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Best of 2025: Antifibrotics - A New Class of Therapies in Rheumatology?
Rheumatologists typically manage systemic autoimmune rheumatic diseases and associated interstitial lung disease with immunosuppressants. However, evidence increasingly supports also the use of antifibrotic agents in this setting.
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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.
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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.com. 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?
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Role of the Nurse in the Care and Management of Rheumatic Diseases - EULAR Review
In 2023, a EULAR subcommittee set out to assess the roles of nurses and Advanced Practice Nurses (APN) in the care of arthritis as outlined in published EULAR guidelines. The scope of APN practices was first proposed in 2012 and revised in 2018.
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Lancet review of skin cancer risk w/ inflammatory arthritis - both melanoma and Non-melanoma skin cancers are increased in RA & inflammation. Also Package inserts for TNFi say all TNFi Rx pts should have complete skin exams "periodically". Skin cancer screening advised. https://t.co/XddFDe0xh8
Dr. John Cush RheumNow ( View Tweet)
Japanese retrospective study-194 #RA pts Rx w/ JAK inhib (74 vaccinated w/ recombinant zoster (RZV) & 120 Not-Vax). H.zoster lower w/ RZV (4.8/100PY) vs UnVax (7.8/100PY) w/ overall efficacy of 59.1%. RSV Vax pts who got HZ had signif lower lymphocyte #s, higher SDAI & CDAI. https://t.co/vJJRflJ23x
Dr. John Cush RheumNow ( View Tweet)
Austrian 1K Paracelsus cohort study; from 9,665, 296 (3.1%) had RA. CKD prevalence was higher in RA vs controls (11.8% vs. 6.7%, p<0.001). Albuminuria was dominant renal dz in RA (6.8% vs 4.2%, p=0.027), but missed signif after adjustments (OR 1.43; 0.96–2.13) https://t.co/9DnErwT4rX
Dr. John Cush RheumNow ( View Tweet)
Cases & Guidelines: Tuesday Night Rheumatology
Panelists discuss their approaches to a range of difficult cases in multiple areas, including RA, PsA and PMR. Panelists: Audrey Gibson, PA-C; Benjamin A. Smith, PA-C; Emma Bavage, ANP; Jack Cush, MD
https://t.co/vl5J9NYUKZ https://t.co/nsTf370bu9
Links:
Dr. John Cush RheumNow ( View Tweet)
🦴 Genant-Modified Sharp Scoring System
🧮 A radiographic scoring system used to quantify joint damage in Rheumatoid Arthritis (RA), especially in clinical trials and long-term follow-up.
🔍 What does it assess?
X-rays of hands and feet for:
•Erosions
•Joint Space Narrowing https://t.co/r5bvzFliBP
Ravi Kumar RheumattDoc ( View Tweet)
Lancet review of skin cancer risk w/ inflammatory arthritis - both melanoma and Non-melanoma skin cancers are increased in RA & inflammation. Also Package inserts for TNFi say all TNFi Rx pts should have complete skin exams "periodically". Skin cancer screening advised. https://t.co/MNuQO6Dw5b
Dr. John Cush RheumNow ( View Tweet)
IN RA: IgA-RF seen in 50%, IgA-ACPA in 20-40% (& are very specific). IgA-RF or -ACPA found in serum, saliva & syn.fluid.& may underlie "mucosal hypothesis" of RA. IgA-RF assoc w/ more severe RA, worse outcomes, Xtra-articular manifestations, & blunted TNF inhibitor responses https://t.co/SVUJmrIy2F
Dr. John Cush RheumNow ( View Tweet)
Japanese retrospective study-194 #RA pts Rx w/ JAK inhib (74 vaccinated w/ recombinant zoster (RZV) & 120 Not-Vax). H.zoster lower w/ RZV (4.8/100PY) vs UnVax (7.8/100PY) w/ overall efficacy of 59.1%. RSV Vax pts who got HZ had signif lower lymphocyte #s, higher SDAI & CDAI. https://t.co/4VMWPhzXeL
Dr. John Cush RheumNow ( View Tweet)
Austrian 1K Paracelsus cohort study; from 9,665, 296 (3.1%) had RA. CKD prevalence was higher in RA vs controls (11.8% vs. 6.7%, p<0.001). Albuminuria was dominant renal dz in RA (6.8% vs 4.2%, p=0.027), but missed signif after adjustments (OR 1.43; 0.96–2.13) https://t.co/qf0IpZC50Q
Dr. John Cush RheumNow ( View Tweet)
AANP survey of US 2338 Nurse Practitioners (mostly primary care) re: shared pts w/ rheumatologists. NPs managing RA want improved communication w/ rheums, & education on RA management. PC NP confidence w/ RA was 47% Somewhat confident, 6% very confident, 19% not confident. https://t.co/YVEpJua9hj
Dr. John Cush RheumNow ( View Tweet)
Tarsal Tunnel Syndrome - review and quiz.
A compressive neuropathy of the posterior tibial nerve within the tarsal tunnel. 80% caused by lipoma, ganglion, varicosity, trauma, tenosynovitis, rheumatoid arthritis, diabetes, etc https://t.co/zCyeVIJEuy https://t.co/f4jA13FDvN
Links:
Dr. John Cush RheumNow ( View Tweet)
In US, Tofacitinib loses patent exclusivity & goes generic in 2026. Worldwide Tofa sales in 2024 were $3.08 billion (55% use in RA; N. America 1st w/ ~38% of market). Tofa sales projected to rise to $5.7 bill in 2029 https://t.co/nKPaQdglYw https://t.co/DdMymmk8go
Dr. John Cush RheumNow ( View Tweet)
Israeli retrospective study of 9736 colchicine Rx FMF pts matched w/ 97 360 controls. On F/U Psoriatic arthritis developed in more FMF pts (43 vs 119) - HR 3.52 (CI: 2.48, 5.0). ^Risk w/ older age, smoking, SES https://t.co/blDIsmHWPC
Dr. John Cush RheumNow ( View Tweet)
I Can't Believe it's Not Seronegative Rheumatoid Arthritis?!
In rheumatology, we're no stranger to uncertainty. In any diagnosis of seronegative rheumatoid arthritis, it's always our invitation to reconsider the diagnosis.
https://t.co/JaLfRha6dq https://t.co/WwT5Q8B5Ad
Dr. John Cush RheumNow ( View Tweet)
Retrospective EHR study of 38,327 COVID-19 infx pts & 1,143 whodeveloped post Covid Syndrome (PCC). PCC risk was signif higher in women & obese. Pre-COVID, psoriasis (OR 1.41) & RA (OR 1.64) had incr risk of PCC. Post COVID, more Sjögren’s (OR 4.05) among PCC. https://t.co/0Z48Hy43XY
Dr. John Cush RheumNow ( View Tweet)
Cases & Guidelines: Tuesday Night Rheumatology
Panelists discuss their approaches to a range of difficult cases in multiple areas, including RA, PsA and PMR. Panelists: Audrey Gibson, PA-C; Benjamin A. Smith, PA-C; Emma Bavage, ANP; Jack Cush, MD
https://t.co/1HPBdPdIVx https://t.co/30Q6azQU3r
Dr. John Cush RheumNow ( View Tweet)
