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MTX Fails Knee OA (6.6.2025)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com
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JAKi: expanding RMD indications—but important safety concerns to consider
⚠️ Cancer: Neutral vs MTX/placebo, ↑ risk vs TNF
⚠️ Infection: ↑ with age, disease activity & GC use—not uniformly higher with JAKi
🗣️ Patients rank infection risk as top concern
@rheumnow #EULAR2025 https://t.co/RJRDWQjqNC
Links:
Jiha Lee JihaRheum ( View Tweet)
Age & dose ⬆️ infections in JAKi
Not all JAKi are created w equal risk
@RheumNow @eular_org #EULAR2015 @drdavidliew
#JAKi & #infection https://t.co/F7zLUBuzJR
Janet Pope Janetbirdope ( View Tweet)
Stabilize the pts with HLH with steroids when still trying to figure out the diagnosis of #HLH/ #MAS
Many drugs can be used...but important to balance infection risk with immunosuppression
These are critical pts. Be vigilant..
#EULAR2025 @RheumNow https://t.co/id4ae3SWtj
Links:
Bella Mehta bella_mehta ( View Tweet)
3 Fs of diagnosis of #HLH
-Fever
-Ferritin
-Falling blood count
Raising awareness is the key! Especially in rare diseases like this where the morbidity and mortality is super high!
Collaboration between specialists help
HLH networks will be helpful like this
@RheumNow #EULAR2025 https://t.co/HWbvIma3yx
Bella Mehta bella_mehta ( View Tweet)
ACQUIVAS: RTX-treated AAV patients had poor response to #pneumococcal vaccine PCV-13 (8% vs 45% in non-RTX). Boosting w/ PPV-23 helped a few but 48% failed to mount robust response. Time to rethink vaccine strategies in RTX-treated patients?
@RheumNow #EULAR2025 #OP0173 https://t.co/soU5qfwRib
Mrinalini Dey DrMiniDey ( View Tweet)
POS0627: RA patients aged ≥90 yrs can benefit from biologics/JAKi! In 3,600 pts, 84% of those ≥90 achieved low disease activity, 71% were on JAKi. But serious infections occurred in 21%—mostly pneumonia. Use w/caution in the oldest-old. #EULAR2025 @rheumnow
Jiha Lee JihaRheum ( View Tweet)
What’s worse for infection in GCA: tail end steroid taper, or a JAK inhibitor?
This is exactly SELECT-GCA in the second 6mo. What happened?
upa skews better on serious infection, worse on HZ
JAKi might have infection risk, but not like steroids. OP0057 #EULAR2025 @RheumNow https://t.co/FigxviOW3e
David Liew drdavidliew ( View Tweet)
Case series of 22 PsA pts treats w/ combination bioDMARDs & JAKi,TYK2i or APR
IL17i + JAKi 10.5 PY = 1 mild infectious stomatitis
IL23i + JAKi 3.7 PY = no AE
IL-17i + TYK2i 8.5 PY = 2 mild upper respiratory infections
IL-23i + TYK2i 8.3 PY = 2 mild URIs, 1 folliculitis
TNFi + https://t.co/Qg9HIwuslJ
Aurelie Najm AurelieRheumo ( View Tweet)
Rheumatologists can’t ignore hypereosinopilic syndrome anymore, not when it borders on our diseases and therapies. Great takeaways on subtypes and therapies from Giacomo Emmi in an elegant talk #EULAR2025 @RheumNow https://t.co/vqZajY0nUp
David Liew drdavidliew ( View Tweet)
135 pts w/ neurologic autoimmune dz (MS, GBS, myasthenia gravis) who had cancer & Rx w/ checkpoint inhibitors (ICI) showed exacerbations in SOME - 18% of MS pts, but 67%of MG, latter often w/ hospitalization (50%) or death (17%). GBS faired well w/ ICI Rx. https://t.co/RksC6QXce0 https://t.co/mYjzgxbcdQ
Dr. John Cush RheumNow ( View Tweet)
In 2019 there was an estimated 273,000 coccidioidomycosis cases in the USA; 23,000 hospitalizations and 900 coccidioidomycosis-associated deaths. Mostly from endemic states California & Arizona. https://t.co/JXPs8B4Dwb https://t.co/ddXIcub0pG
Dr. John Cush RheumNow ( View Tweet)
CMAJ reminds us that w/ parvovirus B19 infection, Arthropathy seen in ~60% of adolescents & adults, but the classic “slapped cheek rash” is uncommon. Symmetric, polyarticular inflamm arthralgias/itis affects PIPs, MCPS mostly. Sxs resolve w/in 3 wks. ~20% can last mos-yrs https://t.co/WXnuViSLbe
Dr. John Cush RheumNow ( View Tweet)
Metanalysis of 12 trials, 12 902 adults hospitalized w/ COVID betw May, 2020 & March, 2022 (7 Bari, 3 Tofa, 2 Ruxo). Fewer deaths in those on JAKi (11·7% vs 13·2%; aOR 0·67 [95% CI 0·55–0·82]; high-certainty evidence); 39 fewer deaths/1000. JAKs had less mechanical ventilation https://t.co/QSMRo3RcRr
Dr. John Cush RheumNow ( View Tweet)
135 pts w/ neurologic autoimmune dz (MS, GBS, myasthenia gravis) who had cancer & Rx w/ checkpoint inhibitors (ICI) showed exacerbations in SOME - 18% of MS pts, but 67%of MG, latter often w/ hospitalization (50%) or death (17%). GBS faired well w/ ICI Rx. https://t.co/RksC6QXce0 https://t.co/HbwYDVrIAt
Dr. John Cush RheumNow ( View Tweet)
In 2019 there was an estimated 273,000 coccidioidomycosis cases in the USA; 23,000 hospitalizations and 900 coccidioidomycosis-associated deaths. Mostly from endemic states California & Arizona. https://t.co/JXPs8B4Dwb https://t.co/90e1TYxGoW
Dr. John Cush RheumNow ( View Tweet)
Sacroiliitis is a rare adverse reaction of isotretinoin. Review of 67 pts finds median age 21 yrs, onset median 2.5 mos (0-24) post isotretinoin. Sxs: LBP 70%) & hip pain 45%. Dx by MRI (73%) w BME. Full recovery 81% isoretinoin D/C & NSAIDs (< 10% biologics)
Dr. John Cush RheumNow ( View Tweet)
Review of ARF & Post-streptococcal reactive arthritis (PSRA) following Group A strept infxn. Early Dx & Rx of Strept can prevent ARF & PSRA. PSRA is a sterile arthritis, bimodal age onset, lower extrem arthritis, usually resolves without lasting sequelae https://t.co/ld208yf0Zk
Links:
Dr. John Cush RheumNow ( View Tweet)
CMAJ reminds us that w/ parvovirus B19 infection, Arthropathy seen in ~60% of adolescents & adults, but the classic “slapped cheek rash” is uncommon. Symmetric, polyarticular inflamm arthralgias/itis affects PIPs, MCPS mostly. Sxs resolve w/in 3 wks. ~20% can last mos-yrs https://t.co/2SuL5igcnz
Dr. John Cush RheumNow ( View Tweet)
Sacroiliitis is a rare adverse reaction of isotretinoin. Review of 67 pts finds median age 21 yrs, onset median 2.5 mos (0-24) post isotretinoin. Sxs: LBP 70%) & hip pain 45%. Dx by MRI (73%) w BME. Full recovery 81% isoretinoin D/C & NSAIDs (< 10% biologics)
Dr. John Cush RheumNow ( View Tweet)
