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Rheums Speak: Changing Rheumatology Practices & Choices

Jack Cush, MD

RheumNow surveyed clinicians worldwide on how their rheumatology practice, treatment decisions, and career outlooks have changed over the past 20 years. 242 respondents (68% from the USA) shared their perspectives on the changing landscape of rheumatoid arthritis care, practice patterns, and professional development.

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Repurposing & Pipeline (8.8.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, reports, pipeline and drug repurposing on this week’s podcast.

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Smoking and the Global Burden of Rheumatoid Arthritis

Jack Cush, MD

Detailed analysis of the Global Burden of Disease (GBD) 2021 database shows that tobacco and smoking is one of the most significant environmental risk factors for Rheumatoid Arthritis (RA) over the last 20 years. 

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Juvenile Idiopathic Arthritis - NEJM Review

Jack Cush, MD

Sandborg et al. has published an overview of juvenile idiopathic arthritis (JIA) - its classification, biology, genetics, , clinical presentations and treatment advances in the New England Journal of Medicine (NEJM).

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2025 BSR Recommendations for ANCA-associated Vasculitis

Jack Cush, MD

The British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) have published a guideline for the management of adults with ANCA-associated vasculitis (AAV); specifically three conditions: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA).

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Mid East/N African Survey on #SpA referrals. - 190 Rheum responded (68% consultants, 53% tertiary,95% urban) - 89% reported delay in axSpA presenting (most: Ortho, FP, internists) - 2/3 Dx challenges - > 60^ Pt non-adherence (side effects or Sx improvement) https://t.co/6jBdOqp2gM
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Full read review of DMARD effects on CV Risks. Strongest CV protective effects for MTX & TNF inhibitors. Potentially beneficial are sulfasalazine, hydroxychloroquine, & leflunomide. More info needed on IL-6, IL-17/23 inhibitors. Concerns over NSAIDs & JAKi https://t.co/0BW4StS15N
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Large metanalysis of TNFi use in immune-mediated inflammatory diseases (45 studies, 150K pts) shows no increased risk of de novo heart failure (HF), and no significant risk of HF worsening w/ TNFis. https://t.co/9sRVsMZ1kv https://t.co/igCdcQMVK3

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Dr. John Cush RheumNow ( View Tweet)
Smoking and the Global Burden of Rheumatoid Arthritis Detailed analysis of the Global Burden of Disease (GBD) 2021 database shows that tobacco and smoking is one of the most significant environmental risk factors for RA over the last 20 years. https://t.co/4IDf1ZTl7w https://t.co/oM0bNXIw28

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Dr. John Cush RheumNow ( View Tweet)
Retrospective study of 63 pts w/ Cryoglobulinemia (essential mixed [EM], CTD-related) vasculitis (CryoVas) in remission post RTX induction. W/ 58 mos F/U Relapse rates were 23%, 42%, 71% (@ 1yr, 2yrs, 5yrs). Relapse risk w/ purpura [HR 2.2] & prior CryoVas flare (HR 1.9). https://t.co/6zGgSN8Wfe
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COVID Vaccine study in rheum pts on JAKi (n 22) or TNFi (n 16) Showing 50% response in JAKi and 81% w/ TNFi Rx. Pt PBMCs were stim by SAR-CoV2 spike proteins & CD4+ T cells IFNγ production as Pos. response. Do JAKi impair COVID-19 Vax responses? https://t.co/dZAktwrytf https://t.co/mjkBfcGcfD

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Dr. John Cush RheumNow ( View Tweet)
Full read overview of Immune Checkpoint Inhibitors and their downside - immune related Adverse Events https://t.co/h1AzFaGVMz https://t.co/s75UdhE1HK

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Dr. John Cush RheumNow ( View Tweet)
Japans IORRA study of 10,613 RA pts (2007-21) - 915 deaths from cancer (28%), lung Dz (22%), CV Dz (16%). Protective Rx were MTX and bDMARDs, while even low-dose glucocorticoids showed increased mortality risk. https://t.co/lV5WmC5l1X https://t.co/QncyqXSRE9

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Dr. John Cush RheumNow ( View Tweet)
Retrospective review of 9 #RA pts w/ elevated liver enzymes who were Rx w/ TNF inhibitor (4 adalimumab, 5 etanercept; 78% female, median BMI 37). Over 3 yrs F/U, LFTs declined, fibrosis scores (FIB-4) signif decreased; albumin & bilirubin remained stable https://t.co/Hcwa3qaupv https://t.co/OwGY5jxxyZ

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Dr. John Cush RheumNow ( View Tweet)
Potentially novel RA vaccine of recombinant HLA-DRB1 04:01 bound to type II collagen (COL2) peptide COL2259-273 that was chemically modified at glycine position 265 & shows to suppress collagen induced arthritis in human DRB1 04:01-expressing mice https://t.co/TtBt49DQDa https://t.co/qMXzmvNc1b

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Dr. John Cush RheumNow ( View Tweet)
A New RA Approval (8.1.2025) Dr. Jack Cush reviews the news, journal reports and a new treatment for RA from the FDA https://t.co/hHNvdOKp2z https://t.co/lUAZM7bY7X

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Dr. John Cush RheumNow ( View Tweet)
Full read review of DMARD effects on CV Risks. Strongest CV protective effects for MTX & TNF inhibitors. Potentially beneficial are sulfasalazine, hydroxychloroquine, & leflunomide. More info needed on IL-6, IL-17/23 inhibitors. Concerns over NSAIDs & JAKi https://t.co/INEdCt0pxa
Dr. John Cush RheumNow ( View Tweet)
Large metanalysis of TNFi use in immune-mediated inflammatory diseases (45 studies, 150K pts) shows no increased risk of de novo heart failure (HF), and no significant risk of HF worsening w/ TNFis. https://t.co/9sRVsMZ1kv https://t.co/Kapg9ZwVGf

Links:

Dr. John Cush RheumNow ( View Tweet)
French retrospective observational study of Bx/CT/PET Dx of 380 #GCA pts found 7.6% (29) w/ Nl baseline CRP < 10 mg/L at Dx. GCA w/ low CRP had less fever, more ocular Dz (ant ischemic optic neuropathy 28 vs 13%), & limb claudication (24 vs. 8%) but equal relapse rates https://t.co/fPy92NjJzS
Dr. John Cush RheumNow ( View Tweet)
CCL17 is a downstream mediator of GM-CSF. Drug repurposing review of FDA approved Rx shows 5 Rx w/ anti-CCL17 effects - fluoxetine, ractopamine, ponesimod, terbutaline & etravirine, w/ inhibition of STAT5, IRF4 & CCL17 & shows antiinflamm effects in RA animal model https://t.co/2aTyZMWPJn
Dr. John Cush RheumNow ( View Tweet)
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