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Adrenal Dysfunction after Steroids in PMR and GCA Patients

Jack Cush, MD

JAMA has published a study of PMR and GCA patients who stopped glucocorticoid (GC) therapy and noted a low (1.2%) risk of GC-induced adrenal insufficiency after planned cessation.

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PAFLAR Guidelines for Polyarticular Juvenile Idiopathic Arthritis

Jack Cush, MD

The Pediatric African League against Rheumatism (PAFLAR) initiative has published its guidelines for the diagnosis and treatment of polyarticular juvenile idiopathic arthritis (pJIA).

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Mizoribine Effective in Lupus Nephritis

Jack Cush, MD

A randomized clinical trial has shown that oral mizoribine, a common immunosuppressant in Japan, was noninferior to intravenous cyclophosphamide (CTX) as induction therapy in patients with active lupus nephritis. 

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World Changers (3.14.2025)

Jack Cush, MD

Dr Jack Cush and his podcast friends are out to change the world. Here is his weekly review of the news and journal reports from the past week on RheumNow.

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Channeling Bias and Cancer Risk with Biologic or Targeted Synthetic DMARDs

Jack Cush, MD

A retrospective US administrative claims cohort study of RA patients on tumor necrosis factor inhibitors (TNFis), non-TNFi biologics, or Janus kinase inhibitors (JAKis) found a statistically significantly higher risk of incident cancer in patients receiving rituximab, abatacept, or JAKis (compared with TNFis).

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Glucocorticoid Toxicity Index

Jack Cush, MD

Dr. John Stone has led the effort to develop the GTI - glucocorticoid toxicity index. In this review article he acknowledges the need and benefit of steroids, but details a novel means to identify and limit the untoward effects of glucorticoids (GC).

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2024.year.review

2024 Rheumatology Year in Review

Jack Cush, MD

2024 was a year of surprising new growth in technology, with the expansion of new therapeutic options for many patients and clinicians.  While these many advances offer new hope, they are countered by disappointments and gapping unmet needs in rheumatology. Below is my top 10 list (in no particular order) of 2024 developments and desires that may change rheumatologic practices.

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Ontario study of 11 641 older psoriasis pts & hospitalized serious infx in those on b/tsDMARDs. IL-12, IL-23, and IL-17 inhibitors were assoc w/ 35% lower rates of SIE, while MTX, other older systemic meds, TNFi were not incr/decr. But JAK inhibitors had signif 3 fold incr in… https://t.co/ffFdHjme65 https://t.co/DkTsadUNx2
Dr. John Cush RheumNow ( View Tweet)
Glucocorticoid Toxicity Index Dr. John Stone has led the effort to develop the GTI - glucocorticoid toxicity index. In this review article he acknowledges the need and benefit of steroids, but details a novel means to identify and limit the untoward effects of glucorticoids… https://t.co/xR8D4Jpjfv https://t.co/LyfHrbneTO
Dr. John Cush RheumNow ( View Tweet)
Cardiovascular and Fracture Risk with Denosumab Versus Bisphosphonates in Dialysis Patients Annals of Internal Medicine has published a Japanese administrative claims database study showing that, compared with oral bisphosphonates (BIS), denosumab (DEN) lowered fracture risk… https://t.co/kNqGNTrsAF https://t.co/xgCeaMDT1N
Dr. John Cush RheumNow ( View Tweet)
Stelara Biosimilar Steqeyma Launches at 85% Discount https://t.co/2ZR7LMq1JT https://t.co/coHj1jh8JB

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Dr. John Cush RheumNow ( View Tweet)
Alpha-gal syndrome (AGS) is a (Lone Star) tick-borne allergy to the galactose-α-1,3-galactose carbohydrate, found in mammalian meat/products; Sxs (hives, itching, swelling, and GI issues) present 2-8 hrs after meat & be life-threatening. Time to Dx has dropped considerably, w/… https://t.co/p1M9Qaf1jz https://t.co/jTJzq7YtVJ
Dr. John Cush RheumNow ( View Tweet)
Sobi announced it has submitted to FDA a supplemental (sBLA) for Gamifant (emapalumab-Izsg) for use in adult & kids w/ hemophagocytic lymphohistiocytosis (HLH)/macrophage activation syndrome (MAS) in Still’s disease with an inadequate response glucocorticoids, or with recurrent… https://t.co/a3I1fzHLdl https://t.co/WTFAs5PLWF
Dr. John Cush RheumNow ( View Tweet)
With GLP-1 agonists, is there a risk of aspiration during gen. anesthesia. Most advise against elective surgery/anesthesia unless the GLP-1 is held for 1-2 weeks. Based on MOA of delayed gastric emptying - 7/8 studies show Incr residual gastric contents in GLP-1, but none… https://t.co/BMeYVaBmIy https://t.co/DpTqKhb1Sg
Dr. John Cush RheumNow ( View Tweet)
Are Combination Biologics Safe? Real-life data from a French observational study suggests the overall risk of severe adverse events (SAE) with combotherapy does not seem to be increased (vs monotherapy), but certain combinations warrant caution. https://t.co/zcmo9mTRoS https://t.co/Q1lB0LvymF

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Dr. John Cush RheumNow ( View Tweet)
Sobi announced it has submitted to FDA a supplemental (sBLA) for Gamifant (emapalumab-Izsg) for use in adult & kids w/ hemophagocytic lymphohistiocytosis (HLH)/macrophage activation syndrome (MAS) in Still’s disease with an inadequate response glucocorticoids, or with recurrent… https://t.co/PLpcD5jzxH https://t.co/0LUe9bXaYS
Dr. John Cush RheumNow ( View Tweet)
With GLP-1 agonists, is there a risk of aspiration during gen. anesthesia. Most advise against elective surgery/anesthesia unless the GLP-1 is held for 1-2 weeks. Based on MOA of delayed gastric emptying - 7/8 studies show Incr residual gastric contents in GLP-1, but none… https://t.co/U690OmeqJm https://t.co/Q6kyv9fyVJ
Dr. John Cush RheumNow ( View Tweet)
A Veterans study of 27,540 #RA pts shows the risk of multiple myeloma (MM) did not differ b/tsDMARD & csDMARD users. 30% took b/tsDMARD during follow-up (192,000 PYs). MM incidence rate: b/tsDMARD-naïve 0.37/1000PYs vs csDMARDs 0.42/1000PYs (HR 1.32; 0.78, 2.26)… https://t.co/Xp4v4eIQnd https://t.co/5MVdz5UQSb
Dr. John Cush RheumNow ( View Tweet)
Long-Term Use of NSAIDs Linked to Lower Dementia Risk https://t.co/nlo2BodhLG https://t.co/TiE34zyvts

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Dr. John Cush RheumNow ( View Tweet)
Are Combination Biologics Safe? Real-life data from a French observational study suggests the overall risk of severe adverse events (SAE) with combotherapy does not seem to be increased (vs monotherapy), but certain combinations warrant caution. https://t.co/IEIi6kQI4b https://t.co/KVSbqeMbyA

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Dr. John Cush RheumNow ( View Tweet)
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