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3 x IL-23 = IL do Better (11.6.2026)

Jack Cush, MD

Dr. Jack Cush reviews the FDA approvals and news reports from this past week on RheumNow.com. This week we discuss playing the numbers in rheumatology, playing the long game with stem cell transplants, and a=the Positive spin on seronegative RA. 

Article

Don’t Hold the JAK (10.9.2026)

Jack Cush, MD

On this week's podcast, Dr. Jack Cush reviews the news: Steroids are easy to start and hard to stop; hold the MTX but not the biologic or JAK, weighing in on avacopan, and age-old messages for old-age patients. 

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Tocilizumab is effective in glucocorticoid-resistant adult-onset Still’s dz. 40 AOSD pts rx w/ TCZ (4-8 mg/kg q4wks). @12 mos clin remission 55%, 6 mos CID 62%, signif drops in CRP, ESR, ferritin & daily pred decr 91% (50 to 4.4 mg; p<0.001). TCZ retention 65%; MAS 7.5% & https://t.co/jtAxrz6ETd
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Menopause Hormone Therapy Tied to Small Autoimmune Disease Risk Estrogen-only menopausal hormone therapy was associated with a slightly higher incidence of autoimmune disease compared with estrogen-progestogen therapy, a retrospective cohort study suggested. https://t.co/kV4Y7tvpC8
Dr. John Cush Tweet
RheumNow
Menopause Hormone Therapy Tied to Small Autoimmune Disease Risk Estrogen-only menopausal hormone therapy was associated with a slightly higher incidence of autoimmune disease compared with estrogen-progestogen therapy, a retrospective cohort study suggested. https://t.co/g6BvYuBzVj
Dr. John Cush Tweet
RheumNow
Monogenic Inflammatory Disorders Go Unrecognized Lancet Rheumatology published a large cohort analysis using a genome-first approach with whole-exome sequencing, finding a prevalence of 1 in 4026 (159/640092) for monogenic disorders, half with inflammatory features. Only one https://t.co/bItqMXIoUH
Dr. John Cush Tweet
RheumNow
Should You Use Low Dose Naltrexone? A recent review of 105 studies and 15 randomized controlled trials of LDN found that, across a range of disorders (chronic pain, autoimmune and neuroimmune disorders, gastrointestinal disease, dermatological conditions, post-infectious https://t.co/sC7kteQVMZ
Dr. John Cush Tweet
RheumNow
Should You Use Low Dose Naltrexone? A recent review of 105 studies and 15 randomized controlled trials of LDN found that, across a range of disorders (chronic pain, autoimmune and neuroimmune disorders, gastrointestinal disease, dermatological conditions, post-infectious https://t.co/lmjJoGlFAZ
Dr. John Cush Tweet
RheumNow
52 VEXAS pts Rx w/ IL‐1i, IL‐6i, or JAKi therapy judged as compl Resp (CR), partial (PR), Failure (TF). @ 6mos: 3/19 IL‐6i had CR, 4/19 PR, 7/19 TF. JAKi had 2/17 CR, 3/17 PR, 6/17 TF. No CR w/ IL‐1i or TNFαi, only 1/5 IL‐1i patients experienced PR. Only IL‐6i & JAKi had https://t.co/wqogmfeAru
Dr. John Cush Tweet
RheumNow
Retrospective review of 33 referred pts w/ Recurrent fever w/ MSK & skin Sxs, assessed by NGS. NLRP1 had FMF-like Dz; NLRP recurrent fevers w/ mucocutaneous; NLRP12 periodic fevers w/ MP/EN rash; NLRC4 episodic systemic inflammation GI Sxs & atypical skin rash https://t.co/Ll2V0Uzfio
Dr. John Cush Tweet
RheumNow
Retrospective review of 33 referred pts w/ Recurrent fever w/ MSK & skin Sxs, assessed by NGS. NLRP1 had FMF-like Dz; NLRP recurrent fevers w/ mucocutaneous; NLRP12 periodic fevers w/ MP/EN rash; NLRC4 episodic systemic inflammation GI Sxs & atypical skin rash https://t.co/IWafJVFoaJ
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