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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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Rheumatology: Believe It or Not (4/25/2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Should we believe the reviews and metanalyses?

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Earlier ACL reconstruction and a lower risk of knee osteoarthritis

EurekAlert!

A preclinical study by HSS investigators found that earlier anterior cruciate ligament (ACL) reconstruction led to lower immune cell activity, less inflammation and fewer joint changes associated with knee osteoarthritis compared to delayed surgery.

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2024 Rheumatology Year in Review

Jack Cush, MD

2024 was a year of surprising new growth in technology, with the expansion of new therapeutic options for many patients and clinicians.  While these many advances offer new hope, they are countered by disappointments and gapping unmet needs in rheumatology. Below is my top 10 list (in no particular order) of 2024 developments and desires that may change rheumatologic practices.

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A Review of Relapsing Polychondritis

Jack Cush, MD

A current review in the Journal of Thoracic Disease on relapsing polychondritis (RP), suggests that while this rare disorder may have an uncertain pathogenesis, its diagnosis and therapeutical management has improved.

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Survival in #RA pts undergoing cervical spine surgery is not good! Retrospective study of 139 RA pts who underwent Cx surgery shows higher mortality risk if they are older, w low albumin levels, high-dose pred. and have subaxial subluxation. https://t.co/hKvgaas2gh https://t.co/ygtJjb4mVl

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Dr. John Cush RheumNow ( View Tweet)
Variability of Guidelines on the Perioperative Use of DMARDs in Rheumatic Diseases Patients 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 https://t.co/gjJOjZhSHU
Dr. John Cush RheumNow ( View Tweet)
Genicular nerve block (GNB) is effective intervention for Knee OA. Metanalysis of 6 RCTs & 420 KOA pts. GNB significantly reduced pain & improved function (p<0.003), w/ significant relief as early as 2wks and function by 12 weeks. https://t.co/wC2dPvVR7x https://t.co/HCFSXBfVGM

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Dr. John Cush RheumNow ( View Tweet)
Genicular nerve block (GNB) is effective intervention for Knee OA. Metanalysis of 6 RCTs & 420 KOA pts. GNB significantly reduced pain & improved function (p<0.003), w/ significant relief as early as 2wks and function by 12 weeks. https://t.co/NMtiQPICpw https://t.co/gVJ0TyuY01

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Dr. John Cush RheumNow ( View Tweet)
@RheumNow So rheumatoid nodule treatment might target some of that pathophysiology. Rituximab, abatacept, or JAKi? And while surgery often isn’t great (plus they often grow back), definitely an option for some. Christopher Edwards #EULAR2025 @RheumNow https://t.co/sFWnQN8uC4

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David Liew drdavidliew ( View Tweet)
1 shot will do! #symptomatic #Knee #OA given #gene #therapy #intra-#articular Seemed to last up to 104 weeks! But no placebo small safety study but sustained #WOMAC responses Needs large #RCT but v interesting #EULAR2025 @RheumNow @eular_org Abst# POS0492 https://t.co/hqTqBorrbA

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Janet Pope Janetbirdope ( View Tweet)
Bullhead Sign in #SAPHO Syndrome ▶️Synovitis, ▶️Acne ▶️Pustulosis ▶️Hyperostosis ▶️Osteitis 👉🏽https://t.co/ownI4Q543w via @MayoProceedings https://t.co/FXlTtmsDDX

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Dr Ai Lyn Tan DrAiLynTan ( View Tweet)
Shanghai hospital retrospective cohort study of 249 pts w/ post-Unilat TKA & lat knee pain. 144 Rx w/ IA steroids vs 105 Rx w/ PO meds. Infection rate w/in 6 mos post-TKA found no signif difference (2.1% vs 2.9%); Injx pts had signif better pain relief, QOL & knee function (KSS) https://t.co/ULVO6KU7pn
Dr. John Cush RheumNow ( View Tweet)
JAMA Staphylococcus aureus Review - s. aureus bacteremia leads to septic arthritis (7%), vertebral osteomyelitis (≈4%) - bacteremia (≥48 hs) has 39% 90-day mortality risk https://t.co/1UQoz7JDPU https://t.co/xTAkakv2he

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Dr. John Cush RheumNow ( View Tweet)
Consensus Against Interventional Injections for Chronic Spinal Pain BMJ has published a clinical practice guideline resulting from the work of an international, multidisciplinary panel addressing chronic spine pain (≥3 months duration) not associated with cancer or https://t.co/mCsz88JACh
Dr. John Cush RheumNow ( View Tweet)
Joint Implant Metals May Be Leaking Patients with metal-containing joint replacements had significantly higher concentrations of cobalt in their cerebrospinal fluid (CSF) relative to patients without arthroplasties, researchers reported. https://t.co/ubDhWqtTSL https://t.co/GjMnog8mcJ

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Dr. John Cush RheumNow ( View Tweet)
Consensus Against Interventional Injections for Chronic Spinal Pain BMJ has published a clinical practice guideline resulting from the work of an international, multidisciplinary panel addressing chronic spine pain (≥3 months duration) not associated with cancer or https://t.co/PfXM210PsZ
Dr. John Cush RheumNow ( View Tweet)
Peripheral Nerve Blocks for Hip Fractures JAMA reviews the use of peripheral nerve block with hip fractures as an effective pain management strategy that can be performed by credentialed clinicians outside of the operating room. https://t.co/baeLWVxeUo https://t.co/ZBTVDT0jGR

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Dr. John Cush RheumNow ( View Tweet)
Japanese study of hip replacements (THA) - #RA pts undergoing THA at higher risk for dislocation and reoperation. Retrosp database study of THA - matching 3,951 RA vs 11,853 OA. w/ RA incr risk of dislocation (OR 2.8) & reoperation (OR: 2.25). No diff infx, Fx, VTE, death… https://t.co/Mz8niRlFaa https://t.co/mgcXTnw5Al
Dr. John Cush RheumNow ( View Tweet)
Ankle Fusion or Total Replacement? In a large study of British patients needing surgical treatment for advanced arthritis in the ankle, fusion appeared to be a better option than total ankle replacement. https://t.co/ZFbd2VinpP https://t.co/QCqMkxNLoQ

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Dr. John Cush RheumNow ( View Tweet)
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