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Methotrexate Safety Tips (7.31.2026)
Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.
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Four Decades of Gout Management
During this month-long campaign on Gout, we have documented many significant changes in our approach to gout, as well as many unmet needs and deficiencies that merit our continued, primary attention. We are all familiar with the famous 1905 quote, “Those who cannot remember the past are
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New Avacopan Analysis Sent to FDA
MedPage Today
After data manipulation allegations, the FDA has been calling for the vasculitis drug to be pulled from the market since January.
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Uricase-Targeted Therapies in Gout
In most mammals, uricase catalyzes the oxidation of uric acid to allantoin, a highly soluble compound easily excreted by the kidneys. But humans lack functional uricase, leaving xanthine oxidase inhibitors (allopurinol/febuxostat) as first-line urate-lowering therapy (ULT). Uricase-based biologics are reserved for uncontrolled/refractory gout patients with gouty flares, active synovitis, and/or non-resolving tophi despite optimized oral ULT.
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Study of 154 anti-Ku Ab+ pts (51 IMMM, 46 SLE, 30 Sjögrens, 27 Sc) = 60 (39%) had ILD - 75% progressed; more rapidly in males. BUT Ku+ is rare <4%, not specific, without clear clinical implications. Ku is a myositis-assoc Ab (like Ro52/Ro60, U1-RNP, PM/Scl) https://t.co/MHz8mdqDqi
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Best proof of difference betw Seropos vs seroneg RA from TREAT-EARLIER 12 mos study 236 clinically suspect arthralgia pts w/ subclinical Jt inflammation Rx w/ MTX vs PBO. MTX prevented RA only the seroneg RA (9 v 35%); But no protection in seropos RA (58 vs 65%) https://t.co/ufY9ZJmKgf
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U Alberta Rheumatology study of GCAPS score in 62 new onset, suspected GCA referrals. GCA Dx in 39 pts excluded in 23. 50% had a High risk GCAPS (screening) score, 38% Intermediate & 13% had Low risk GCAPs. Intermediate or High risk GCAPS sensitivity 97%, specificity 30%, PPV 70% https://t.co/gKD1Je3QRH
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Best proof of difference betw Seropos vs seroneg RA from TREAT-EARLIER 12 mos study 236 clinically suspect arthralgia pts w/ subclinical Jt inflammation Rx w/ MTX vs PBO. MTX prevented RA only the seroneg RA (9 v 35%); But no protection in seropos RA (58 vs 65%) https://t.co/A5aFUgMPQR
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U Alberta Rheumatology study of GCAPS score in 62 new onset, suspected GCA referrals. GCA Dx in 39 pts excluded in 23. 50% had a High risk GCAPS (screening) score, 38% Intermediate & 13% had Low risk GCAPs. Intermediate or High risk GCAPS sensitivity 97%, specificity 30%, PPV 70% https://t.co/HxHL60VAuO
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In a Cohort of 410 #SLE pts, there were 37 MALES who demonstrated a high prevalence of renal (IV/V lupus nephritis 49%) and a notable incidence of Plaquenil-related retinal toxicity. 62% on HCQ, but 22% D/C HCQ due to retinal toxicity or drug intolerance. https://t.co/FcIFxRoZ6O https://t.co/7OgexLYWge
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Retrospective study, 41 pediatric Behcets Dz pts looked at Inflam. indices (NLR, SII, PIV, CRP/albumin) vs controls. BD systemic involvement in 68%, CNS dz in 10%, Vascular Dz in 12% & major organ dz 46%. Inflamm indices significantly higher in BD w/ systemic, CNS, & Vasc https://t.co/wHiBIaOWWU
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6 mos. RCT of low-dose baricitinib (Bari) plus danazol for refractory ITP (n 216); Pts Rx w/ either Bari+DNZ vs DNZ alone. At 6-mos a durable response was seen in 45% of Bari+DNZ vs 20% in DNZ monotherapy (P < 0.001). AEs were equal (48% vs 45%), More studies needed on this https://t.co/YbF49ZNA0E
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Cerebral atrophy is common in SLE - assoc w/ age (OR 1.1), higher education (0.22), NPSLE (OR 4.6), cognitive impairment & lower dsDNA titers. 70 pts (mean age 40, Dz dur 12yrs). Cerebral atrophy 53% (mostly 76% mild). https://t.co/ewRmNj8zNA https://t.co/yT8TCXZREA
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Gout: Diagnosis
The diagnosis of gout - labs, imaging and polarized microscopy, created by @MithuRheum for RheumNow.
https://t.co/s8gkANFJSB https://t.co/pkUeFLG5if
Links:
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Interferon-α as an Immunologic Driver of Sjögren's Disease
Using data from a Sjogren's registry, researchers have shown that IFNα drives Sjögren's disease, and can be elevated a decade before diagnosis. This study assessed the role of type 1 interferon (IFNα) in its onset and https://t.co/Clj9u5COzQ
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The Wider Implications of Dactylitis
Dactylitis, AKA the "sausage digit", is a hallmark of psoriatic arthritis (PsA), but as Possemato and colleagues point out, it is fundamentally a clinical sign, and not a diagnosis.
https://t.co/HRaIvMHMSV https://t.co/XOcHbFVMsS
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2 T2T RCTs of 383 gout pts starting allopurinol - 31% had tophi. At 12 mos achieving target uric acid (<0.36mmol/L) was same in pts with and without tophi (70.3 vs 73.6), as was the %gout flares in month 11 (71.4% vs 79.7%; p=0.21). Allopurinol T2T success not influenced by https://t.co/zr7K8Y2Bqz
Dr. John Cush RheumNow ( View Tweet)
Interferon-α as an Immunologic Driver of Sjögren's Disease
Using data from a Sjogren's registry, researchers have shown that IFNα drives Sjögren's disease, and can be elevated a decade before diagnosis. This study assessed the role of type 1 interferon (IFNα) in its onset and https://t.co/0BDDvR5cUB
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UTSW observational study of labs (n 14,199) changes w/ MTX use in 2,439 pts (13% RA, 11% PsO/PsA, 15% inflam arthritis) - found no difference in labs q3 vs q6 mos. No signif correlation betw monitoring intervals & changes in ALT, AST,WBC, HCT, MCV, PLT, FIB-4. Small https://t.co/gKwA7juexG
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Fibrosis-4 (FIB-4) Index for Liver Fibrosis is calculated from age, AST, ALT, Plts. Study of 174 RA, PsA, PsO pts on MTX find 11% w/ fibrosis (by elastography). FIB-4 AUC for fibrosis =0.68 (weak). Fibrosis was signif assoc w/ FIB-4 >1.62, DM, obesity, advanced steatosis https://t.co/GYrhs2U1s3
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