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Consensus Definitions on Difficult to Treat Psoriatic Arthritis
A substantial number of patients with psoriatic arthritis (PsA), have difficult, persistent and hard-to-treat disease. A GRAPPA task force has developed a consensus terminology for two distinct states: complex-to-manage PsA and treatment-refractory PsA.
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Hematologic Malignancies Increased in Systemic Sclerosis
Swedish national study found that among a cohort of systemic sclerosis (SSc) patients a two-fold increase risk of hematological malignancies was seen.
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Turkey Tryptophan (11.28.2025)
Dr. Jack Cush reviews the news and reports from this past week on RheumNow.com, including reports on FDA resurrections, FM seasonal worsening, and do you fight switch or swap biologics in PsA TNFi nonresponders?
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Treating Refractory Still's Disease
A full read systematic review article examined treatment options for difficult to manage systemic juvenile idiopathic arthritis, or Still’s disease.
Managing Perioperative DMARDs with Arthroplasty
Postoperative complications with arthroplasty may be related to chronic inflammation and immunosuppressive therapy. Yet a recent retrospective study total ankle arthroplasty in end-stage RA patients shows that early postoperative wound complications are unaffected by the continued use of their preoperative medications including DMARDs.
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Hematologic Malignancies Increased in Systemic Sclerosis
Swedish national study found that among a cohort of systemic sclerosis (SSc) patients a two-fold increase risk of hematological malignancies was seen.
https://t.co/BypsCRUthe https://t.co/lfLJhSqn9e
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Korean claims study of 60 315 adult #RA pts (matched 1:5 controls), found risk for nontuberculous mycobacteria pulmonary disease was 3 fold higher in RA (0.23% vs 0.06%; 0.54 vs 0.14/1000PYs). Mostly in seropositive RA (OR 3.77), also males, obese, EtOH use. https://t.co/hJgoD8mnhv
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Taiwan Health Insurance study of 5749 #RA pts Rx w/ b/tsDMARD, followed >2.5 yrs - 268 (4.7%) had serious infx (1.3 SIE/100PYs); 51% pneumonia, 25% UTI, 10% TB). 60% had b/tsDMARDs dose reduction- not assoc w/ increase SIE (3.4% v 4.2%), but D/C increased SIE (35% v 26%) https://t.co/6J8rB3IyFR
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Scandinavian study of > 13.6 million PYs shows NO increased risk of myositis after SARS-CoV-2 (mRNA & adenoviral vector) vaccines. Data from 101 myositis events in 7,002 398 unvaccinated PYs. Adj IRR 180d risk was 0.84 (0.63–1.11) and 1.31 (0.72–2.36) respectively https://t.co/D5KVyvXaot
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CBC & Psoriasis - case–control study 60 pts: 30 PsA & 30 PSO pts showed that PsA showed elevated WBCs, neutrophils, monocytes & inflammatory markers (NLR, MLR, SII, SIRI, & decr PMR (all p < 0.001). NLR 100% Dx accuracy (AUC = 1.000). WBC > 6.7, MLR > 0.17, & PMR ≤ 503 were https://t.co/AB7iFiMuSM
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Taiwans insurance claims, Maternal Database, & BirthRegistry examined 42,493 births to fathers w/ autoimmune Dz, 14.3% exposed to immunosuppressants or biologics. MTX posed no risk, but Cyclosporin, AZA, JAKi may be assoc w/ adverse preg outcomes, but event #s small. https://t.co/6JXaZ2HdAF
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Zantac is Back! Ranitidine has been off the market for 5yrs, withdrawn over concerns about N-nitrosodimethylamine (NDMA) impurity affecting shelf-life. The FDA has approved reformulated ranitidine tablets - the drug has the same prior efficacy and safety label. https://t.co/ktTz5EO2Ja
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Retrospective study of 39 pts w/ MDA5 + DM-ILD Rx w baricitinib. 31 (79.5%) had improvement in Gottron’s, heliotrope, dyspnea, HRCT score, ferritin, LDH, steroid dose & 6 mo survival (87% vs. 70%, p = 0.047). https://t.co/RCTbBsCkeV https://t.co/dF8I0gF4Dy
Dr. John Cush RheumNow ( View Tweet)
Zantac is Back! Ranitidine has been off the market for 5yrs, withdrawn over concerns about N-nitrosodimethylamine (NDMA) impurity affecting shelf-life. The FDA has approved reformulated ranitidine tablets - the drug has the same prior efficacy and safety label. https://t.co/j655eiCvgf
Dr. John Cush RheumNow ( View Tweet)
Retrospective analysis of 2614 FM pts in the Italian Fibromyalgia Registry underscores the seasonal changes in FM pain, w/ signif. differences in FM assessment tools WPI p=0.042 & FASmod p=0.037); these changes were only seen in female patients, not males https://t.co/LqXnTgGIMB https://t.co/ihw1yJqKLC
Dr. John Cush RheumNow ( View Tweet)
Retrospective study of 39 pts w/ MDA5 + DM-ILD Rx w baricitinib. 31 (79.5%) had improvement in Gottron’s, heliotrope, dyspnea, HRCT score, ferritin, LDH, steroid dose & 6 mo survival (87% vs. 70%, p = 0.047). https://t.co/8whN2I1hXh https://t.co/voSVzPQWUI
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/lIX4gDLjqd
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Lupus Nephritis study of 136 pts followed 121 mos. Median time to wean GC to 7.5 mg/day, 5 mg/day & D/C was 9, 12 & 29 months post-Dx. Predictors of shorter time to D/C= Sustained CR/SLEDAI-2K≤4, membranous LN, & HCQ. Prolonged GC & renal flares increase damage accrual
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New quadrivalent modRNA influenza vaccine is more efficacious than conventional inactivated quadrivalent influenza vaccine. Really interesting excited to see mRNA technology transforming therapies. https://t.co/ZM13ojQUCl
Alberta Hoi alberta_hoi ( View Tweet)
No risk of MACE seen w/ initiation of IL-17(R)A inhib. French study of 34 241 ipts Rx IL-17(R)Ai and 381 MACEs. MACE risk was not elevated (OR, 1.25 [95% CI, 0.75-2.08] vs TNF-α inhibitors. https://t.co/WcjgRhr8mj https://t.co/Gp54eLlXSI
Dr. John Cush RheumNow ( View Tweet)
