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Variability of Guidelines on the Perioperative Use of DMARDs in Rheumatic Diseases Patients

Jack Cush, MD

More effective treatments in patients with rheumatic diseases have resulted in less need for major surgery, yet a substantial number of RMD patients will undergo surgery often in the setting of DMARDs use. A scoping review looked at numerous clinical practice guidelines/recommendations for the perioperative management of DMARDs and found inconsistencies and low quality evidence, with great reliance on conditional (expert opinion) recommendations.

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Early DMARD Initiation Benefits in Psoriatic Arthritis

Jack Cush, MD

Mease et al has published the results of a cohort study showing early initiation of disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis (PsA) resulted in better outcomes compared to late initiation.

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Immunomodulators in the Treatment of Autoimmune Hepatitis

EurekAlert!

Autoimmune hepatitis (AIH) is a chronic, progressive inflammatory liver disease driven by autoimmune mechanisms, characterized by elevated serum aminotransferases, hypergammaglobulinemia, and interface hepatitis on histology.

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ICYMI: Channeling Bias and Cancer Risk with Biologic or Targeted Synthetic DMARDs

Jack Cush, MD

A retrospective US administrative claims cohort study of RA patients on tumor necrosis factor inhibitors (TNFis), non-TNFi biologics, or Janus kinase inhibitors (JAKis) found a statistically significantly higher risk of incident cancer in patients receiving rituximab, abatacept, or JAKis (compared with TNFis).

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Hepatitis B (Keep)

ICYMI: AGA Guideline: Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals

Jack Cush, MD

The American Gastroenterology Association has published its revised clinical practice guidelines for the prevention and treatment of hepatitis B virus (HBV) reactivation in at-risk patients, particularly those with immune-mediated disease, receiving immunomodulatory therapy and steroids.

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ICYMI: TNF Inhibitor Drug-Induced Lupus

Jack Cush, MD

A study from the FDA's adverse event reporting system (FAERS or Medwatch) database identified cases of drug induced systemic lupus erythematosus (SLE) in patients receiving tumor necrosis factor-α (TNF-α) inhibitors - a paradoxical reaction to common antiinflammatory biologic agents.

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ICYMI: Axial Involvement in Psoriatic Arthritis

Jack Cush, MD

Analysis of a Greek Psoriatic Arthritis (PsA) cohort shows that nearly one quarter of patients have axial involvement, and among them, ∼30% have isolated spinal axPsA and nr-axSpA, respectively.

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PCR: Prevalence, Cost, & Risk (6.27.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from last week on RheumNow.com

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10-20% of IBD pts have IBD-assoc. spondyloarthritis, as either peripheral arthritis or axial Dz, subclinical gut inflammation w/ IL-23–IL-17–TNFα playing central roles. TNFi & JAKi Rx is effective, but IL-17i may exacerbate IBD (vedolizumab??) Review here>> https://t.co/kNIAi55Y7z
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No Increased Malignancy Risk with Ixekizumab A pooled analysis of 25 randomized clinical trials affirms the safety of ixekizumab (IXE) when used to treat patients with psoriasis (PsO), psoriatic arthritis (PsA), or axial spondyloarthritis (axSpA). The observed incidences of https://t.co/7dAoQyeq5x
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Rheums! Question or case for Jack Cush? Record it here and we may feature it on an upcoming podcast. https://t.co/HsqM9xLNtP https://t.co/voONsOLeSK

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Reducing Progression of Psoriasis to Psoriatic Arthritis Tumor necrosis factor (TNF) inhibitor therapy was effective in reducing the likelihood that psoriasis would progress to psoriatic arthritis (PsA), a retrospective study indicated. https://t.co/xOtA2Hrgue https://t.co/S522IYnFgz

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Biologic experienced ankylosing spondylitis patient show better retention on TNF compared to IL-17 inhibitors. 148 AS pts (F/U 31 mos), IL-17i drug survival trended better but only signif after 3yrs. More D/C w/ higher BASDAI (HR: 1.3) & ^# prior biologics (HR 1.62) https://t.co/5HXGsV4xol
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Granzyme expression is upregulated in RA, esp early RA. Blood & synovium from early arthritis & TNFi nonresponders (R4RA RCT) gene expression five granzymes, perforin, & serglycin determined by bulk RNA-sequencing data. GZM A, B, H, K, M, PRF-1, SRGN was higher in lymphoid https://t.co/v1rdFZHuuh
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❓️Is early intensive therapy with combination csDMARDs or TNFi superior to standard step care for the treatment of moderate to severe #psoriatic_arthritis? 🅰️ Yes 🔅Check out the SPEED RCT presented by @DrLauraCoates at #EULAR2025 OP0089 @RheumNow #Strategy

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Efficacy and safety of deucravacitinib up to week 52 in the POETYK PsA-2 study •ACR20 at W16: 54.2% (deucravacitinib) vs 39.4% (placebo), p=0.0002 •PASI75: 40.9% vs 15.4%, p<0.0001 •MDA: 25.6% vs 14.7%, p=0.0007 •FACIT-F: +2.5 vs +1.8 •SAE: 1.9% (low) TYK2 inhibition shows https://t.co/PLJytueZDt
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Sex differences in biologic response in PsA. DISCOVER-2 post hoc analysis showed: •Radiographic progression at Week ♂️: 2.22 units ♀️: 1.10 units •Early ACR-like response (cDAPSA LDA at 8wks) linked to less damage in men (0.39 vs 2.24) Women less likely to progress https://t.co/hvRxKTMJT5
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Early intensive therapy in PsA. STAMP RCT in early PsA: •ACR50 at 3mo: 43% (early secukinumab) vs 22% (SoC) •MDA at 3mo: 48% vs 25% •PASI90 at 3mo: 60% vs 22% By 12months: outcomes similar, but early secukinumab led to faster control and fewer therapy escalations. https://t.co/Mn0uW3cckf
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Remission in Axial Spondyloarthritis Unrelated to Gut Inflammation Most patients with early, active axial spondyloarthritis (axSpA) who quickly received a tumor necrosis factor (TNF) inhibitor experienced remission, and it didn't matter whether or not they had intestinal https://t.co/Sa10k6neRP
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What would it take for JAKs to ROCK the boat? JAK inhibitors have taken a beating over the last three years. The excitement and potential has been tempered by mounting cardiovascular safety concerns, but specifically in at-risk patients, compared to TNF inhibitors. https://t.co/tgfsU3uFVo
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