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DMARDs,biologics,RA

Efficacy of Subsequent b/tsDMARD Use in Rheumatoid Arthritis

May 04, 2022

Analysis of rheumatoid arthritis (RA) data from the British Society for Rheumatology Biologics Register shows that, even after failing three or more biologic or targeted synthetic DMARDs (b/tsDMARDs), patients may continue to benefit from repeated trials of unused b/tsDMARDs. 

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RheumNow Podcast – What You Do For & What You Do To the Patient (4.8.2022)

Apr 08, 2022

Dr. Jack Cush reviews the news and journal articles from the past week and discusses the use of fibroscan in RA, steroid hip injections in OA and famous quotes from a famous cardiologist.




  1. CorEvitas Registry study of173 Axial #PsA pts showed 6 mos of bDMARD/tsDMARD resulted

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Ask Cush Anything! Have a rheumatology question or case for Dr. Cush? Submit it here and we may feature it on an upcoming podcast. https://t.co/KgPIeScthr https://t.co/nk4re9mlcH
Dr. John Cush @RheumNow( View Tweet )
Mar 25, 2022
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Tocilizumab Works Best in Non-Mechanical Ventilated COVID-19 Patients

Mar 04, 2022

JAMA has published a meta-analysis of 15 studies of hospitalized patients with COVID-19 treated with tocilizumab and corticosteroids, showing that a clinically meaningful mortality benefit from tocilizumab (and steroids) was best seen in those not requiring invasive mechanical ventilation (

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ACR Updates Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With COVID

Feb 09, 2022

A Task Force from the ACR has provided an updated (version 3) guidance for the diagnosis and management of Multisystem Inflammatory Syndrome in Children (MIS-C), a COVID related condition characterized by fever, inflammation, and multiorgan dysfunction. The current guidance also applies to

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Yesterdays RheumNow Live Vote survey of 170 Rheumatologists, showed that 74-80% of Rheums are reporting shortages of IV tocilizumab (Actemra) -- TCZ listed by FDA site as a drug in shortage largely due to demand, Genentech says there is supply https://t.co/YAvR4vbVHV
Dr. John Cush @RheumNow( View Tweet )
Jan 21, 2022
RheumNow Live Vote survey of 159 Rheumatologists shows, because of the Actemra Shortage, Rheums are either changing to subQ TCZ (45%), changing to other biologic or tsDMARD (33%) or waiting for resupply of TCZ (21%). https://t.co/zNeyRsYClD @CreakyJoints https://t.co/aGYO2fqw7J
Dr. John Cush @RheumNow( View Tweet )
Jan 21, 2022
UTSW Rheum Grand Rounds - Dr. Nigrovic shows the efficacy of long acting IL-1 inhibition (canakinumab) and IL-6 (tocilizumab) in systemic JIA patients @UTSWRheum https://t.co/XdG8pAq1c4
Dr. John Cush @RheumNow( View Tweet )
Jan 20, 2022
J Rheum reports rheums may not be adequately screening for HBV, HCV when using tofacitinib & tocilizumab, despite rec's from CDC, AASLD, PI (but not ACR) to do so. TCZ & TOFA had partial screening (45% & 50%) or no screening (26% & 26%) https://t.co/y28kSJ1JgA

Dr. John Cush @RheumNow( View Tweet )

Jan 18, 2022
2021,year

2021 Rheumatology Year in Review

Jan 08, 2022

Our top 10 list of advances, game-changers, worries and those better medical practices that evolved during 2021.

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COVID,teen,young,man,mask

Clinical Practice Guidelines for Multisystem Inflammatory Syndrome in Children

Jan 05, 2022

Multisystem inflammatory syndrome in children (MIS-C) is new and serious complication of COVID-19 that preferentially affects adolescents. A review of proposed management guidelines is compiled in this report, suggesting a unified approach to therapeutic management of MIS-C.

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Best of 2021:Synovial Tissue Signature Guiding Targeted IL-6 Therapy in RA RNA sequencing-based stratification of rheumatoid arthritis synovial tissue showed stronger associations with clinical responses compared with histopathological classification. https://t.co/SD8ceTmbnm https://t.co/D98XBLj1YY
Dr. John Cush @RheumNow( View Tweet )
Dec 31, 2021
COVID Test Antibody

Serious Adverse Events Associated with Tocilizumab in COVID-19 Patients

Dec 14, 2021

Safety analysis of over 1000 adverse events associated with the use of tocilizumab in the treatment of COVID‐19 infection shows both rare expected and some unexpected AE.



Tocilizumab, an interleukin-6 receptors monoclonal antibody, is currently authorized for emergency treatment of

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When to Stop Biologics in Systemic JIA?

Dec 13, 2021

Systemic onset juvenile idiopathic arthritis (sJIA) is a dramatic onset inflammatory condition marked by spiking fevers, intermittent rash, polyarthritis and a host of other hyperinflammatory manifestations. The condition may be well controlled in many through the use of high dose

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Cytokine Inhibitor Lung Disease in Still's Linked to HLA-DRB1 Alleles

Dec 01, 2021

Pulmonary complications in the setting of Still's disease (juvenile and adult) has seldom but consistently been reported, including reports of pneumonitis, pulmonary hypertension and a severe or fatal lung disease, often associated with hypersensitivity to anticytokine therapy. A multicenter

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The Influence of Obesity on Choice of Biologic in Rheumatoid Arthritis

In rheumatoid arthritis we have a wide range of options available to us when we progress to a biologic treatment option. We have little to differentiate between these agents based on the clinical trials. We often make our choices based on minor hints from clinical features, comorbidities, or

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Top vasculitis takeaways from ACR 2021

There were several hot topics at ACR21. Here I concentrate on top abstracts in vasculitis. 

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FDA Update: 3 trials showing Efficacy of Tocilizumab in COVID 19: 1. RECOVERY - lower mortality 2. EMPACTA - Less progression to mech vent or death 3. REMDACTA & COVACTA - did not meet primary endpoints (but not contradictory) FDA Metanalysis of all 4 trials #ACR21 EUA 6/21 https://t.co/9yHu87KGej
Dr. John Cush @RheumNow( View Tweet )
Nov 08, 2021
TCZ in GCA: one disadvantage is that you can't use CRP+/- ESR for flares Mavrilimumab in GCA: - CRP/ESR consistently go up with symptomatic flares - CRP/ESR up less (cf. placebo), in the absence of Sx flares More signal, less noise. phase 2 post-hoc #ACR21 ABST1401 @RheumNow https://t.co/c0lMJMcQv0
Nov 08, 2021
NORD-STAR Trial: outcomes in tx-naïve, early RA pts after 48w of csDMARDs+GC vs bDMARD (ABAtacept, CerToliZumab, or ToCiluZumab)+MTX ➡️ Superior CDAI remission rates w/ ABA+MTX & CZP+MTX but not TCZ+MTX vs csDMARD+GC ➡️Imaging progression low in all Abst#0825 #ACR21 @RheumNow https://t.co/QaFIF4WNEG
Meral K. El Ramahi, MD @MeralElRamahiMD( View Tweet )
Nov 07, 2021
#ACR21 Abs#0834: CorEvitas Registry TNFi vs IL-6 in RA ⭐️IL6 pts older, longer h/o RA, higher CDAI, more prior Rx ▶️ No difference in outcomes bw IL6 and TNFi (monotherapy or combo w MTX). ▶️1/3 of pts achieved LDA Limits: real-world, unblindedhttps://t.co/AJtzeMuj1T @Rheumnow
Nov 07, 2021
bathroom scale

The Influence of Obesity on Choice of Biologic Agent in Rheumatoid Arthritis

In rheumatoid arthritis we have a wide range of options available to us when we progress to a biologic treatment option. We have little to differentiate between these agents based on the clinical trials. We often make our choices based on minor hints from clinical features, comorbidities, or

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ADACTA & MONARCH both showed IL6i monoRx > TNFi monoRx for RA in DBRCTs. What about in real-world data? Looking at CorEvitas, less so LDA: aOR 0.99 MCID in CDAI: 1.06 Even without MTX, both great drug classes for RA Equally so? #ACR21 ABST0834 @RheumNow https://t.co/6wvzVrXTW6 https://t.co/fYEktJhZuV
Nov 07, 2021
It's all happening for biologic therapies in PMR! phase 2/3 double-blind RCT: - new PMR - n=36 - 11w PNL taper (until relapse - clinical not lab) - weekly sc TCZ for 16w vs placebo big benefit persists post-TCZ cessation real steroid sparing PMR-SPARE #ACR21 ABST0507 @RheumNow https://t.co/w8tgOPAtyJ
Nov 06, 2021
In GCA, why might you target GM-CSF over IL-6? Entirely plausible TCZ might be leaving some Th1 stones unturned, esp: vascular remodelling downreg pathways Transcriptomics from toci/mavri-treated TAB show it's plausible beyond just theory... Cid group #ACR21 ABST0506 @RheumNow https://t.co/YephlzHOdj
Nov 06, 2021
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