Methotrexate Safety Tips (7.31.2026) Save

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

1. Yesterday the EMA approved upadacitinib (Rinvoq) for the Treatment of Adults and Adolescents with Non-Segmental Vitiligo - the 1st therapy approved for the most common form of vitiligo. Based on positive results from the Phase 3 Viti-Up trials https://t.co/MMv5LjZclQ
2. 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
3. Psoriasis = Myocardial Dysfunction (unrelated to Cardiometabolic Risk Factors) 1010 PsO pts vs controls w/o skin dz, assessed clinically & by ECHO. PSO pts (even w/ controlled dz) had signif more myocardial dysfunction (17% vs 6%). Higher BMI & DM independently assoc w/ https://t.co/MjcRmgyCWX
4. STOP-HZ trial - 30 #RA pts going on tofacitinib given Shingrix (RZV) on day 1 & wk 8 & started Tofa on d1 or wk8. @wk 12 VZV responses incr in both (2.66 & 2.91 fold incr). @wk 4, d1 Tofa had fewer ≥1.5-fold VZV vs wk8 (44.8% vs 80%); BUT can you wait 8wks to start JAKi? https://t.co/tH0zPgBbHQ
5. An AI model trained from routine electronic health record data of 3.7 million individuals predicted cancer 1 year before clinical onset, no less promoted accuracy in detection, staging, treatment response, and prognosis https://t.co/ORrpJ2vIcR
6. Retrospective study of 2187 RA pts initiating menopausal hormone Tx (MHT) vs 8,205 unexposed controls. VTE incidence higher among MHT users (6.49 vs 3.3/1000PY). MHT use was associated with a 92% signif increased risk of VTE in RA (adj HR: 1.92), mostly DVT risk (aHR: 2.26) https://buff.ly/NknTNXK
7. UTSW observational study of labs (n 14,199) changes w/ MTX use in 2,439 pts (13% RA, 11% PsO/PsA, 15% inflam arthritis) - found no difference in labs q3 vs q6 mos. No signif correlation betw monitoring intervals & changes in ALT, AST,WBC, HCT, MCV, PLT, FIB-4. Small https://t.co/gKwA7juexG
8. Fibrosis-4 (FIB-4) Index for Liver Fibrosis is calculated from age, AST, ALT, Plts. Study of 174 RA, PsA, PsO pts on MTX find 11% w/ fibrosis (by elastography). FIB-4 AUC for fibrosis =0.68 (weak). Fibrosis was signif assoc w/ FIB-4 >1.62, DM, obesity, advanced steatosis https://t.co/GYrhs2U1s3
9. 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 tophi https://t.co/zr7K8Y2Bqz
10. 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
11. The Wider Implications of Dactylitis Dactylitis, https://rheumnow.com/news/wider-implications-dactylitis
12. $2 Million in Research Grants for Juvenile Arthritis  July is Juvenile arthritis month
13. Tips for safe use of allopurinol
14. Treatment goals in gout: aim for remission!