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Rheumatology Pitfalls (3.20.2026)
Dr. Jack Cush reviews the regulatory actions, news and journal reports from this past week on RheumNow.com.
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FDA Approves Icotrokinra for Plaque Psoriasis
Today the FDA approved an oral IL-23 inhibitor, icotrokinra (Icotyde), for use in moderate-to-severe plaque psoriasis in adults and children 12 years of age and older (who weigh at least 40 kg) who are candidates for systemic therapy or phototherapy.
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Hydralazine and the Rare Risk of Vasculitis
Since the 1980s, hydralazine has been a notable cause of drug-induced lupus, and inferred to cause vasculitis as well.
2025 Update: EULAR Recommendations on Rheumatoid Arthritis Management
The European Alliance of Associations for Rheumatology (EULAR) has updated their rheumatoid arthritis (RA) management recommendations, notably with fewer recommendations (total of 9, down from 11 in 2022 version), by merging and removing previous recommendations.
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Worldwide Trends in Hyperuricemia
A Lancet Rheumatology systematic review shows the prevalence of hyperuricaemia has risen markedly over the past two decades in both men and women, owing to population growth, aging, and increasing age-specific rates
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RA pt on 7.5 mg/d Prednisone need hip replacement. What do you advise re: pred dose before TKR?
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Pitfalls of autoimmune serologic testing
Misuse of laboratory testing may lead to misdiagnoses and mismanagement; this is particulary prevalent when clinicians consider the use of the diagnostic use of serological autoimmune markers.
https://t.co/QDWTRgdlOh https://t.co/3hvM1OBcMC
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NEJM: Obinutuzumab in Active Systemic Lupus Erythematosus
A phase 3 trial of obinutuzumab, an anti-CD20 monoclonal antibody, showed potent B-cell depletion and clinical efficacy active systemic lupus erythematosus without evidence of nephritis.
https://t.co/OEuNAZlgzp https://t.co/yjUmJITAmQ
Dr. John Cush RheumNow ( View Tweet)
FDA Approves Icotrokinra for Plaque Psoriasis
The FDA approved an oral IL-23 inhibitor, icotrokinra (Icotyde), for use in moderate-to-severe plaque psoriasis in adults and children 12 years of age and older who are candidates for systemic therapy or phototherapy, according to a https://t.co/q5b3TceFHx
Dr. John Cush RheumNow ( View Tweet)
Retrospective Japanese study of 544 pts w/ GPA or microscopic polyangiitis (MPA) followed > 48 wks; only 29 (5.3%) achieved steroid free remission (GFCR) at wk 48. Predictors of GFCR: rituximab induction (OR 3.9) & avacopan use (OR 24.3). MP pulse RX had lower likelihood of GFCR https://t.co/EMRqA5oHJQ
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Prospective multinational cohort of 1180 lupus pts, followed ~2.7 yrs. 37% had renal biopsies (Class III/IV 56%). They achieved mCRR 46%, mPERR 53%, LLDAS 60%, & REMission 46% at least once. renal response highest @ 2 yrs. New organ damage 11% @ 1yr; 33% by 5yr. https://t.co/ugh60M08Xf
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Hydralazine and the Rare Risk of Vasculitis
Since the 1980s, hydralazine has been a notable cause of drug-induced lupus, and inferred to cause vasculitis as well. A retrospective cohort study from Canada has shown that vasculitis resulting from hydralazine is possible, but https://t.co/ewqCesatbm
Dr. John Cush RheumNow ( View Tweet)
Urinary biomarkers improve w/ anifrolumab in TULIP-LN (lupus nephritis) trial; 112 pts, 197 uriniary proteins assessed. Urinary CD163 and MCP-1 signif improved as early as wk 12. Anifrolumab reduced the proteomic inflammatory signature, regardless of responder status https://t.co/n6fIJVDCN1
Dr. John Cush RheumNow ( View Tweet)
Pitfalls of autoimmune serologic testing
Misuse of laboratory testing may lead to misdiagnoses and mismanagement; this is particulary prevalent when clinicians consider the use of the diagnostic use of serological autoimmune markers.
https://t.co/VKosO3bVL2 https://t.co/4FTvTcrGJa
Dr. John Cush RheumNow ( View Tweet)
ILD found in 3% of #PsA pts. Metanalysis of 6 studies, 14,272 pts found ILD pooled prevalence was 3% in PsA; highers ((6%) in studies w/ CT, HRCT. Smoking was a signif. risk factor for ILD in PsA (OR 2.94, 95% CI: 1.22–7.12; I2 = 1.8%). https://t.co/9mY4Eiqc9d
Dr. John Cush RheumNow ( View Tweet)
Rheumatic Immune-related Adverse Effects with Checkpoint Inhibitor Therapy
A retrospective study of patients who developed rheumatic immune-related adverse events (R-irAEs) after receiving immune checkpoint inhibitors (ICIs) at two oncology centers in Spain suggests that early https://t.co/hYf6GiR6TN
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Long-Term Hydroxychloroquine Retinopathy Risk
About one in 18 patients taking hydroxychloroquine (HCQ) for 15 years develop retinal damage, a new meta-analysis indicated.
https://t.co/TBSTIb29Pf https://t.co/7TYQe4N4JH
Dr. John Cush RheumNow ( View Tweet)
Basic, full-read overview of "JAK inhibitors: risks and safety principles" from the Pharmaceutical Journal. Addresses MOA, indications, warnings, monitoring, adverse effects, interactions, Serious AEs, vaccination and best practices. https://t.co/6kZCde1NdF https://t.co/NlEKtvUGPa
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Dr. John Cush RheumNow ( View Tweet)
Rheumatic Immune-related Adverse Effects with Checkpoint Inhibitor Therapy
A retrospective study of patients who developed rheumatic immune-related adverse events (R-irAEs) after receiving immune checkpoint inhibitors (ICIs) at two oncology centers in Spain suggests that early https://t.co/jKCbIvfebm
Dr. John Cush RheumNow ( View Tweet)
Metanalysis of calcineurin inhib. in RA - 11 RCTs, 1793 RA pts. Cyclosporin (CSA( (RR 1.6 & Tacrolimus (TAC (RR 2.1) signif improved ACR20 responses. CSA was dose dependent, less so w/ TAC. Both require serum Creat. monitoring consistent increase in s-Cr https://t.co/OxNGYbupnt https://t.co/F08vDCMYtr
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Dr. John Cush RheumNow ( View Tweet)
