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Rheumatoid & Inflammation Testing
Master the dos and don'ts of ordering RF, CCP (ACPA), and inflammatory markers that could transform your diagnostic accuracy.
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Best of 2025: 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 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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Best of 2025: Hydroxychloroquine for Everyone
Nearly 25 years ago, while lecturing on best therapies for rheumatoid arthritis (RA), I loudly stated that hydroxychloroquine was “useless” and, deservedly, I was “boo-ed” off stage. My point then was that rheumatologists needed to be aggressive, if not overly aggressive, in treating all RA patients. And my view was that HCQ was representative of under-treatment. I have reconsidered the use of HCQ in RA substantially in the last few years, based on its merit.
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PNAS/Yale researchers report on a mice model of RA, MIF-dependent, CD74+ memory T cells (normally very few) expand & incr in number in the inflammed joint. When MIF genes were deleted in a CIA model, arthritis was prevented. MIF-dependent, CD74+ T cells promote chronic synovitis. https://t.co/pdPIqtSCwG
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2026 Resolutions (1.9.2026)
Dr. Cush reviews the news, announcements and journal articles from this past week on RheumNow. More on Variable bendability, a better way to treat RA, and a novel advance for GLP1a in PsA; and 2026 Resolutions!
https://t.co/DgY2trZGKA https://t.co/3ka4SDRnJO
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FIBROSCANS in 60 RA pts on #MTX for 5 yrs w/ liver studies. Mean age = 39.5yrs, w/ Dz Dur 8.2 yrs, mean BMI 24.4 & MTX 12.5–25 mg for ~8 yrs (cum dose 6728mg). All had normal AST, ALT, APRI, Abd US; fibroscan score = 170 ((steatosis grade 0). Only 4(6.7 %) had mild, fibrosis https://t.co/OOctcfI1sT
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DANFLU-2 RCT of 332 438 elderly (43 881 w/ diabetes) tested high (HD-IIV) vs standard dose SD-IIV) flu vaccine. HD-IIV signif. reduced cardioresp., CV, CHF, influenza, hospitalizations vs SD-IIV, irrespective of DM status. Similar results previously seen in a Canadian RA pop. https://t.co/GGZPThoHrs
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UK study of 1846 RA pts starting a b/tsDMARDs, ~30% on steroids & majority (2/3) continued use over the first year of new novel treatment. This suggests these aer either severe RA pts or that we are not vigilant in limiting/weaning/stopping steroids in RA patients - which is it? https://t.co/TrAktincKT
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Japan retrospective study of 38 RA pts who developed MTX assoc lymphoproliferative disorder (LPD) - 22 w/ spontaneous regression (SR) vs 16 non-SR (w/ 5 deaths). non-SR Pt had higher LDH levels at Dx & lower lymphocyte recovery 1 mo. post MTX withdrawal & higher mortality risk https://t.co/TRizVwP2BQ
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Plenty of evidence that toxic environmental exposures increase #RA risk. Full read, intelligent report from Stanhope et al showing how (healthy environmental) green space exposures are protective & capable of preventing RA!! Lifestyle is gigantically important in your https://t.co/LUWmHhUT7F
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VA registry study; among 2771 RA pts (~65y), 64 (2.3%) had CPPD by ICD9/10 codes. RA+CPPD pts signif older [68 v. 64y], w/ more comorbidity/OA (94 v 80%), spine Dz, DM, but less ACPA (63 v 78%). SNRA+CPPD achieved less LDA, more use of pred & b/tsDMARDs (OR >2), death, TJR. Is https://t.co/hUPJzDseVc
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Systematic review of Difficult-to-treat RA (D2T-RA): 23 articles, 27,987 RA pts from 13 countries - pooled prevalence of D2T-RA was 11.7% (10.9% overall; 13.2% in b/tsDMARDs-treated RA). 47% D2T-RA had persistent inflammatory refractory RA (PIRRA). Prevalence decreased w/ https://t.co/0Gatzbfxid
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UK study of 1846 RA pts starting a b/tsDMARDs, ~30% on steroids & majority (2/3) continued use over the first year of new novel treatment. This suggests these aer either severe RA pts or that we are not vigilant in limiting/weaning/stopping steroids in RA patients - which is it? https://t.co/7NWeAWTjSy
Dr. John Cush RheumNow ( View Tweet)
Japan retrospective study of 38 RA pts who developed MTX assoc lymphoproliferative disorder (LPD) - 22 w/ spontaneous regression (SR) vs 16 non-SR (w/ 5 deaths). non-SR Pt had higher LDH levels at Dx & lower lymphocyte recovery 1 mo. post MTX withdrawal & higher mortality risk https://t.co/SsBQRxFvD1
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JAMA teaching case: 57 yoF w/ RA Rx w/ HCQ, NSAID, TNFi (ETN -->ADA) develops a new rash - pruritic vesicles/papular on neck, mouth, ears, chest, hands w/ some becoming ulcerated plaques, ESR >100. WHAT TO DO? A) steroids; B) stop ADA; C) Benadryl or D) Read more? Pt had https://t.co/DQpeUOC5I3
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Best of 2025: Variability of Guidelines on the Perioperative Use of DMARDs in Rheumatic Diseases Patients
Despite advances in treatments reducing the need for major surgery, many rheumatic disease patients still require surgery while on DMARDs. A review of perioperative https://t.co/LHClCUvHrb
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SMART study - Single vs. Split Dose Methotrexate in RA
Split dose weekly, oral methotrexate (MTX) was shown to be superior to single dose MTX in treating active rheumatoid arthritis (RA) patients.
https://t.co/JN5wPGNjao https://t.co/hI8dxWmZe8
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Hydroxychloroquine for Everyone
Nearly 25 years ago, while lecturing on best therapies for rheumatoid arthritis (RA), I loudly stated that hydroxychloroquine was “useless” and, deservedly, I was “boo-ed” off stage. My point then was that rheumatologists needed to be aggressive, https://t.co/rlnogTqk49
Dr. John Cush RheumNow ( View Tweet)
Best of 2025: 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/hzfF7UVKVI
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Telling You Where to Go (12.19.2025)
Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow. Who would've thunk - a PsA FMF connection? Labs to diagnose SSc-ILD? IgA-RF may be important or RZV may not work in JAK inhibitor treated patients? https://t.co/bwF89L9Z7R
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