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Prescribing Lessons (4.17.2026)
Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.
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Adjunctive Prednisolone for Kawasaki Disease
An NEJM study has shown that glucocorticoids provide no added benefit when added to standard primary treatment in Kawasaki disease patients.
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Still's Disease Update
Arthritis Research & Therapy has published an overarching review of Still's disease - claiming it to be a single acquired and complex autoinflammatory disease in which both pediatric and adult forms share core pathogenic mechanisms, genetic associations and clinical presentations, with minor differences between children and adults who are afflicted.
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Litifilimab in Cutaneous Lupus Erythematosus
Biogen has announced positive results of their Phase 2 study, evaluating litifilimab in patients with active cutaneous lupus erythematosus (CLE), presented at the recent American Academy of Dermatology (AAD) Annual Meeting.
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Opioids Down, Gabapentins Up
The number of U.S. patients prescribed long-term opioid therapy declined from 2015 to 2023, but co-prescribing of opioids with gabapentinoids increased, prescription data showed.
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Retrospective observational study of IPAF (ILD w/ autoimmune) pts - from Mt Sinai ILD registry 791 - 14 Rx w/ rituximab vs 19 not. Betw group outcomes same: PFTs, O2 use, Infx, Resp admissions, mortality. RTX group recv more immunosuppressives. https://t.co/sle4a0JOFL https://t.co/rS69epQiif
Dr. John Cush RheumNow ( View Tweet)
A LESSON FOR GC OVERUSE: Inappropriate PPI use was Twice as successful w/ reduced w/ GP & Pt-facing intervention (15 vs 7%) vs usual care or GP-only intervention. Study of 1498 GPs, 34K pts https://t.co/QWW0VYVpzU https://t.co/X3V6NMawq2
Dr. John Cush RheumNow ( View Tweet)
Malignancies Not Increased with Biologic Therapies
The risk of malignancy in RA patients receiving biologic agents was evaluated by metanalysis of RCTs and found no significant increased risk of malignancy compared with other DMARDs or with placebo.
https://t.co/ZEO4jP5RwA https://t.co/C1YeTSh7ZN
Dr. John Cush RheumNow ( View Tweet)
TRACE study in 90 active axSpA, biologic-naïve, Rx w/ secukinumab 150 mg; @wk16 ASDAS remission in 30 (35%)& 55 incr SEC to 300 mg. By wk 24, 22% of 300 mg achieved ASDAS remission; but without signif change in MRI inflamm (SPARCC). Most MRI changes in 1st 4wks https://t.co/pMMtrxxDLh
Dr. John Cush RheumNow ( View Tweet)
Cross-sectional study from UK Clinical Practice Research Datalink Aurum looked at > 40K w/ #PMR Rx w/ steroids - 67% were coprescribed bisphosphonates (BP) & 79% Rx PPIs/H2RAs (less in males & pts deprived areas) resulting more Fx w/in 12 mos (2.32% vs 1.4%). https://t.co/b2DFJMjqCu
Dr. John Cush RheumNow ( View Tweet)
Retrospective study of 374 newly diagnosed microscopic polyangiitis (MPA) pts - 97 (26%) had severe infections w/in 6 mos - signif higher risk w/ high dose prednisone & chronic lung Dz. most common: bacterial (43%) & lung infx https://t.co/XXAxUZw7kx https://t.co/atK8Ob9zyQ
Dr. John Cush RheumNow ( View Tweet)
Retrospective observational study of IPAF (ILD w/ autoimmune) pts - from Mt Sinai ILD registry 791 - 14 Rx w/ rituximab vs 19 not. Betw group outcomes same: PFTs, O2 use, Infx, Resp admissions, mortality. RTX group recv more immunosuppressives. https://t.co/sle4a0JOFL https://t.co/SyhK12KhHY
Dr. John Cush RheumNow ( View Tweet)
Opioids Down, Gabapentins Up
The number of U.S. patients prescribed long-term opioid therapy declined from 2015 to 2023, but co-prescribing of opioids with gabapentinoids increased, prescription data showed.
https://t.co/iXEUfR18Is https://t.co/6DCUvGAW6N
Dr. John Cush RheumNow ( View Tweet)
NHIS 10yr survey of 195,600 Americans shows Chronic pain assoc w/ double rates of smoking & vaping. Smoking decr over time, but always higher in chronic pain pts (17.7% 2014, 13.1% in 2023) than w/o pain (12.5% 2014, 7.5% 2023). E-cigs incr over time, more w/ chronic pain https://t.co/iW7IDwHyJa
Dr. John Cush RheumNow ( View Tweet)
2023 FDA’s removal of REMS in-person Rx requirement for mifepristone was assoc w/ large increase in mifepristone Rx at pharmacies (most thru mail order where abortion is legal and telehealth Rxing is permitted https://t.co/9NHMmxUpLl https://t.co/jkV5DmIaJt
Dr. John Cush RheumNow ( View Tweet)
Systematic review of plasma exchange (PE) in myositis (IIM) - 35 studies (mostly observational), 473 IIM pts (361 Rx w/ PE). Many reported improvements (publication bias). 7 comparative RCTs show no mortality benefit (severe ILD) (RR 0.41, 95% CI 0.16–1.06, I2 = 70%) https://t.co/ox0pdUL3Ek
Dr. John Cush RheumNow ( View Tweet)
Claims data 2,751 #AAV patients - 6.2% developed #PJP infx. w/ predictors: age, max GC dose, rituximab, CTX, & PJP prophylaxis had Good concordance (0.70) @2mos & 0.66@1yrs. W/ monthly risk of 1.0%, prophylaxis yielded 34 potentially preventable PJP cases https://t.co/c2ObDnmfYp https://t.co/0JRd1k0R2R
Dr. John Cush RheumNow ( View Tweet)
Couldn’t attend https://t.co/4UQlqwujiR 2026?
You can now watch the entire meeting On Demand.
This high-impact program features leading experts discussing:
• RA outcomes and pathogenesis
• Obesity, inflammation, and rheumatic disease
• Treatment decisions in Psoriatic https://t.co/A3wb3pzbl3
Links:
Dr. John Cush RheumNow ( View Tweet)
Danish real-world study anifrolumab use in 36 #SLE pts. SLEDAI-2K decreased from 8 (baseline) to 2 @ mos 3; @6 mos 52% had SLEDAI-2K=0. 87% had PGA ≤0.5 w/ LLDAS, & 70% DORIS remission. Pred use declined by >50%. Herpes infx were most freq AE https://t.co/gNIAoXplMt https://t.co/D6xhQrY8ep
Dr. John Cush RheumNow ( View Tweet)
Among neuro-ophthalmic complications of Immune Checkpoint Inhibitors, myasthenia gravis (often with concomitant myositis) is most common irAE, followed by optic neuropathy (often as optic neuritis) https://t.co/7pxqSKY3M1 https://t.co/bisbShFHIc
Dr. John Cush RheumNow ( View Tweet)
