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Biologic-treated Psoriasis has Less Progression to Psoriatic Arthritis

Jack Cush, MD

A single center study demonstrates that biologic treatment of psoriasis (PsO) significantly reduces the likelihood of psoriatic arthritis (PsA) development; suggesting a role for more aggressive treatment of PsO. 

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"Don't You Know Who I am?" (5.17.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past 2 weeks. This week's question: can we prevent gout, ILD or psoriasis?

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April Armstrong RNL

ICYMI: Co-management of Psoriatic Disease

Richard Conway, MBBChBAO, PhD

It is a common clinical scenario to see someone with both severe psoriatic arthritis and skin psoriasis. In an ideal world this would involve a combined clinic with our local friendly dermatologist. For many of us, however, this is not practical for many reasons. The excellent Saturday morning session on choosing systemic therapies in psoriatic disease at RheumNow Live 2024 from dermatologist extraordinaire Dr. April Armstrong was therefore hugely insightful.

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1/600 Falls May Die (4.5.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and Journal reports from this past week on RheumNow.com -  including problems w/ falls, pain and treatment of Dupuytren’s contractures.

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Activity & Pain Tolerance (3.29.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com, including where you should sit in clinic and why you should worry about secondary Sjogren's in RA.

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Naysayers & Disrupters (3.22.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week - including a few contrary reports on infection, seropositivity and plasmapheresis.

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2023 EULAR Psoriatic Arthritis Recommendations

Jack Cush, MD

EULAR has updated its treatment recommendations from the prior 2019 guidelines, since which there have been several newly developed agents. The updated guidance includes 7 overarching principles and 11 recommendations regarding treatment strategy and pharmacological therapies.

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Expert Panel Guidance on Managing Psoriatic Arthritis and Comorbidities

Jack Cush, MD

An expert panel has published their consensus guidelines for the management of psoriatic arthritis (PsA) and it's comorbidities in the journal Rheumatology. 

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Save the date! We’ll be covering #EULAR24! https://t.co/HGjP2SFyOp
Dr. John Cush RheumNow ( View Tweet)
TNFi mAbs, JAKi, –IL-17 are protective against Anterior Uveitis (AU) in AxSpA. Metanalysis of 44 RCTs shows AU IR: - TNF mAbs: 4.1 - etanercept 5.4 - IL-17i: 2.8 - JAKi: 1.5 - placebo: 10.8 https://t.co/qN9UL16YPO https://t.co/5WOjAq9ty6

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Dr. John Cush RheumNow ( View Tweet)
This study examined the risk of neuroinflammatory disease after initiation of b/tsDMARDs Overall risk of neuroinflammatory events among new users of TNF inhibitors did not differ substantially as compared to new users of other b/tsDMARDs In AC&R https://t.co/8rGgZmpq9c https://t.co/5gxuWBctBL

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ACR_Journals ACR_Journals ( View Tweet)
#RNL2024 @RheumNow @AlexisOgdie Many therapies for SpA - but ONLY TNFi, IL17i, and JAKi for AxSpA Check out https://t.co/3918uYvdFj to help guide treatment decisions: Prior therapies? enthesitis? concomitant IBD/uveitis? comorbidities? Pt preferences? https://t.co/6ugueBPMTy

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Dr. John Cush RheumNow ( View Tweet)

#RNL2024 @RheumNow @_AprilArmstrong Choosing a biologic in Psoriasis TNF - great in PsA, pregnancy. Avoid in demyelinating, hep B IL-17 - robust skin, PsA (axial too). Avoid in IBD IL-23 - robust skin, PsA evidence, fewer injections https://t.co/42kUaIZxKs

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Dr. John Cush RheumNow ( View Tweet)

vedolizumab-induced enthesitis @lihi_eder #RNL2024 @RheumNow 11/90 (12.2%) of pts on VDZ for IBD w/ develop new-onset enthesitis Is this true drug rxn or previously masked by prior meds (TNF)? Usually unilateral +/- oligo, dactylitis Most respond to NSAID or injxn, 27% change Rx

Dr. John Cush RheumNow ( View Tweet)

Staph. aureus bacteremia (SAB) is assoc w/ poor outcomes & Osteoarticular infection. Danish study of 18 274 SAB pt (367 w RA). 90d SAB risk in RA was 23% vs 12.5% in non-RA (HR 1.93). Higher w/ Jt implants (29%) & TNFi use (42%). 90d Mortality was 35% https://t.co/hjaPnTbE0E https://t.co/7t7omiUVYf

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Dr. John Cush RheumNow ( View Tweet)
Oral Surveillance study revisited: the risk of Venous thromboembolism & Pulmonary emboli were higher with tofacitinib (10>5 mg BID) versus TNFi and were generally consistent over time. VTE & PE risk incr by age, BMI, and VTE Hx https://t.co/v7ISjw5Rvd https://t.co/10oE7MiAAj

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Dr. John Cush RheumNow ( View Tweet)
soluble Fms‐like tyrosine kinase‐1 (sFlt-1)/placental growth factor (PlGF) ratio, biomarkers of placental function and adverse pregnancy outcomes. Study of 158 RA pts, 1/2 on TNFi during Preg. TNFi assoc w/ incr birthweight; no effx on sFlt‐1 & PlGF https://t.co/JFvDxrTAfr https://t.co/CRxSEbm2Ru

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Dr. John Cush RheumNow ( View Tweet)
Korean biologics registry study 526 Ank Spondylitis pts on TNFi > 1yr and tapered; 24.1% experienced flares. Predictors of flare included B27+, inflammatory LBP, psoriasis, SpA Fam Hx, DM, ≥50% TNFi tapering, Dz activity (ASDAS-CRP, BASFI) at tapering https://t.co/jjyMX3borT https://t.co/u0lbtfCyz1

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Dr. John Cush RheumNow ( View Tweet)
Japanese study of 672 autoimmune pts on TNFi & tocilizumab - 1.6% (n=9) developed non-tuberculous Mycobacteria (NTM) infx post biologics. 2 disseminated NTM, 2 died. NTM pts had higher mortality [(22% vs 2.6%) & took more steroid (17 vs 3 mg, P=0.004).https://t.co/fGGafrTeiL https://t.co/DkmiC2hVEA

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Dr. John Cush RheumNow ( View Tweet)
JAK-pot: 46913 Rx courses on JAKi, TNFi, other MOA. Rx D/Cs for AEs: - TNFi = JAKi (HR 1.0) - Other MOA > JAKi (HR 1.11) - TNFi < tofacitinib (0.81) - TNFi > baricitinib (1.15) - TNFi < JAKi; if >65yrs w/ CV risk (0.79) https://t.co/jCtLG3SNvP https://t.co/FN5U5Z1M9M

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Dr. John Cush RheumNow ( View Tweet)
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