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ACP Position Paper on Dietary Supplements

Jack Cush, MD

More than half of U.S. adults use dietary supplements, yet only a quarter use supplements recommended by a healthcare professional, and current law lets supplements reach the market with no premarket safety evaluation, unlike drugs or food additives.

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Gout Cavalcade (7.10.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal articles and regulatory decisions from the past week. July is Gout: More than Flares month.

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Do we need Better Strategies to Prevent Osteoporotic Fractures?

Jack Cush, MD

In a recent JAMA Viewpoints article, Dr. Susan Ott addresses several controversies in preventing osteoporosis (OP) related fractures.

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FDA Delays Gout Drug NASP with Complete Response Letter

Jack Cush, MD

At the end of June, Sobi was awaiting an FDA decision on its Biologics License Application (BLA) for NASP (nanoencapsulated sirolimus plus pegadricase) for the treatment of adult patients with uncontrolled gout. On June 26, 2026, SOBI received a Complete Response Letter from the U.S. FDA that will delay a decision on NASP, pending the company's answer to questions regarding the drugs manufacturing at a 3rd party facility in China.

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Problems with treatment adherence in the management of gout

N. Lawrence Edwards, MD, MACP, MACR

Compared to common medical conditions such as hypertension, type 2 diabetes, hyperlipidemia or osteoporosis, where the reported drug adherence rates are between 50% to 70%, the drug adherence for gout is 37%.

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NEJM Retracts Pivotal ADVOCATE Trial of FDA-Approved Avacopan

MedPage Today

The New England Journal of Medicine (NEJM) retracted the pivotal study supporting FDA's approval of avacopan (Tavneos) for severe forms of anti-neutrophil cytoplasmic

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DMARD Efficacy in RA-ILD

Jack Cush, MD

A network meta-analysis in the Journal of Autoimmunity reviews the pharmacologic options for rheumatoid arthritis–associated interstitial lung disease (RA-ILD). RA-ILD guidelines were recently presented by ERS/EULAR, but these were mainly conditional, low-certainty recommendations.

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The Power of Self-Management with Chronic Low Back Pain

EurekAlert!

Almost everyone will deal with back pain at some point in their lives.

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In 2010 Colchicine fell under patent protection and price increased 16 fold, & out-of-pocket price increased 4.4-fold, colchicine use decreased 27%, while allopurinol, steroid & gout visits (ER, Rheum) increased. https://t.co/xyOxsnoM5z https://t.co/yoXehV0mPa

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Dr. John Cush RheumNow ( View Tweet)
Premenopausal women can get gout, if they are post-transplant, taking cyclosporin or tacrolimus. For more gout content, follow our Gout: More than Flares campaign at https://t.co/lQoiFjubZJ, https://t.co/kawSlJ2tb6

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Dr. John Cush RheumNow ( View Tweet)
RZV (Shingrix) response in 76 immunosuppressed SSc & 304 controls (CG) recv two RZV doses. High seroconversion seen in SSc but signif lower than CG (92.6% vs 99.7%, P 0.001), w/ lower concentration but comparable CMI, lower AE (74% vs 86%) https://t.co/ALlnVEZIAt https://t.co/kYYy2JIo2J

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Dr. John Cush RheumNow ( View Tweet)
20 yr. Tx trends in 6583 #SSc pts. 2005 to 2025 endothelin receptor antagonists & prostanoids/prostacyclins from 3% to 28%. CCB & PDE-5 inh stable. CTX shifted to mycophenolate, RTX, & nintedanib. Steriods decr from 50% to 18% https://t.co/nrm1Ov285f https://t.co/ftLn3bGH72

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Dr. John Cush RheumNow ( View Tweet)
DMARD Efficacy in RA-ILD A network meta-analysis in the Journal of Autoimmunity reviews the pharmacologic options for rheumatoid arthritis–associated interstitial lung disease (RA-ILD). RA-ILD guidelines were recently presented by ERS/EULAR, but these were mainly conditional,

Dr. John Cush RheumNow ( View Tweet)

FDA Delays Gout Drug NASP with Complete Response Letter On June 26, 2026, SOBI received a Complete Response Letter (CRL) from the U.S. Food and Drug Administration (FDA) that will delay a decision on NASP, pending the company's answer to questions regarding the drugs https://t.co/NmPbWmYd0p
Dr. John Cush RheumNow ( View Tweet)
Non-gout drugs that may lower uric acid – losartan, amlodipine, ACE inhibitors, fenofibrate, atorvastatin, leflunomide, vitamin C, estrogen, and high-dose ASA. For more gout content, follow our Gout: More than Flares campaign at https://t.co/xnBVBN5IXZ, https://t.co/vmNvqojAcS

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Dr. John Cush RheumNow ( View Tweet)
Problems with treatment adherence in the management of gout Compared to common medical conditions such as hypertension, type 2 diabetes, hyperlipidemia or osteoporosis, where the reported drug adherence rates are between 50% to 70%, the drug adherence for gout is 37%. This https://t.co/OoLh0HUUH2
Dr. John Cush RheumNow ( View Tweet)
Netherlands pragmatic open-label RCT from 8 rheum centres tested T2T vs Sx Rx in 308 Gout pts starting ULT (87% male; 66 yrs). Remission (no flares & pain < 2) betw 18-24 mos was more in T2T pts (39% vs 24%; p=0.02), but more AE w/ Sx driven Rx (53 vs 42%) https://t.co/5g2dY5y900
Dr. John Cush RheumNow ( View Tweet)
NEJM Retracts Pivotal ADVOCATE Trial of FDA-Approved Avacopan The New England Journal of Medicine (NEJM) retracted the pivotal study supporting FDA's approval of avacopan (Tavneos) for severe forms of anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis. https://t.co/GOVyk5poNq
Dr. John Cush RheumNow ( View Tweet)
Whats the BEST FIRST Rx in DMARD-Naive #RA - Tofacitinib or MTX. RCTs (ORAL Start, RA-BEGIN, SELECT-EARLY, FINCH 3) prove JAKi > MTX. A recent 116 RCT from China also shows Tofa > MTX by SDAI50 (94% v 75%) @3 mos & Tofa was more cost effective. https://t.co/KL2qlDgF6D https://t.co/wNVBgQkaMI

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Dr. John Cush RheumNow ( View Tweet)
Long term F/U of Gout (CARES) trial (febuxostat vs allopurinol) shows remission increased from 37% (1,593/4,259) 1st Yr to 63% (322/510) at year 6. Over the 6 years, ~60 achieved remission at least once; more likely based on age, race, dz severity, comorbidities, & febuxostat

Dr. John Cush RheumNow ( View Tweet)

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