Double Trouble (10.23.2026) Save

Dr. Jack Cush reviews the journal articles and regulatory announcements from this past week on RheumNow, including: two crystals in one joint, twice the cryptococcus risk in JAKs; Myositis and Scleroderma; and Sjögren’s plus early damage = >> 2 fold risk lymphoma. Double trouble week on the RheumNow podcast.

1. FDA has approved NDA for Evoxac, granting Cosette right to sell oral, liquid Evoxac as an alternative treatment option for managing dry mouth symptoms in Sjögren’s patients. NA until end of 2026. https://t.co/jTySNljXMv
2. The FDA is reviewing Sun Pharma’s tildrakizumab (Ilumya), an IL-23 inhibitor, for use in active psoriatic arthritis, with an October 29, 2026 action (PDUFA) date. Decisons to be based on PsA INSPIRE-1 and INSPIRE-2 Phase 3 Studies https://t.co/iDWhub0k91
3. Open Evidence study of 952 008 US clinicians (556K MDs), submitted 271 million AI clinical queries over 2.5 yrs study period. MDs submitted ~371 queries/mo - 33% for Rx & 14% fo Dx. Highest use w/ young MD, oncology, hematology, Int medicine, & family medicine https://t.co/FGErefxWD5
4. REVEAL study enrolled 418 early microscopic polyangiitis pts - High baseline (Pre-Rx) neutrophil-to-lymphocyte ratio (NLR > 10) was assoc w/ signif higer Dz activity (BVAS), alveolar hemorrhage, poor renal function, reduced survival & higher infection-related mortality (P = 0.002). Low NLR < 10 had higher risk of ILD (UIP). https://buff.ly/Kz39HRI
5. Cryptococcus is rare, but twice as likely with JAK inhibitors. Retrospective TriNetX analysis of RA pts (>30k/grp) starting JAKi vs TNFi; JAKi vs non-TNFi; & TNFi vs non-TNF. Crypto seen in <0.2% in all groups; but signif higher HR for JAKi (HR 2.2 & 2.15) https://buff.ly/t9QJktX
6. Thai study of opportunistic infx in Pediatric SLE - 177 pSLE, & 38 developed OI (3.4/100PY). Most common OIs: Candida (27%), Aspergillus (13.5%), CMV (13.5%) - lung & skin mostly. Risk factors: Pulse steroids, Dz activity (SLEDAI-2K ≥11) https://t.co/0zjDOnDCEh
7. 150 #Gout pts (56 yrs old; 33wks F/U; 21% drank EtOH, 29% obese, 5% MASLD) on allopurinol followed w/ labs. 30y (20%) had incr AST/ALT (87% mild, none severe). Allopurinol was cont 18/10 without change in AST/ALT. Allopurinol was not the primary cause of LFT elevation https://t.co/nBCACpvr5W
8. Tokyo study of 107 pts (age: ~86y) on synov. aspiration found to have CPPD crystals - MSU crystals also seen 17 pts (16%), where CPPD crystals predominated. 7/17 had Hx of gout or hyperuricemia. None were Rx for gout. https://t.co/lDnBhd5EFA
9. Impact of Myositis in Scleroderma Patients Systemic sclerosis (SSc) may have overlap features such as myositis. When present, myositis in SSc is associated with an increased risk of cardiac involvement and a shift in mortality away from ILD towards a greater cardiac risk. https://t.co/dsGOXvdEuK
10. Prospective RCT of 39 refractory carpal tunnel pts (63 wrists) were injx w/ 1) US hydrodissection w/ normal saline (NS); 20 steroid injx; 3) US saline + steroid. Wk 24: Improved 86% & 90% grps 1 & 3; Saline superior to steroid; & adding steroid to NS yielded no benefit https://t.co/vCAB7Hojlo
11. Portugese single center study of primary Sjögren’s dz shows early damage is assoc w/ 12-14X incr risk of lymphoma. 208 pts (F/U 14_ yrs) Damage seen in 79% & 85%. Mortality linked to age but not damage. 17 (8%) had lymphoma. Early damage incr lymphoma (HR 14.5 or HR 12)  (Damage assessed by SSDI & SSDDI)https://t.co/g62KtjDuWg
12. Polish study compared comorbidities #s in incident RA & PsA. RA pts were older at dx (61 vs 44 yrs) & may drive higher rates in RA. 23/3 comorbidities (74%) were signif more prevalent in RA, including HTN (18 v 12%), ischemic HD (11 v 6%), cerebrovascular dz (4 vs 2%) https://t.co/l0RW6bVVHd
13. Italian GISEA (early RA) registry = 1304 pts Rx w/ JAK inhibitors. Retention rates at 6, 12, & 24 mos = 81%, 75%, & 61%. Low retention w/ baseline GC, high Dz activity, & pain. https://t.co/kKZmTHmEUb
14. RheumNow Live 2027 registration is NOW OPEN. GLP-1s in your clinic. CAR-T in lupus. Rheumatology experts vs. AI, with your vote. Jan. 30–31 | Onsite + virtual Early Bird Pricing through 12/15/2026. See the agenda. Register: https://t.co/zYYC2350tE