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Practical management of rheumatic immune-related adverse events with immune checkpoint inhibitors

Jack Cush, MD

Joint Bone Spine has published a full read review of the management of immune-related adverse events (irAEs) in patients receiving Immune checkpoint inhibitors (ICIs) for cancer.

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Lung,AI,Pleura

RA Lung Disease Portends Poor Outcomes

Jack Cush, MD

A retrospective Harvard affiliates study shows that rheumatoid arthritis (RA) patients with lung disease have higher mortality, especially respiratory and infection-related mortality than those without lung disease (LD).

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farm

Pesticides and Rheumatoid Arthritis?

MedPage Today

Women exposed to pesticides through farm work or as farmers' wives face increased risk for developing rheumatoid arthritis, a new analysis of Agricultural Health Study data indicated.

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RheumNow Podcast square

NHANES, Numbers, & Risk (7.18.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com along with interesting case questions from "Ask Cush Anything".

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DNA,genotyping,gene,sequencing

Molecular profiling of RA synovium predicts biologic responses

Jack Cush, MD

Machine learning analysis of pre-treatment synovial tissue biopsy from rheumatoid arthritis (RA) patients starting either etanercept (ETN), tocilizumab (TCZ) and rituximab (RTX) revealed

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human figures on blue circle

1 in 5 Patients are Unaware of their Arthritis Diagnosis

Jack Cush, MD

Current CDC numbers suggest that arthritis (any type) affects an estimated 67.1 million (27.9% ) adults in the USA.  Interestingly, 1 in 5 do not know their arthritis subtype (21.6%, 14.4 million).

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hospital,surgery

Variability of Guidelines on the Perioperative Use of DMARDs in Rheumatic Diseases Patients

Jack Cush, MD

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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Pesticides and Rheumatoid Arthritis? Women exposed to pesticides through farm work or as farmers' wives face increased risk for developing rheumatoid arthritis (RA), a new analysis of Agricultural Health Study (AHS) data indicated. https://t.co/ISddKbnxMY https://t.co/E5tpX5D70X

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Dr. John Cush RheumNow ( View Tweet)
Diminishing trend in serious infections assoc w/ TNFi use in inflammatory arthritis over the years. ICEBIO study 1387 Rx w/ 1st TNFi 2003–2018 (vs 6936 comparators. Over tme the SI rate dropped 52% (IRR 0.48; 0.25–0.94), but not for controls (Abx use stable) https://t.co/jDsKlCrd0p
Dr. John Cush RheumNow ( View Tweet)
New ICD-10 Diagnostic Code -- R76.81 -- for ’At-Risk RA’ (AKA Clinically suspect arthralgia or Pre-clinical RA); this applies to pts w/ abnormal RF or ACPA without having RA. Thanks to Dr. Kevin D. Deane for leading this effort. https://t.co/14I6RCZrXb https://t.co/YxTwPB0YDQ

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Dr. John Cush RheumNow ( View Tweet)
La Paz study of 903 RA pts; 136 (14.5%) were D2T-RA, 96 for inefficacy. They define early vs Late D2T-RA=44.5 mos, & differed>> Early D2T-RA (1/3) pts more likely to have anxiety or depression (76% v 0), higher CRP @6mos, & time to develop D2TRA (35 vs 70 mos) https://t.co/KFG68y9Uq5
Dr. John Cush RheumNow ( View Tweet)
Full read overview of new imaging modalities for inflammatory arthritis, including high-res.quantitative CT, ultra-high field MRI), PET, fluorescence optical imaging, optoacoustic imaging, contrast-enhanced ultrasonography - all with artificial intelligence analysis https://t.co/rbHiPWAAFP
Dr. John Cush RheumNow ( View Tweet)
MTX lowers risk of serious infxn (SI) - UK Observational study of 17 472 newly Dx RA (2018–2023); 10K on MTX, 4,540 other csDMARDs; 13680 corticosteroids (GC). 1307 SI (3/100 PY) w/ reduced adj HR 0.72 (95% CI: 0.63–0.82). 311 SI-related mortality (IR 0.69;0.61–0.77) https://t.co/iuxAivtrYZ
Dr. John Cush RheumNow ( View Tweet)
Sulfasalazine as a preventative against Pneumocystis (PJP). 594 RA pts & 848 Rx episodes - 181 on SSZ, 667 controls. W/ 850 Pt-Yrs F/U, 21developed PCP, 3 died of PCP. SSZ significantly lowered PJP risk (p = 0.003, rate ratio = 0.05; 95% CI 0.00–0.34). https://t.co/PAgBaJGldR https://t.co/PuTxGXTeRS

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Dr. John Cush RheumNow ( View Tweet)
Molecular profiling of RA synovium predicts biologic responses Machine learning analysis of pre-treatment synovial tissue biopsy from RA patients starting either ETN, TCZ and RTX revealed high accuracy prediction of 16 week outcomes unique to each biologic. https://t.co/4d6NEY6JN6
Dr. John Cush RheumNow ( View Tweet)
MTX lowers risk of serious infxn (SI) - UK Observational study of 17 472 newly Dx RA (2018–2023); 10K on MTX, 4,540 other csDMARDs; 13680 corticosteroids (GC). 1307 SI (3/100 PY) w/ reduced adj HR 0.72 (95% CI: 0.63–0.82). 311 SI-related mortality (IR 0.69;0.61–0.77) https://t.co/YhJV3vyAmB
Dr. John Cush RheumNow ( View Tweet)
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 https://t.co/gjJOjZhSHU
Dr. John Cush RheumNow ( View Tweet)
Sulfasalazine as a preventative against Pneumocystis (PJP). 594 RA pts & 848 Rx episodes - 181 on SSZ, 667 controls. W/ 850 Pt-Yrs F/U, 21developed PCP, 3 died of PCP. SSZ significantly lowered PJP risk (p = 0.003, rate ratio = 0.05; 95% CI 0.00–0.34). https://t.co/PAgBaJGldR https://t.co/VV3MvVEGal

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Dr. John Cush RheumNow ( View Tweet)
NHANES study (1999–2018) of 38,272 participants looked at the neutrophil-to-albumin ratio (NPAR), & elevated NPAR significantly assoc w/ an increased risk of RA (ORtertile3vs1 = 1.27), esp if NPAR > 13.6. NPAR superior to SI), SIRI, PLR, MLR, & NLR. https://t.co/asLc6ghz7w https://t.co/2dAhIvekGA

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Dr. John Cush RheumNow ( View Tweet)
NHANES study (2007 to 2020) of 19,904 participants (≥ 20 years), including 1,477 RA pts. Prevalence of kidney stones was higher in RA (17% vs. 8%, p < 0.001) (OR = 1.77) https://t.co/0NZKQdQWR8 https://t.co/BRZ1RTNh5W

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Dr. John Cush RheumNow ( View Tweet)
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