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Lung,AI,Pleura

Combined Therapy in Rheumatoid Arthritis Interstitial Lung Disease

Richard Conway, MBBChBAO, PhD

Rheumatoid arthritis interstitial lung disease (RA-ILD) represents a major therapeutic evidence void in our current treatment paradigm. RA-ILD is common, with clinically significant disease seen in 8% of patients. In the past RA-ILD was frequently under-diagnosed, leading to identification of a disproportionate volume of severe cases and subsequently inflating the mortality statistics. However, RA-ILD, particularly in the progressive pulmonary fibrosis phenotype, retains a poor prognosis. I would propose a new framework for RA-ILD treatment.

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ILD Begins (8.29.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from RheumNow.com. This week news on vaccines, safety of acetaminophen and more.

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Long-term Lab Monitoring in RA is Inefficient

Jack Cush, MD

Annals of Internal Medicine has published a retrospective study of long-term routine laboratory toxicity monitoring (lt-RLTM) in patients receiving disease-modifying antirheumatic drug (DMARD) therapy showing that most very abnormal laboratory finding occur early in therapy (first 6 months) or are anticipated or only after dose escalation.

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MTX.pills

Methotrexate intolerance in rheumatoid arthritis

Jack Cush, MD

Methotrexate (MTX) is the most commonly used DMARD in rheumatoid arthritis (RA); however, there is significant intolerance to this drug among adult RA patients - especially at doses above 15 mg per week. 

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Physical Therapy Underprescribed

MedPage Today

Just one patient in six was referred for physical therapy (PT) within 15 days of being treated for knee pain at one major U.S. health system, researchers found, despite nearly universal consensus that PT should be recommended in most cases.

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Sjogren.eye.mouth

It's now called Sjögren Disease!

Jack Cush, MD

Sjögren syndrome is now Sjögren disease, according to recommendations stemming from the 2023 International Rome consensus for the nomenclature of Sjögren disease.

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Future,space,time

Rheums Speak: Future of Rheumatoid Arthritis

Jack Cush, MD

The third survey in this series addressed clinician views on future trends (AI), future therapies and lessons learned.

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Might systemic autoimmune Dz related anti-protein arginine methyltransferase 5 (PRMT5). ELISA study of 33 SSc, 87 RA, & 31 controls. Vs controls, anti-PRMT5 Abs seen in SSc (48% vs 0; AUC 0.9) & RA (15% vs 0; AUC 0.768). PRMT5 Abs signif assoc w/ ILD & ANA positivity. https://t.co/svjjtQQsIY
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Methotrexate intolerance in rheumatoid arthritis Methotrexate (MTX) is the most commonly used DMARD in rheumatoid arthritis (RA); however, there is significant intolerance to this drug among adult RA patients - especially at doses above 15 mg per week. https://t.co/aizooTPNTe https://t.co/FZ52bwHBfq

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Dr. John Cush RheumNow ( View Tweet)
RA has lower risk of colorectal cancer (CRC). Korean claims compared 41K RA pts 1:5 vs 204K non-RA. RA had signif. decreased risk for CRC (HR 0.89), main in seroneg RA (HR 0.79) but not seropos RA (HR 0.93). Inverse assoc mainly w/ rectal CA (HR 0.63) & women (HR 0.80). https://t.co/dudG4Is5oj
Dr. John Cush RheumNow ( View Tweet)
China study of 670 SpA pts rx w/ sulfasalazine betw 2016 to 2023 (469 pure AS; 201 w/ peripheral Sxs). SSZ Signif. reduced peripheral Sxs development (HR 0.49) and improved disease activity in both pure axial and axial-with-peripheral Sxs. https://t.co/5HdQCos9yM https://t.co/tTMScQDHBq

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Dr. John Cush RheumNow ( View Tweet)
RHEUM Survey: How important is "Seropositivity" in RA?

Dr. John Cush RheumNow ( View Tweet)

Celltrions tocilizumab biosimilar, tocilizumab-anoh (Avtozma, CT-P47), had similar efficacy when switching from reference tocilizumab (Actemra; Genentech) in a study of 444 RA patients x 52 wks. https://t.co/7aAyuUkZJ9 https://t.co/kJUrRkhstb

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Dr. John Cush RheumNow ( View Tweet)
Single-center Retrospective study of 4,736 RA, propensity matched 509 w/ RA-ILD vs 509 without ILD. In multivariate analysis RF positivity was an independent risk factor for RA-ILD (adj OR = 1.5) w/ signif nonlinear relationship observed, risk threshold @60 IU/mL Paradoxical https://t.co/0XtWnIsbmK
Dr. John Cush RheumNow ( View Tweet)
Clinical Rheumatology Thread for Busy GPs: Post 1 Early inflammatory arthritis(IA): the 3–3–3 rule •Onset ≤3 months •Morning stiffness ≥30–60 minutes •≥3 swollen joints (MCP/MTP common) If present, manage as IA: urgent rheum referral; NSAIDs if no contraindications. https://t.co/hcoumX1ZVY

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Aravind Palraj Rheumat_Aravind ( View Tweet)
Rheumatic Dz & HIV - Arthralgia: self limiting - HIV-assoc arthritis: mimics RA - Occurs w/ HIV: SpA, ReA, PsA - Less : IIM, vasculitis, opportunistic infxn https://t.co/Yf7jZ0icZw https://t.co/6FuJgvDYRF

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Dr. John Cush RheumNow ( View Tweet)
Cohort study of 1,553 Biologic or JAKi Rx IBD (Crohns; UC) pts (SpA excluded) found 106 (6.8%) w/ MSK Sxs & 30 (1.9%) later Dx w/ SpA (20: axial, 10: peripheral) after median F/U 5.2 yrs. SpA risk factors: partial Mayo UC (HR 1.57) & HLA-B27 positivity (HR 3.70) https://t.co/WgLLUjlLMk
Dr. John Cush RheumNow ( View Tweet)
The world of rheumatoid arthritis treatment has changed dramatically. What do the experts say about the evolution of biologics and DMARDs over the last 20 years? Join us for a live webinar, moderated by Dr. Jack Cush, where we'll unpack the results of a nationwide survey. Tues, https://t.co/pKhuHPwcs0
Dr. John Cush RheumNow ( View Tweet)
The Patient Journey with Rheumatic Disease Oton and colleagues have reviewed the "patient journey" - from symptoms to specialty referral in those diagnosed with rheumatic and musculoskeletal diseases (RMDs). They identify the eight stages along the way and where improvements https://t.co/VY3kB3Ohmp
Dr. John Cush RheumNow ( View Tweet)
Pain Flares in RA are just pain, not inflammation. Study of 195 RA pts (11+ yrs dz dur), 49-89% experienced at least 1 flare (median 2-4 flares/mo), IQR 2.1-5), lasting median of 2 days. Flares preceded by worsening mood, anxiety, sleepiness - but no change in Accelerometer https://t.co/csbHtiEglp
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