RheumNow Live Preview (1.30.2026) Save

Hi, everyone. This is the RheumNow podcast. It's 01/30/2026, and I'm Jack Cush with rheumnow.com. Actually, rheumnow.live. That's right.

Our meeting's coming up in one week. We hope you'll be there. I'm gonna give you top five reasons why you should come to RheumNow live. Number five, it's next week, but it's cold and it's far, but you can be there online. Register now.

Number two no. Number four, If you register, you'll get full access to everything, including the hand handouts, the downloads, the lectures, the pictures, the pre learns, whatever. Number three, something you didn't expect, live entertainment Saturday night, Colin Boyd. He's great. One of Artie's favorites, one of my favorites.

Number four, I was looking at all the talks, and I liked this, set of talks by Rohit Agarwal from Philadelphia. He's doing a step talk, actually two of them, and they're like TED talks. One on myositis antibodies testing, and the other one on asymptomatic CK. Not a lot of slides. This is wisdom from the guru of myositis from the University of Pittsburgh.

I'm liking this. And the last one is registration gives you, and I think it's the number one reason, access and download to more than 400 review questions from this year's meeting 2026, from the 2025 and the 2024 meeting. It's a lot of questions. It's really good. So, I'm gonna certainly enough reasons.

When I look over the program, there's a few things that really jump out at me, and that's when we begin on Saturday morning. We've got a a session, we call them pods, on RA. And Elena Mayasadova is talking about mortality in RA, and why there's a trend downward that looks good, but still there's bad news. Why we've sort of stalled. Why your DMAR therapies are the first most important thing you can do to reduce mortality risk in RA, but it's still not enough, and there's more you gotta do.

Second on the agenda is Kristen Demarell from Colorado. This is the center where all the great research is being done on the earliest biology that starts RA, pre clinical RA, CSA, at risk disease, and this mucosal hypothesis theory, the mucosal hypothesis that they're working on, and she's one of the main investigators, you think you need to know this because it is this interface, I think, with the environment through the mucosa, inhaled, GI, that we're gonna find ten years from now is where we're gonna focus prevention of disease, and that's just my idea. Next down the program is from a friend from HSS, Susan Goodman. You may not know Susan Goodman, but she's done the ACR task force and all the great work on how we should manage our patients perioperatively. And it happens.

And sometimes we don't quite know what to do with their therapies, what the surgeons are saying. She's written the guidelines. She's the guru. She's the source. She'll be on stage.

Bob Turkletaub is maybe the world's greatest authority in gout, and he'll be giving two gout talks. One on gout pearls, and the other one on the rich history of gout. You don't wanna miss this. Next, know, Artie and I like, we're New Yorkers, but we moved to Texas and we like, you know, sort of this Texas music scene. And in the nineties we actually got into, we discovered the Dixie Chicks.

Well, we don't have the Dixie Chicks showing up, we got the Spondyloarthritis Chicks showing up. And that may be sexist, but, I'm telling you, these two gals together, Catherine Bakewell and Jessica Walsh, two friends, two academics from Utah, are gonna be on stage, and they're giving, you know, their talks on spondyloarthritis, but you know it's gonna be much more. They're doing a tandem, side by side thing, and it's a it's not just gonna be highly informative, it's gonna be entertaining because they are really, really good. Two more. Matt Baker from, Stanford's gonna talk about all the hot stuff going on in Sjogren's.

You know, the drought is over on therapy. We've got therapies coming in, and maybe you don't know about them. This includes nipocalimab, teletastasep, enalumab. That was actually presented at a few of these were presented, including the Neptunus one and two trials presented as positive phase three trials at ACR. This is good news for Sjogren's.

And then lastly, on the last day, Michael Putman, who's been managing our pre learns for this meeting, and if you haven't seen Michael's pre learns, you're really missing out. And he's gonna give an address on relapsing, relapses of PMR and GCA. Is it all about steroids? Or is it all not about the steroids? Michael's gonna tell us.

Alright. So this week on the podcast, we got a number of things that are worth reviewing. The Journal of Rheumatology, has an interesting talk, lecture or sorry, report about remission in RA and lupus. This is a single center study from Dresden, Germany, led by Michael Arringer, and I like this study because it put some hard numbers on some real world patients. They're looking at one hundred RA and 100 lupus patients from their center, and they use standard measures for remission, S dye and SLE dye.

What do you think they found in lupus? One hundred lupus patients, three ninety two visits. I was shocked by this. Eighty nine eighty eight percent achieved either remission or low disease activity state in lupus. Was it as good in RA?

It was better in RA. Ninety one percent of almost four hundred RA visits in a 100 patients. No difference between RA and lupus as far as how often they're achieving remission, but they did actually have some more remissions in lupus than RA, because we accepted remission and LDA as the outcome measure there, and that eighty eight-ninety one percent. But there were more remissions with lupus seventy nine percent versus sixty nine percent in RA, and I find that really surprising. But this is the real world.

This is probably what you're seeing. Other good news this week comes from two different sources. The Lupus Foundation of America announced that the US government, House of Representatives, has approved $27,000,000 for lupus funding in 2026. In 2025, the whole thing was a new administration, all these cutbacks, research is being screwed. Well, it looks like a lot of that money is coming back.

And that money is going to be available from the CDC, the Department of Defense, and other agencies. At the CDC, funding increased by 40%. At OMH by 33%, and $415,000,000 has been put into the NIH budget for lupus. So this is really good news, especially if you're a lupus researcher. Also this week, there's they had a stakeholders meeting called the Lupus Accelerating Breakthroughs Consortium, and they looked at skin lupus and outcomes.

And I think it was sort of a documenting paper where there, a consortium of lupus leaders, and the meeting and the paper has all the stakeholders, including representatives of the FDA, and they say that the CLASI measure is should be the recommended measure. That's a Cutaneous Lupus Erythematosus Disease Area and Severity Index, which I think was established by Victoria Wirth at the University of Pennsylvania. She's got a version of it for dermatomyositis. So classy should be the primary endpoint in clinical trials that can be used to get drugs approved in lupus. My beef in lupus is that it's really hard to prove a drug works in lupus with the current measures, although the SRI-four seems to have furthered things in the last ten years.

But it's still hard to get a general lupus indication. If I'm developing a drug, I'm going after a singling indication. And why not go after CLE, lupus skin disease, and why not use the CLASI as your primary endpoint? The FDA is going to accept it now. And we have commissions and guidelines and experts on this.

This should really further lupus research and drug development. JAMA published this week an interesting paper, a general paper in JAMA, about deprescribing. Yes, deprescribing. You know, this is really important, and I brought this up during ACR because the ACR updated its JIA guidelines and its systemic JIA guidelines. That was presented by Susan Shenoy.

An important part of their update to JIA treatment guidelines, as you can imagine, this drug, not that drug, whatever, was the component of deprescribing and down ratcheting therapy as we are adding on therapy, and that's really never been discussed. And this leads to the problem of patient confusion through polypharmacy and safety issues, does it not? So this JAMA paper basically shows if you employ two different interventions using an EHR, your electronic record, in a study of eleven forty six patients, most of them being old, mean age 74, they were able to either reduce the number of drugs being used, deprescribing, by either six point five percent or ten point four percent. And that the overall approach to using the EHR as a reminder to deprescribe can lead to forty percent more success in deprescribing. It is something we should talk about, something we should think about.

Again, I tell my patients, especially the ones I'm seeing that, you know, they've got that long laundry list and they're confused about their drugs, I tell them and I write down: If another doctor is going to give you two more drugs, you gotta say, oh, good. Thank you. But doctor Cush said, if you're gonna give me two, you gotta take two away. So it's gotta be zero sum management, or even, again, dig deep prescribing. The simpler the regimen, the more the compliance.

The more the compliance, the better the outcomes. Speaking of outcomes, there is this Strong Star Consortium started out of, I think, Fort Hood, Texas, and the military base there. They published a report in Arthritis Care and Research about a longitudinal study of 1,761 military service members, and their assessment of them before and after they were deployed. They found that the prevalence in males and females pre deployment was about two percent. But post deployment, meaning after they went to wherever they went, fibromyalgia meeting criteria went up to eight percent in males and eleven percent in women, a significant change.

Underlying all this was PTSD. It turned out that if you had PTSD before you were deployed, you had a three fold higher risk of fibromyalgia after deployment. And then similarly, if you had PTSD before and after, it went up from twenty one to twenty three percent in males and eighteen to twenty six percent in females, suggesting a bigger effect slightly bigger effect in females, pain being a bigger effect in females. I I again, this Strong Star Consortium has published in the past about military service and the risk of fibromyalgia, and it's an underlying feature in that Gulf War syndrome, a lot of which was fibromyalgia like disease. I think this is what underlies the post COVID syndrome.

I and and so but again, I I applaud them for their their efforts. Another interesting effort, and again, this is a stone in my shoe. This is bug that I keep going back to, is the use of ADHD drugs in our patients. You know, they're good for ADHD, are they not? That's why they developed them, they're FDA approved, and there's four of them that are out there on the market.

But in our patients it leads to worse sleep. Worse sleep leads to fibromyalgia. Fibromyalgia and ADH drugs leads to them seeing you thinking they've got multi centric reticulitis or whatever they're worried about. So a Lancet study of a European EHR network called Darwin showed a shocking statistic that in five major countries in Europe all the biggies the use of ADHD drugs more than doubled between 2010 and 2023. In some places it went up fivefold.

In The UK, it went up twentyfold in females, fifteenfold in males. What? Again, look at the drugs when they show up in your office. Talk to them I try to deprescribe ADHDs. I know its utility in severe ADHD, especially in children.

I think it tends to be overused in adults, in America at least. Seminars Arthritis and Rheumatism looked at the cardiovascular risk in inflammatory, idiopathic inflammatory myopathy patients, myositis patients, and in this sort of multi country international expert data set that was a retrospective chart review of three thirty six IIM patients, they found that over a third of them had a moderate to high risk for cardiovascular disease. And of those people, only a third of them were actually receiving a statin. So even though there's a risk, maybe we're not paying attention to how it should be managed. It turns out that, you know, not surprisingly cardiovascular risk is, you know, twenty to eighty percent higher in people taking that have dyslipidemia or people taking steroids.

But would you have guessed that necrotizing myopathy gives you a four point six fold higher risk of cardiovascular events? That's kind of gigantic. What is it about them? And it's not just the steroids, because that's sort of factored in in the analysis, I believe. So, something to consider in your, IIM patients.

A Turkish study from the Turkish League Against Rheumatology, TLAR, studied PSO and PSA patients looking at periodontal disease. Now, we know periodontal disease is a risk factor in rheumatoid arthritis, a lot written about that. I don't think I've seen this in psoriasis and psoriatic arthritis. Anyway, they found periodontitis in PSA more than PSO, forty seven versus thirty one percent, almost significant at point zero six, point zero five eight. It was but but it was significantly higher for disease activity.

It was significantly associated with disease activity, and with enthesitis as measured by the Massey's measure. So, again, something to look at in your PSA patients and PSO patients. Do they have periodontal disease? You shouldn't be addressing it because it's complicating things and maybe driving things. You know, we all make mistakes.

Even me. And I like that when you, the listener or reader, write me an email saying, you know, you kinda screwed up on that one. And and I I appreciate that, and I usually will put it out there for in case it gets seen again so that, I don't mislead people. But I found a really interesting publication this week called retractions in rheumatology. And it's really interesting.

These investigators looked at the retractions in rheumatology between 1989 and 2024 and found three eighty one rheumatology articles that were retracted officially. Two thirds of them come from Southeast Asia, about half of the cases come from China. Reasons for retraction was mainly what they call scientific misconduct about three quarters of cases: data fabrication, bad and fake peer reviews, duplication of previously published data, authorship, deceit, you know, there's a whole bunch of things that go on. 15% data errors, eight percent other reasons, But the important part is that this was pretty uncommon back between 2000 and 2009, only 18 reports were found. But in a you know, that was a nine year period.

In a three year period, 02/2023, it was 02/2007. So why is it increasing? Is it worrisome? Is this, deceitful rheumatologic research and practices? Or is it the fact that over time we have the Internet and more eyeballs?

Know, certainly more eyeballs are a big contributor, but both there are there. And the author's recommendation was, early on in a rheumatologist career they need strong heavy exposure to research, especially methodology and ethics. And I think that that would go a long way in the education of better rheumatologists in the future. You know I'm interested in serologies, rheumatoid factors, CCP. I gave that lecture at RheumNow Live last year, I'm going be lecturing on that at RWCS in a few weeks.

The Mayo Clinic did an interesting report. And this is Cynthia Croson, Elena Mayasadova, you know, John Davis, all the great, you know, researchers at the Mayo, did a retrospective population study from Olmsted County on RF and CCP in thirteen hundred plus incident RAs. So the question is: Who was RF positive? Who was CCP positive? Who was double positive?

What does it all mean? Well, they lay it out. At diagnosis, only thirty seven percent were dual positive for RF and CCP. Only thirteen percent were CCP positive at diagnosis only at diagnosis, and only twelve percent. What?

Again, they had thirty eight percent that were seronegative. So when you add all those combinations of positivity up, you know, it was again that sixty percent number we often quote, and thirty percent being seronegative. But I didn't know that so few were double positive, or even single positive. Ultimately, being double positive resulted in a higher risk of erosive disease and future flares. Thirty one percent were going have erosions, future flares, and double positives versus, I guess, single or seronegatives was sixty nine percent versus fifty nine percent.

Only rheumatoid factor positivity related to mortality risk. So we do know that CCP has a really, really strong, really, much more so than RA erosive risk. And CCP probably has a greater risk of developing RA than does RF. There are certainly other autoantibodies in play that we don't often measure. But rheumatoid factor has a higher mortality risk and I find that interesting.

If you like this subject, you should look at I have a few videos up right now called Advanced Practice Rheumatology. I did it as a part of our APP campaign in December and in January. I got one up on the evaluation of the rheumatic patient, methotrexate, difficult to treat RA. These are short, roughly ten-twelve minute videos. I got one up on RF and CCP and I throw in a little sed rate and CRP for you.

You might want to look at that, especially if you're an APP looking to strengthen your knowledge base. Again, 2026, RheumNow live. Great meet great rheumatologists go to great meetings like this. I hope you'll join Artie Cavanaugh and I and a powerhouse faculty on February in Dallas. You can register at roomnow.live.

Take care of yourselves. We'll talk next week.