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Glucocorticoid Injections in Knee Osteoarthritis

Jack Cush, MD

A randomized clinical trial of 60 patients found that glucocorticoid injections into the infrapatellar fat pad (IPFP) did not significantly reduce pain scores in patients with inflammatory knee osteoarthritis (compared to placebo).

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Best of 2025: 2025 BSR Guideline for Treatment of Axial Spondyloarthritis

Jack Cush, MD

Editor's note: This article was originally published April 22, 2025, and is being shared again as part of RheumNow's 'Best of 2025' series as we close out the year. Enjoy!

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Best of 2025: 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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Best of 2025: ERS/EULAR guidelines for CTD-related interstitial lung disease

Jack Cush, MD

The European Respiratory Society (ERS) and European Alliance of Associations for Rheumatology (EULAR) have published clinical practice guidelines for the evaluation and management of connective tissue diseases (CTD) associated interstitial lung disease (ILD) in two simultaneous publications in the European Respiratory Journal and Annals of Rheumatic Diseases.

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variety of contraception methods

Best of 2025: Contraception in SLE

Lisa Sammaritano MD

Pregnancy in SLE gets a lot of press in the rheumatology literature, and deservedly so, since pregnancy risks can be markedly increased. It was not that many years ago that women with SLE were counseled to avoid pregnancy.

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Best of 2025: Hydroxychloroquine for Everyone

Jack Cush, MD

Nearly 25 years ago, while lecturing on best therapies for rheumatoid arthritis (RA), I loudly stated that hydroxychloroquine was “useless” and, deservedly, I was “boo-ed” off stage. My point then was that rheumatologists needed to be aggressive, if not overly aggressive, in treating all RA patients. And my view was that HCQ was representative of under-treatment. I have reconsidered the use of HCQ in RA substantially in the last few years, based on its merit.

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Best of 2025: Glucocorticoids in SLE: how to start, how to follow, how to stop

Guillermo Ruiz-Irastorza, MD, PhD

Current guidelines recommend limiting the use of glucocorticoids by coining the new concept of “bridging therapy”, that is, use GCs when the disease is active and get rid of them as soon as you can. This way of thinking is conceptually attractive, however, the formula for translation to real life settings is not included.

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Best of 2025: Vitamin D for Prevention of Disease

Jack Cush, MD

JAMA has published a clinical guideline on the use of vitamin D to prevent disease in children and adults.

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ILD damage fibrosis path

Best of 2025: Antifibrotics - A New Class of Therapies in Rheumatology?

Shervin Assassi, MD

Rheumatologists typically manage systemic autoimmune rheumatic diseases and associated interstitial lung disease with immunosuppressants. However, evidence increasingly supports also the use of antifibrotic agents in this setting.

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APP Pearls “Steroids: Set a stop date upfront, educate on side effects, and teach "every milligram matters." Prevents dependence and eases tapering” - Barbara A. Slusher, MSW, PA-C, DFAAPA, DipACLM

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UK study of 1846 RA pts starting a b/tsDMARDs, ~30% on steroids & majority (2/3) continued use over the first year of new novel treatment. This suggests these aer either severe RA pts or that we are not vigilant in limiting/weaning/stopping steroids in RA patients - which is it? https://t.co/7NWeAWTjSy
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Japan retrospective study of 38 RA pts who developed MTX assoc lymphoproliferative disorder (LPD) - 22 w/ spontaneous regression (SR) vs 16 non-SR (w/ 5 deaths). non-SR Pt had higher LDH levels at Dx & lower lymphocyte recovery 1 mo. post MTX withdrawal & higher mortality risk https://t.co/SsBQRxFvD1
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JAMA teaching case: 57 yoF w/ RA Rx w/ HCQ, NSAID, TNFi (ETN -->ADA) develops a new rash - pruritic vesicles/papular on neck, mouth, ears, chest, hands w/ some becoming ulcerated plaques, ESR >100. WHAT TO DO? A) steroids; B) stop ADA; C) Benadryl or D) Read more? Pt had https://t.co/DQpeUOC5I3
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APP Pearls “It’s important to explain the difference between an overreactive immune system vs. a weakened immune system” - Miguel Rodriguez, ANP

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Best of 2025: Glucocorticoids in SLE: how to start, how to follow, how to stop 70+ years after their debut, glucocorticoids remain a fast, powerful tool for SLE—but long-term toxicity comes at a high cost. Guidelines now favor GC “bridging therapy”: use briefly, taper fast. The https://t.co/RS0JQquv6j
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2025 update of EULAR recommendations on lupus nephritis At the 2025 EULAR congress in Barcelona, Prof Dimitrios Boumpas presented updated EULAR recommendations on managing lupus nephritis (LN). The key change is that the historic standard of care (mycophenolate with https://t.co/78J1L80Zxe
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GC dose and tapering may influence serious infection risk in patients with GCA. Discover the key safety outcomes observed during a year of JAKi therapy in a Phase 3 trial. Sponsored by AbbVie Medical Affairs +Health Impact. https://t.co/xIC7Vqx659 https://t.co/6n3XfXeeg2

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Rapid rituximab infusions are safe & efficient. Metanalysis of 7 RCTs, 538 pts w/ autoimmune/rheumatic dz, showed infusions(RTX 1000 mg) of 90-120 min (w/ premedication) had low risk (3-15%) of mild (Grades 1, 2) infusion Rxns; only 6 Grade 3 Rxns https://t.co/uVKuhhc80F https://t.co/9EhyBpSaAE

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Best of 2025: Methotrexate intolerance in rheumatoid arthritis 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. https://t.co/hzfF7UVKVI
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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/KacbtcMn5G
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