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Best of 2025: Methotrexate intolerance in rheumatoid arthritis

Jack Cush, MD

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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Nerandomilast FDA Approved for Progressive Pulmonary Fibrosis

Jack Cush, MD

The FDA has approved nerandomilast (Jascayd), a PDE4b inhibitor, to treat adults with progressive pulmonary fibrosis (PPF). Nerandomilast was approved to treat idiopathic pulmonary fibrosis (IFP) in October 2025.  

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Disease Activity Criteria for Adult-Onset Still's Disease: EULAR Points to Consider

Jack Cush, MD

EULAR has published a "points to consider" (PtCs) guidance on the development of criteria for the assessment of the disease activity in adult-onset Still’s disease (AOSD).

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Role of the Nurse in the Care and Management of Rheumatic Diseases - EULAR Review

Jack Cush, MD

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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Optimizing Hydroxychloroquine Blood Levels in Lupus

Jack Cush, MD

A large observational cohort study suggests that monitoring hydroxychloroquine (HCQ) blood levels is effective in systemic lupus erythematosus (SLE) patients with a target therapeutic range (for HCQ level monitoring) of 750-1150 ng/ml.

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Reefer Madness (12.12.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal and regulatory reports from this past week on RheumNow.com.  B cell drugs in SLE and ITP, biomarkers in GCA & PSS and great videos by APPs.

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2025 Adult Rheumatology Fellowship Match is Strong (Again)

ACR

The American College of Rheumatology (ACR) announced today that 2025 Medicine and Pediatric Specialties Match results show rheumatology fellowship positions continuing to fill at high rates.

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Medical Cannabis for Pain Management

Jack Cush, MD

Recent research and publications have underscored the use, efficacy, safety and limitations to the use of cannabis for arthritis and pain patients.

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B Cell Targeting in Idiopathic Thrombocytopenic Purpura

EurekAlert!

The New England Journal of Medicine  has published a phase III clinical trial showing that a B cell targeting monoclonal antibody, ianalumab, was effective in more than half of the patients with primary immune thromboc

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Nerandomilast FDA Approved for Progressive Pulmonary Fibrosis The FDA has approved nerandomilast (Jascayd), a PDE4b inhibitor, to treat adults with progressive pulmonary fibrosis (PPF). Nerandomilast was approved to treat idiopathic pulmonary fibrosis (IFP) in October 2025. https://t.co/G2SS0qJTfl
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“Absence of proof of efficacy does not equal proof of absence of efficacy” - Arthur Kavanaugh, MD

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FDA has approved nerandomilast (Jascayd) for the treatment of progressive pulmonary fibrosis (PPF) in adults, based on the results of the phase 3 FIBRONEER trial. Nerandomilast is PDE4 inhibitor,, in Oct 2026 it was approved for use in diopathic pulmonary fibrosis (IPF) https://t.co/WVrGj7q7hB
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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

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Survey of physician assistants finds 56% use AI daily (19% AI extensively). 87% PAs say they need to learn more about AI, 83% desire formal, employer-led AI training. 89% believe AI will dramatically changes PA practice, but only 32% have clear workplace guidelines on AI usage https://t.co/yGqZRC3mNt
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JAMA reports that by end of 2025, half (52-56%) of USA nonfederal acute care hospitals will use generative AI and predictive AI. Teaching hospitals and EPIC EHR are early adopters, while For-profit and government hospitals were less likely to currently adopt AI. https://t.co/iJib0YjnW3
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Roche announced that the European Commission has approved obinutuzumab (Gazyvaro in EU/UK & Gazyva in US) in combination with mycophenolate mofetil for the treatment of adult patients with active Class III or IV, with or without concomitant Class V, lupus nephritis. https://t.co/usUidNVMNY
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FDA has issued its final guidance on: Promotional Labeling and Advertising Considerations for Prescription Biological Reference Products, Biosimilar Products, and Interchangeable Biosimilar Products: Questions and Answers https://t.co/69sbgoWnSW https://t.co/kpTgdPOkka

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Dr. John Cush RheumNow ( View Tweet)
FDA has issued its final guidance on: Promotional Labeling and Advertising Considerations for Prescription Biological Reference Products, Biosimilar Products, and Interchangeable Biosimilar Products: Questions and Answers https://t.co/bjiV4S0Fur https://t.co/dDyJqhV5VF

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British Society of Rheumatology Guideline for Monitoring DMARDs The British Society of Rheumatology has published an update to their previous 2017 BSR/BHPR guideline regarding the use and monitoring of DMARDs (disease-modifying anti-rheumatic drugs) used to treat systemic https://t.co/7KNf6cIjfo
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Low Dose Naltrexone for Fibromyalgia Pain - Use it or Lose it? Medscape recently reviewed off-label use of low dose naltrexone (LDN) in fibromyalgia (FM) and found it is deemed effective by some clinicians and patients, but 1) there is no FDA indication for LDN use in FM and 2) https://t.co/RgRRHU9ZRo
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