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“ABCDE” Approach to Difficult-to-Treat Rheumatoid Arthritis

Jack Cush, MD

The proposed approach to difficult-to-treat rheumatoid arthritis is based on the EULAR definition (having failed 2 or more b/tsDMARDs). The authors provide guidance in the form of an easy acronym, A B C D E, which covers both diagnostic and therapeutic considerations.

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NME: New Molecular Entities (8.28.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com. Take this week's RheumIQ and test your knowledge!

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Mentshlichkeit* (8.7.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and recent journal reports on RheumNow.com.

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A Tribute to Daniel L. Kastner, MD, PhD (1951–2026)

Jack Cush, MD

The rheumatology, genetics and NIH communities mourn for Dr. Daniel L. Kastner, who died on July 28, 2026, in Bethesda, Maryland, at age 74. The following are declarations, tributes, and memories dedicated to this mensch of a man, titan of science, memorable mentor and humble physician.

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Chikungunya Club Meeting (7.24.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal reports from the past week on RheumNow.com.

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Seronegative RA Disease Activity (7.17.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal articles and Gout features from this past week on RheumNow.com.

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ICYMI: Updated CRA/SPARCC Recommendations for Axial Spondyloarthritis

Jack Cush, MD

In 2024, the Canadian Rheumatology Association (CMA) and the Spondyloarthritis Research Consortium of Canada (SPARCC) published a comprehensive set of 56 treatment recommendations for the management of axial spondyloarthritis. This first update is focused on the reassessment of IL-17i recommendations.

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Rheums! Do you have a Rheumatology question or case for Dr. Cush? Record it here, and we may feature it on an upcoming podcast. Tell us your name and where you practice rheumatology. https://t.co/LZ59KW8HdA https://t.co/DwHdvpTYax

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SELECT-PsA 2 subanalysis of 195 active PsA not responding to TNFi shows switching to upadacitinib 15 (vs PB) was superior @wk 24 - ACR20 (58% vs 22%), ACR50 (38% vs 9.5%), ACR70 (22% vs 0%), MDA (24% vs 3%) & maintained thru wk 152. Switching MOAs makes sense! https://t.co/YEkZuQ95Mu
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Resolved HBV infx (HBsAg-neg/anti-HBc+) retrospective study of HBc seroclearance in 230 pts Rx w/ anti-CD20 mAb. anti-HBc seroclearance seen in 16.5% (assoc w/ Younger age, less CD20 Rx, MMF Rx). HBV reactivation seen 5/230 (2.2%), including two w/ HBc seroclearance. HBc https://t.co/T0gfxftOgu
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True or False: A meta-analysis of 61 studies found that exercise showed anti-inflammatory trends, including reductions in CRP, IL-6, and TNF-α, in most chronic diseases. Test your knowledge in this week's RheumIQ at https://t.co/TBlB4pmnKa. https://t.co/7MxkveOuZE

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Does exercise affect inflammatory biomarkers? Metanalysis of 61 studies shows mostly low certainty evidence of inflammation-modulating effects of exercise. In most chronic diseases, exercise showed anti-inflammatory trends w/ reductions in CRP, IL-6, TNF-α https://t.co/EP74b3mVAT https://t.co/WBTHjsCzKL

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VA study of 4108 RA-ILD (2006-21). PRED use was 65-77%, A& 1st line Rx (MMF, AZA, RTX, CTX) incr after ILD, use was low (1.2-12%). MTX decr (47 to 30%), but LEF, TNFi, ABA incr. Predictors of ILD Rx: FVC, CCP+, ILD Dx after 2012. https://t.co/GT3Vwo11w1 https://t.co/KFDKsjkN0k

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Dr. John Cush RheumNow ( View Tweet)
Prolonged exposure to targeted Rx in #SpA not assoc w/ increased cancer risk. French claims study 56,591 SpA pts- 1,224 CA (1,029 solid, 116 Heme). TNFi, IL17i, IL12/23i, IL23i, JAKi Exposure >6 vs ≤6 mos assoc w/ lower CA (HR 0.86; 0.75-0.99); signif for Heme (HR 0.65), not https://t.co/rHAa0CkAjT
Dr. John Cush RheumNow ( View Tweet)
French study of 90 RA F pts w/ 100 pregnancies (steroids 46% & biologics 39% were used). Vs 359 controls, RA had signif. more preterm birth (PTB;OR 2.08) & small for gestational age. SGA assoc w/ nulliparity (adj OR 4.38), PTB assoc w/ maternal age (aOR 1.14) & GC ≥10 mg/d (aOR https://t.co/StCJW2rsZI
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ZEUS Trial: IL-6 Inhibition Fails to Cut Cardiovascular Events The phase 3 ZEUS trial tested the IL-6 ligand inhibitor ZVK in over 6,000 patients with ASCVD, CKD, and elevated hsCRP. Although ZVK significantly lowered IL-6 and CRP levels, it did not improved outcomes (HR 0.99 https://t.co/jf2gAtvmpZ
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FDA & Fresenius Kabi Issues Nationwide Recall of Tyenne® (tocilizumab biosimilar) Injection 400 mg/20 mL Vials Due to Presence of Glass Particles. Applies to NDC Number 65219-594-20, Lot Number 16UI07 , Expiration date: 08/2028 . FDA warns possible ISR or VTE. https://t.co/YMRC9FO7Mu
Dr. John Cush RheumNow ( View Tweet)
JAMA Case Quiz - A 57 yoF w/ #RA has a new vesicular rash. 9mos prior ETN change to ADA. Rash (painful, pruritic) started 2 wks ago. Exam: PIP swelling, & ulcerated plaques on neck, chest, & erythroderma on hands, CRP 15.0 mg/L , ESR 111 mm/h. What would you do? order?

Dr. John Cush RheumNow ( View Tweet)

3 Rx are FDA approved for hidradenitis supprativa (secukinumab, adalimumab, bimekizumab). New JAK1i Povorcitinib in STOP-HS1 and STOP-HS2 ph 3 PCTs (608/619 pts). Povo showed HiSCR50 ~42% vs PBO 29% @wk12. AE: acne, pharyngitis https://t.co/n3FJUOjNuo https://t.co/9YAmPqW44z

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RHEUM SURVEY>> Which Gout drugs lower the risk of cardiovascular death? Answer here: https://t.co/1OY1B3ET7B https://t.co/MRJP5OOtXb

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