Methotrexate Safety Tips (7.31.2026)
Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.
Read Article
Gout: Diagnosis
The diagnosis of gout - labs, imaging and polarized microscopy, created by @MithuRheum for RheumNow.
https://t.co/s8gkANFJSB https://t.co/pkUeFLG5if
Links:
Dr. John Cush @RheumNow( View Tweet )
Future therapies (in development) for gout - the goal is durable crystal depletion.
Created by: Dr. Aravind Palraj @rheumat_aravind for RheumNow.
https://t.co/yeCSAnHiY2 https://t.co/nH8f2Y3hNP
Dr. John Cush @RheumNow( View Tweet )
Calcium Pyrophosphate Deposition Dz new terminology from 2026 G-CAN consensus. Preferred:
- acute CPP crystal arthritis
- Chronic CPP crystal arthritis
- Chronic CPP crystal arthritis
- OA w/ CPP
- Chondrocalcinosis (xray)
* Pseudogout is obsolete
https://t.co/bsztXz9UDs https://t.co/GOey5YmKif
Dr. John Cush @RheumNow( View Tweet )
When Gout Flares, So Does the Cardiovascular System
We have spent decades teaching that a gout flare is a joint problem: a hot, swollen, painful joint that we treat with anti-inflammatory drugs and move on from (i.e., the treat to avoid symptoms strategy). The campaign title https://t.co/HCUQVaor4f
Dr. John Cush @RheumNow( View Tweet )
Upgrading & Maximizing the Classics
Panelists: Dr. Angelo Gaffo Dr. Lisa Stamp Dr. Michael Pillinger Dr. Ted Mikuls Dr. Jack Cush (moderator)
https://t.co/gO4CQD2f19 https://t.co/ESSLL0iK8F
Dr. John Cush @RheumNow( View Tweet )
2 T2T RCTs of 383 gout pts starting allopurinol - 31% had tophi. At 12 mos achieving target uric acid (<0.36mmol/L) was same in pts with and without tophi (70.3 vs 73.6), as was the %gout flares in month 11 (71.4% vs 79.7%; p=0.21). Allopurinol T2T success not influenced by https://t.co/zr7K8Y2Bqz
Dr. John Cush @RheumNow( View Tweet )
Treatment goals in gout: aim for remission!
Rheumatologists are used to the concept of disease remission as this is a treatment goal we use for many chronic rheumatic diseases in our clinical practice. Recently, G-CAN (the Gout and Crystal Arthritis Network), endorsed a
Read Article
Evidence-Based Dietary Recommendations for Gout
Gout, historically referred to as the “disease of kings,” was once associated with a lifestyle of excess. Today, it is more appropriate to refer to gout as a “disease of commoners,” as it is the most common inflammatory arthritis https://t.co/uIrSeOjxJZ
Dr. John Cush @RheumNow( View Tweet )
Tips for safe use of allopurinol
These are tips and hopefully the patients are abstaining from moderate alcohol and are not tipsy! Here are 5 tips that may not be totally obvious.
Read Article
Pragmatism in Gout: How therapeutic choices can have multiple benefits
Drugs prescribed to calm flares or lower uric acid are designed with one primary goal in mind, yet many also produce meaningful effects beyond the joints. Some of those secondary effects are unwelcome; such https://t.co/QvXAwFM7LJ
Dr. John Cush @RheumNow( View Tweet )
When Gout Flares, So Does the Cardiovascular System
We have spent decades teaching that a gout flare is a joint problem: a hot, swollen, painful joint that we treat with anti-inflammatory drugs and move on from (i.e., the treat to avoid symptoms strategy). The campaign title says it well — gout is more than flares. I would add
Read Article
UK primary care database (2000–21) gout study of new colchicine initiators (n 31,478) vs noninitiators (mean 60 yrs, BMI 30), follow-up of 4.5 yrs. Colchicine use had a signif. 12% lower risk of Joint Arthroplasty (HR 0.88); 23% lower TJA in knee/hip OA (HR 0.77) https://t.co/bT07lUYBB2
Dr. John Cush @RheumNow( View Tweet )
Chikungunya Club Meeting (7.24.2026)
Dr. Jack Cush reviews the news, journal reports from the past week on RheumNow.com.
Read Article
QD Clinic: Gout, Sepsis… or Both?
Dr. Mrinalini Dey, London, discusses a complex case.
https://t.co/UtncfZgZyL https://t.co/xVTA0LnPpN
Dr. John Cush @RheumNow( View Tweet )
"Leeuwenhoek (invented the microscope) examined uric acid (C5H4N4O3) crystals from gout patients and found them to resemble needles. He expounded on his observations in an 11 July 1679 letter responding to an earlier query from Mr. Lambert van Velthuysen (1622–1685), a physician, https://t.co/mY2wqYlRda
Dr. John Cush @RheumNow( View Tweet )
UK primary care database (2000–21) gout study of new colchicine initiators (n 31,478) vs noninitiators (mean 60 yrs, BMI 30), follow-up of 4.5 yrs. Colchicine use had a signif. 12% lower risk of Joint Arthroplasty (HR 0.88); 23% lower TJA in knee/hip OA (HR 0.77) https://t.co/TkYFYhANuH
Dr. John Cush @RheumNow( View Tweet )
Evidence-Based Dietary Recommendations for Gout
Gout, historically referred to as the “disease of kings,” was once associated with a lifestyle of excess, including ready access to alcohol and rich meats once reserved for society’s highest ranks. Today, it is more appropriate to refer to gout as a “disease of commoners,” as it is
Read Article
QD Clinic: Gout: Is it the Journey or the Destination?
Dr. Arthur Kavanaugh discusses a gout patient whose frequent flares improved after lifestyle changes, despite medication not being enough on its own.
https://t.co/frf4O87L0I https://t.co/cjtiYY9Ayt
Dr. John Cush @RheumNow( View Tweet )
Predicting and Managing Gout Flares in Hospitalized Patients
Dr. Kanon Jatuworapruk, Bangkok, discusses predicting and managing gout flares in hospitalized patients as part of RheumNow's "Gout: More than Flares" campaign in July 2026.
https://t.co/wrLbjsayrI https://t.co/eWmRqPNWsJ
Dr. John Cush @RheumNow( View Tweet )
Genetic study of 16 pts w/ Allopurinol-induced severe cutaneous adverse Rxn (SJS/TEN) shows 2 class I alleles to be associated: HLA-B*58:01 (OR, 28.0 [95% CI, 8.6-100.6]) and HLA-A*34:02 (OR, 20.6 [95% CI, 3.3-131.1]). Both explain 80% risk in US pts https://t.co/OxDXuWCbup https://t.co/oky61JImQV
Dr. John Cush @RheumNow( View Tweet )
Persistence of education and monitoring is crucial to optimal gout management
It is important that the misconceptions and myths held by the patient are discussed and dispelled and, most importantly, establish a clear understanding of “the plan” and the reason for initiating urate-lowering therapy (ULT).
Read Article
Gout patients are at greater risk for dementia, sleep apnea, septic arthritis and erectile dysfunction.
For more gout content, follow our Gout: More than Flares campaign at https://t.co/lQoiFjubZJ, https://t.co/p4WQ1GCB68
Dr. John Cush @RheumNow( View Tweet )
The Marriage between Gout and the Kidney
While the link between uric acid and gout was first described by Alfred Baring Garrod in the 1800s, the proof that uric acid might actually be the cause had to await the self-experimentation of two rheumatologists from the University of https://t.co/AWZbjaUtdu
Dr. John Cush @RheumNow( View Tweet )
SGLT2i use in gout reduces use of gout meds. Study of 26,739 gout pts w/ NIDDM (mean 66 yrs), 67% w/ polypharmacy. SGLT2i (vs DPP-4i) user had less Allopurinol starts (HR 0.62;0.52–0.73), also lower use of steroids (,78), NSAID (.85), colchicine (.87) & diuretics (.87) https://t.co/1dW27YzSvg
Dr. John Cush @RheumNow( View Tweet )
Therapeutic Updates
Watch our 'Systemic Burden of Gout' series as part of this month's Gout More than Flares campaign. Videos include: Gout Management in Patients with CKD, Gout and CVD, and Gout & Obesity.
Read Post
Campaign Videos
Podcasts
TU: Systemic Burden of Gout Part 2 (24 plus)
Gout Lessons from the Clinic Part 3
Systemic Burden of Gout Part 1