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Treating During Pregnancy (11.14.2025)

Jack Cush, MD

Dr. Jack Cush reviews the journal articles, news and guidelines from this past week on RheumNow.com

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Gottrons,mechanics

Hospital Mortality in Dermatomyositis

Jack Cush, MD

A cohort study shows that hospitalized patients with dermatomyositis have higher in-hospital mortality in the presence of active rash, interstitial lung disease, and elevated neutrophil to lymphocyte ratio at admission.

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ILD damage fibrosis path

More on Methotrexate and ILD Risk

Jack Cush, MD

To assess the progression of the interstitial lung disease related to Methotrexate (MTX) exposure, and to evaluate the lung involvement in RA non-ILD patients with MTX exposure, a systematic review was performed to assess whether RA patients receiving methotrexate (MTX) are at greater risk f

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CPPDwrist.JPG

IL-1 Inhibition in CPPD

Jack Cush, MD

Controlled clinical trials in patients with calcium Pyrophosphate Deposition Disease (CPPD) are scant. Now a metanalysis provides evidence that anakinra, an interleukin-1 inhibitor, is a promising alternative for patients with acute CPPD flares.

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Sjogren_syndrome_salivary%20bx%282%29.jpg

DAHLIAS study - Nipocalimab in Sjögren's Disease

Jack Cush, MD

Nipocalimab, a neonatal Fc receptor blocker that reduces circulating IgG and autoantibodies, was shown to be effective in a phase 2 trial in patients with severe Sjögren's disease.

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Stevens-johnson-syndrome.jpg

Genetic Risks and Severe Cutaneous Reactions to Allopurinol

Jack Cush, MD

A matched cohort study shows that HLA-B*58:01 and HLA-A*34:02 are strongly associated with allopurinol-induced severe cutaneous adverse reactions (SCARs), these alleles were absent in more than one-third of those affected, suggesting these are strong but incomplete indicators of SCAR risk. 

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ACR, guidance, guidelines

New ACR 2025 Guidelines for Non-Renal Lupus

MedPage Today

Written by Lisa Sammaritano, MD, of the Hospital for Special Surgery in New York City, and a committee of nearly 50 other experts, the new guideline also stipulates that corticosteroids are OK for gaining symptom control in newly diagnosed patients and when flares erupt, but the duration should be kept as short as possible.

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In 2024, 77 pts referred to Rheum for possible PMR were ultimately Dx w/ B19 viral infx. 96% had arthralgia & 7% had PMR-like features (5/5 w/ BL shoulder/neck. prolonged AM stiff, fever & Hi CRP/ESR - none had hip pain. 4/5 were male, w/ mean age of 55 yrs. None were RF/CCP+ https://t.co/SsLVEyL8X8
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Having #RA does not increase mortality in CA pts Rx w/ immune checkpoint inhibitors (ICI). 301 Veterans w/ RA & 2114 nonRA controls were compared: all-cause mortality was similar (HR 1.09; 0.94, 1.25). Most deaths from cancer (90% & 91%), but rarely from infection (<1%) https://t.co/gsXie6HpTu
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SLE Prospect. Observational Study of 826 SLE pts over 3 yr for outcomes& IFN signature (IFNGS). 71% were IFNGS-high. IFNGS-high pts were younger. on GC w/ Hi SLEDAI-2K. SLEDAI-2K decreased over time, regardless of IFNGS. By 36mos, 45% had ≥1 flare; higher in IFNGS. https://t.co/c3zHT2GfR5
Dr. John Cush RheumNow ( View Tweet)
Western Australia study of 1854 SLE pts (median 40 yrs old). Interstitial lung disease was seen in in 3.8% of SLE, 26 fold more than controls. Risk factors for ILD included older age, smoking and serositis. SLE-ILD pts had higher mortality rates (MR 52.0, CI 37.0–71.1).

Dr. John Cush RheumNow ( View Tweet)

Biologic use in 5008 IBD pts finds higher serious infxn (SIE) rates (vs, RA or PsO). In UC the SIE rate was 5.5/100PY w/ vedolizumab & 7/100PY w/ other biologics. In Crohns the SIE rate was 7.9/100PY w/ vedolizumab vs 6.5/100PY w/ other biologics (adj HR 1.15; 0.95–1.40) (P .16) https://t.co/R7YC220NnO
Dr. John Cush RheumNow ( View Tweet)
Genetic Risks and Severe Cutaneous Reactions to Allopurinol A matched cohort study shows that HLA-B*58:01 and HLA-A*34:02 are strongly associated with allopurinol-induced severe cutaneous adverse reactions (SCARs), these alleles were absent in more than one-third of those https://t.co/NLpHVhr9Ww
Dr. John Cush RheumNow ( View Tweet)
Swedish Birth Registry study of adverse preg outcomes (APOs) after SSc Dx [n=941] or w/in 3 yrs [39] or > 3yrs pre-Dx [839]. SSc women have incr APOs post-Dx, including preeclampsia (RR 3.8), preterm (3.3), C-section (2.5); but also incr APO risk w/in 3 yrs of Dx

Dr. John Cush RheumNow ( View Tweet)

NHANES study of 4,622 adults, including 296 w/ RA, shows volatile organic compounds (VOCs) & metabolites (mVOCs) exposures increases the risk of #RA (OR: 1.23 - 1.37), especially in females. https://t.co/pBNLTRkyLn https://t.co/L6nVbYlBhD

Links:

Dr. John Cush RheumNow ( View Tweet)
Genentech announced positive results from the phase III DBRPCT ALLEGORY trial showin safety & efficacy of obinutuzumab in ~300 SLE pts on SOC. Results have yet to be presented publicly. https://t.co/4hoT9dBtPq

Links:

Dr. John Cush RheumNow ( View Tweet)

Systematic review of 10 studies showed TNFi exposure in utero not assoc w/ incr risk of infant severe infxn (4 RCTs); same for breast milk exposure (2 RCTs). Infant vaccination outcomes unaffected by TNFi use, but rec delaying BCG vaccination if TNFi exposed https://t.co/02Nn6TuzR3
Dr. John Cush RheumNow ( View Tweet)
In 2024, 77 pts referred to Rheum for possible PMR were ultimately Dx w/ B19 viral infx. 96% had arthralgia & 7% had PMR-like features (5/5 w/ BL shoulder/neck. prolonged AM stiff, fever & Hi CRP/ESR - none had hip pain. 4/5 were male, w/ mean age of 55 yrs. None were RF/CCP+ https://t.co/AiK2K9whBH
Dr. John Cush RheumNow ( View Tweet)
Stopping therapy in GCA At #ACR25 we saw the SELECT-GCA extension data presented in the first plenary session, looking at the second year after the 52 week original study, comparing upadacitinib versus placebo in GCA. In this second year, patients in remission on upadacitinib https://t.co/GaYNWr3Sjq
Dr. John Cush RheumNow ( View Tweet)
Upadacitinib: revisiting safety data in RA and GCA For the last several years, conversations about JAK inhibitors have often started and ended with safety. The shadow cast by ORAL Surveillance has made clinicians more cautious and regulators more restrictive. Yet in practice, https://t.co/6Wes2npkFd
Dr. John Cush RheumNow ( View Tweet)
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