Emergencies, Independence & Hemorrhage (1.23.2026) Save

Dr. Jack Cush reviews the news and reports from the past two weeks on RheumNow.Com

1. Did you know theres a Subcutaneous (SC) rituximab (Hycela)? Its same RTX but combined w/ hyaluronidase, faster 5-7 minute injection vs hours for IV RTX. FDA approved 2017 for Follicular Lymphoma (FL) and Diffuse Large B-cell Lymphoma (DLBCL). Give 1st dose IV, then use SC RTX. NOT APPROVED FOR RA. https://buff.ly/ACFjOBb
2. UCAN CAN-DU study of 181 JIA pts starting biologics. Early Rx w/in 6 mos (n=35) assoc. w/ greater odds of achieving inactive arthritis (83% vs 57% in late starters (>12 mos). For each month of delay increased the odds of future active arthritis (after 6 mos) by 9%. https://buff.ly/Dnq8R63
3. ADJUST trial (248 JIA pts w/ Uveitis & inactive >6mos, either continued or weaned off adalimumab. ADA weaning resulted in more flares (68% vs 14%, mostly uveitis) w/ no protection from background DMARD Rx. Restarting ADA was mostly effective. https://t.co/ZWHfPl2UNl
4. Acupuncture in SpA metanalysis of 35 RCTs (2,591 AS pts) showed statistically significant improvements BASDAI score, BASFI score, ASDAS, VAS score, CRP level, and ESR level. Findings imited by high heterogeneity & the lack of large-scale, high-quality RCTs. https://buff.ly/EQTLe6c
5. French Retrospective study (2011-22) of 36129 adult psoriasis pts on biologics who recv antibiotics (9366/26% @ baseline, 61% during FU). Abx treatment assoc w/ 12% greater risk biologic D/C (HR 1.12); more for multiple Abx courses (HR 1.29; 95% CI, 1.24-1.35) https://t.co/2Jv5xCibyd
6. FIBROSCANS in 60 RA pts on #MTX for 5 yrs w/ liver studies. Mean age = 39.5yrs, w/ Dz Dur 8.2 yrs, mean BMI 24.4 & MTX 12.5–25 mg for ~8 yrs (cum dose 6728mg). All had normal AST, ALT, APRI, Abd US; fibroscan score = 170 (steatosis grade 0). Only 4(6.7 %) had mild, fibrosis https://t.co/7SACsEYi37
7. Emergency Department Visits by Rheumatoid Patients A Canadian population study shows that rheumatoid arthritis (RA) patients have 30% higher emergency department (ED) visit rates for Ambulatory Care Sensitive Conditions (ACSCs) compared to age- and sex-matched population https://t.co/BL8AkXhkFG
8. Diffuse Alveolar Hemorrhage in Rheumatic Disease A retrospective, cross-sectional, single-center study of adult rheumatic disease patients with diffuse alveolar hemorrhage (DAH), demonstrates a high proportion have coexistent pulmonary infection and significant mortality risk. https://t.co/K1fLo5iHpd
9. Drugs that may cause toxic myopathy, presenting as muscle dysfunction w/ weakness and elevated muscle enzymes and possibly confused w/ idiopathic inflammatory myopathies (IIM) - full read review of mimickers of myositis. https://t.co/3wdLvkxcAX
10. Preoperative Semaglutide for 3 mos. prior to Total Knee Arthroplasty assoc w/ signif less Postoperative Adverse Events in NIDDM. Retrospective study of up to 745 T2DM needed TKR . 2-3 mos of GLP-1a reduces serious AEs by 75% (OR 0.25, P < 0.001). https://t.co/re57y9OvTN
11. 2025 Lancet review https://t.co/Qbwup6QxZK of Osteoarthritis did not mention/endorse Rx w/ platelet rich plasma (PRP) prompting several letters of protest. Read the authors response: Despite the popularity of PRP, there are few PBO controlled high quality studies to prove its https://t.co/RCaQVXvvfK
12. Metanalysis of Tramadol included 19 PBO-RCTs, 6506 pts, showing a very modest benefit on chronic pain (low certainty of evidence), but a doubling of risk for serious adverse events (OR 2.13); including nausea (NNH 7), dizziness (NNH 8), constipation (NNH 9), somnolence (NNH 13) https://t.co/0ZEIoy1gqC
13. US Overdose Deaths have dropped in 2024 & 2025!. Overdose (opioids, heroin, fentanyl) deaths peaked at ~110,000 in 2022, fell a little in 2023, but plummeted (27%) to 80,000 in 2024. Reported deaths highest in the N. East & Atlantic states. https://t.co/P3mgrOzGhr
14. Systematic review of cardiovascular death in systemic immune-mediated Dz (SIDs): 39 studies, 171,748 pts - SIDs assoc w/ signif. higher CV mortality (HR 1.26; 1.09-1.47; p = 0.002), especially for SLE, GPA, RA & females. 92% of CV deaths from acute coronary syndrome (ACS) https://t.co/ogLhqKMwON
15. Retrospective study of recombinant zoster vaccine Rheumatic (RMD) pts on DMARDs (32% JAKi) (114) vs 65 normals. HZoster reactivation: no controls vs 1in RMD. 1 Dz flare requiried steroids. Minor AE (ISR, HA, myalgia) seen in 17.5% & 21.5% w/ 1st & 2nd dose. RZV is safe in RMD https://t.co/Mu3OyA4EOD
16. COCHRANE REVIEW: Metanalysis of 21 clinical trials, 2,100 adults, shows cannabis-based medicines (vs placebo) over 2-26 weeks are not effective in treating chronic neuropathy nerve pain, regardless if given as THC of CBD. https://t.co/ZOJrcMGZkr
17. Retrospective single center --103 EGPA pts finds 36 (35%) w/ cardiac involvement, having cardiac Sxs & biomarkers. Most common: pericarditis (77%), cardiomyopathy w/ CHF (55%), myocarditis (36%), cardiogenic shock (14%), cardiac arrest (6%), coronary v.asospasm (8%) https://t.co/JNdVNlVWvA
18. AJMC Medicare Primary Care Shortage - betw 2013 -2021, PCPs decr 25%, while APPs rose 91%. 2021 AVAILABILITY per 10,000 Medicare beneficiaries; - Total clinicians: 23.4 to 22.2 (–5%) - Total new visits: 1162 to 1102 (–5%) - Total PCPs: 20.0 to 15.5 (–22%) - APPs: 3.4 to 6.7 (+97%) https://t.co/ALQI3O3Ian
19. Advanced Practitioner Biologic Prescriptions for Psoriasis Advanced practice clinicians (APCs; nurse practitioners and physician assistants) deliver a large share of US dermatologic care, accounting for 37% of clinicians and 27% of dermatology visits by 2020. A current JAMA https://t.co/3NtntmpSPV
20. 2024 Cardiology APP Income Survey - CV APP salary has incr 15% from 2019 -23, median=$123K - 50% of APP programs lead by an APP >90% work in outpt. clinics - 2/3 of prgs deploy APPs for lipid & prevention management - 2 APPs for every 3 cardiologists https://t.co/gtdm5qN1qD
21. 1 in 3 NPs and PAs switch specialties at least once in career; often without formal training in the specialty. Both "depend on MDs for mentorship and training". Hence AMA is opposed to Removing physician supervision or collaboration requirements” for nonphysician providers https://t.co/8RXL8zre0p
22. This week’s RheumNow Live pre-Learn spotlight: Vasculitis & Autoimmune disease. We’re diving into this important topic with expert-led talks from Drs. Nancy Olsen, Matthew Baker, and Clay Cockerell. To help you get the most out of their sessions, our speakers have shared key https://t.co/zLKY52Fi17