Is MTX Safe in the Elderly? (12.1.2023)

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Dr. Jack Cush reviews this past week's news and journal reports from RheumNow.com. Good news is that nearly 99% of adult rheumatology positions matched! But the challenge is that 45% of pediatric fellowship programs and 39% of pediatric rheum slots were unfilled in the 2024 NRMP match.

ICYMI: Do Probiotics Improve Psoriatic Arthritis?

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Psoriatic arthritis and the gut microbiome have become more intertwined, especially in the past few years. It was to my amazement that one of the first abstracts I came across was the effect of probiotic modulation on gut dysbiosis and disease activity in psoriatic arthritis patients. 

Rheum Fellowship Slots Fill Up for 2024

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While adult rheumatology programs continue to have high match rates, pediatric rheumatology programs remain less popular.The National Residency Matching Program announced yesterday that the 2024 rheumatology fellowship match filled 97.6% (124/127) of programs, and 98.9% (273/276) of rheumatology fellowship positions. This is on par with last years (2023) adult rheumatology match wherein 97.8% (265/271) of the rheumatology fellow positions were filled.

Next generation JAK-inhibition strategies

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It has been just over a decade since the approval of tofacitinib (JAK1/JAK3-inhibitor) by the US FDA for the treatment of rheumatoid arthritis. Since then, baricitinib (JAK1/JAK2-i), filgotinib and upadacitinib (both selectively targeting JAK1) also have been licensed for the treatment of rheumatoid arthritis. As there are many more JAK-inhibitors evaluated in clinical trials currently, how do you stand out?

MTX Toxicity in Older CKD Patients

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You know this; you've taught this; but here's a good study documenting a higher risk of methotrexate toxicity when used in the setting of older patients with chronic kidney disease. Yesterday's JAMA published a higher 90-day risk of serious adverse events in older adults with CKD taking low-dose methotrexate, compared to hydroxychloroquine.

When should we be starting therapy in GCA and PMR?

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The problem with having therapies that work is that you then have to figure out what to do with them. You cannot hide behind a shrug of the shoulders, or the ambiguity of therapeutic inadequacy. The question that follows the presence of a therapy is the question as to how to best use it. GCA and PMR are at the stage in the growth of their therapeutic development where this problem is moving to the front of mind, and it made for a fitting topic in the ACR Great Debate. Drs. Rob Spiera and Phil Seo - two luminaries in the vasculitis and PMR worlds - were pitted head to head to discuss.

Here’s what will change my practice in Rheumatoid Arthritis

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Here's what I learned at ACR23 that will change the way I practice in rheumatoid arthritis. 

Withdraw DMARDS after remission?

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The possibility of withdrawing DMARDs after patients achieve remission has been in our minds for a while. Yet when our patients ask whether it is a good idea to taper or stop their DMARD when they are doing well, most of us don’t have a black or white answer for them.

Race to the top: how high will treatment response rates in RA reach?

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We have become accustomed to the 60/40/20% rule for the outcome of ACR 20/50/70 respectively for biologics and targeted synthetic DMARDs.

Plotting Future ACR Convergence Meetings (11.24.2023)

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In this week's podcast, Dr. Jack Cush reviews the ACR Convergence 2023 meeting and proposes how to best learn at your next large medical meeting.

Reconsidering Steroids

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There is not a single one of us in rheumatology who hasn’t prescribed steroids, but we really need to reconsider how much and how often we use them.

TNFi and RA-ILD – The Pendulum Swings Again

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TNF inhibitors revolutionised the treatment of rheumatoid arthritis. While highly effective for the joint manifestations of the disease, a note of caution was sounded regarding the potential for worsening of ILD with these agents. Within this framework, a study by England et al presented at ACR23 was highly relevant.