZ in GCA (~2 yrs exposure), over HALF of pts still flared w/in 72 weeks, even among pts w/imaging remission Most flares 3-6 mos post stopping Good evidence for continuing longer; I continue many pts on TCAZ up to 5 years post dx @RheumNow #ACR26 Ab#0186 https://t.co/yq0rXv1l3S

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Nice RWE study of UPA in GCA Refractory cohort w/multiple prior biologics; 22/34 evaluable pts had clinical remission at 6 months; 7/63 stopped for severe adverse events. Useful real-world signal, overall corroborates SELECT-GCA @RheumNow #ACR26 Ab#0184 https://t.co/hGRFAoV6B4

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Exercise is essential for pts w/myositis Improved fatigue and reduced disability among pts with myositis who engaged with structured exercise programs No comparator & small, but important message to pts who are often nervous about working out @RheumNow #ACR26 Ab#0652 https://t.co/c4tejsWQYk

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Beyond Chondrocalcinosis - What’s New in CPPD Disease An overview of calcium pyrophosphate deposition (CPPD) disease by Sara Tedeschi presents our evolving understanding of CPPD with advances affecting nomenclature, classification, imaging, genetics, long-term outcomes and https://t.co/YrFjGJZDph

Tocilizumab is effective in glucocorticoid-resistant adult-onset Still’s dz. 40 AOSD pts rx w/ TCZ (4-8 mg/kg q4wks). @12 mos clin remission 55%, 6 mos CID 62%, signif drops in CRP, ESR, ferritin & daily pred decr 91% (50 to 4.4 mg; p<0.001). TCZ retention 65%; MAS 7.5% & https://t.co/Olynr7VfhE

Japanese retrospective cohort systemic sclerosis study shows adjunctive tofacitinib improved ower esophageal sphincter pressures (LESP). 50 SSc pts w/ esophageal Sxs Rx w/ Tofa or PBO x 24 wks. Tofa assoc w/ signif LESP increases & lower mRSS & IL-6 levels https://t.co/NNREBddiOi https://t.co/acVOfoorRP

Tofacitinib and esophageal-related manifestations in systemic sclerosis: a retr…

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Therapeutic Updates

Individualized PsA Treatment With an IL-23i or a JAKi

Sponsored by AbbVie Medical Affairs + Health Impact

Nov 01, 2026

In Part 2 of our PsA management series, Saakshi Khattri, MD, and Lindsay Tom, PA-C, discuss tailoring treatment for patients with multidomain PsA and how IL-23i and JAKi data guide their decisions

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