Methotrexate Safety Tips (7.31.2026)
Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.
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The Wider Implications of Dactylitis
Dactylitis, AKA the "sausage digit", is a hallmark of psoriatic arthritis (PsA), but as Possemato and colleagues point out, it is fundamentally a clinical sign, and not a diagnosis.
https://t.co/HRaIvMHMSV https://t.co/XOcHbFVMsS
Dr. John Cush @RheumNow( View Tweet )
The Wider Implications of Dactylitis
Dactylitis, AKA the "sausage digit", is a hallmark of psoriatic arthritis (PsA), but as Possemato and colleagues point out, it is fundamentally a clinical sign, and not a diagnosis. This review article discusses the wider implications of dactylitis in rheumatology and medicine underscores the
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Coding: ICD-10 Code M45.7 describes ankylosing spondylitis of the lumbosacral region, a billable ICD-10-CM diagnosis code valid for FY2026. M45.7 became effective October 1, 2025 and belongs to the M45 parent category covering ankylosing spondylitis by anatomical site. https://t.co/jBmoD0CVps
Dr. John Cush @RheumNow( View Tweet )
From 2015-2024, 148 inflam arthritis pts (43 SpA, 35 PsA, 50 RA) w/ a prior cancer were followed 58.1 mos. 24 (19%) had CA recurrence/progression. Post-CA exposure to b/ts-DMARDs did not incr. recurrence risk after adjusting for age & comorbidity burden. https://t.co/MHKIqwyjNN https://t.co/uhOdq1cCPW
Dr. John Cush @RheumNow( View Tweet )
Metanalysis of 51 studies shows vaccination is suboptimal in Rheum. Influenza Vax rates: RA 50%, SLE 42%, AS 43% & Psa 53%. Pneumococcal vaccinations even lower: 37%, 30%, 39% and 41%. More by with age & comorbidites and by rheumatologists (vs PCPs) https://t.co/3DborC9BLW https://t.co/MPDeJUH0HI
Dr. John Cush @RheumNow( View Tweet )
Psoriatic Arthritis: EULAR 2026 Recap
Years of IL-17 vs. IL-23 debate in PsA finally got tested head-to-head: bimekizumab outperformed risankizumab on joint outcomes in the BE BOLD trial, while a GLP-1 combination study suggests weight and metabolic status are active drivers of PsA — not just comorbidities. This recap also digs into
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ACP Position Paper on Dietary Supplements
More than half of U.S. adults use dietary supplements, yet only a quarter use supplements recommended by a healthcare professional, and current law lets supplements reach the market with no premarket safety evaluation, unlike drugs or food additives. The paper notes that under DSHEA, dietary
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ICYMI: Updated CRA/SPARCC Recommendations for Axial Spondyloarthritis
In 2024, the Canadian Rheumatology Association (CMA) and the Spondyloarthritis Research Consortium of Canada (SPARCC) published a comprehensive set of 56 treatment recommendations for the management of axial https://t.co/ax0zwNcxYX
Dr. John Cush @RheumNow( View Tweet )
The Power of Self-Management with Chronic Low Back Pain
EurekAlert!
Almost everyone will deal with back pain at some point in their lives. Most recover quickly — but for about 20% of people, acute pain becomes a chronic condition that interferes with daily life and keeps them out of the workforce
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2026 Guidelines for the Treatment of Axial Spondyloarthritis
New guidelines offer clinicians and patients clearer directions on diagnostic workup, treatment selection, and long-term disease management, while emphasizing shared decision-making due to ongoing evidence gap. https://t.co/3V8bfDptDU
Dr. John Cush @RheumNow( View Tweet )
RT @rheumarampa
"There’s more work to do” as Dr. Floris van Gaalen summarizes the challenges in peripheral SpA
-pSpA has limited lab value testing like imaging, clinical diagnosis
- few clinical trials to support tx guidelines
- SPARTACUS trial: GOL vs. MTX in early pSpA
Dr. John Cush @RheumNow( View Tweet )
ICYMI: Updated CRA/SPARCC Recommendations for Axial Spondyloarthritis
In 2024, the Canadian Rheumatology Association (CMA) and the Spondyloarthritis Research Consortium of Canada (SPARCC) published a comprehensive set of 56 treatment recommendations for the management of axial spondyloarthritis. This first update is focused on the reassessment of IL-17i
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Which is NOT a key feature of inflammatory back pain: relief with activity; morning stiffness; age under 40 years; unilateral pain? Test your knowledge in this week's RheumIQ quiz at https://t.co/z8mLbcgE5D. https://t.co/tOdPfEBJa4
Dr. John Cush @RheumNow( View Tweet )
2026 Guidelines for the Treatment of Axial Spondyloarthritis
New guidelines offer clinicians and patients clearer directions on diagnostic workup, treatment selection, and long-term disease management, while emphasizing shared decision-making due to ongoing evidence gap. https://t.co/SUFnOMAUw8
Dr. John Cush @RheumNow( View Tweet )
Generic Tofacitinib (6.26.2026)
Dr. Jack Cush reviews the news and journal articles from RheumNow.com. Updates on tofacitinib, CAR-T therapy and AI.
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2026 Guidelines for the Treatment of Axial Spondyloarthritis
ACR
New and updated clinical guidelines released today provide comprehensive, evidence-based recommendations for the management of axial spondyloarthritis (axSpA) for both adults and children. The effort includes an update to the 2019 ACR/SAA/SPARTAN treatment guidelines focusing on adults,
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Steroids in SpA? DBRPCT of 94 (nonPsA) SpA pts w/ peripheral arthritis (SJC ≥ 2) placebo or steroids (GC) (csDMARDs background allowed). 76% male, age 32 yrs, TJC 10, SJC 3.6. Wk 24 there was no signif diff betw groups for ACR 50, ACR70 or PSpARC outcomes. https://t.co/snJovW31Uk
Dr. John Cush @RheumNow( View Tweet )
Redefining axial spondyloarthritis
An editorial in Lancet Rheumatology calls for "..reframing axSpA as a systemic, autoimmune inflammatory disease with multiorgan involvement and substantial unmet need."
The pathogenesis relies on not only HLA-B27, but also on environmental triggers, immune dysregulation, and
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JAMA Review on Low Back Pain
A comprehensive JAMA review synthesizes current evidence on the epidemiology, pathophysiology, clinical evaluation, and treatment of nonspecific low back pain, drawing on 108 publications identified from a PubMed search (2005–2026) and the most recent guidelines from the WHO, ACP, and NICE.
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A Disease Seeking Its Identity: Peripheral SpA, PsA, and the SPARTACUS Evidence
For years, peripheral spondyloarthritis has been managed with a cautious, stepwise approach: start with NSAIDs, escalate to conventional synthetic DMARDs, and only reach for biologics when everything else fails. The SPARTACUS trial, presented at EULAR 2026 in London, challenges that paradigm
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EULAR 2026: Updated Recommendations for Vaccination in Patients with Autoimmune Inflammatory Rheumatic Diseases
This update includes new pandemic era evidence, recombinant zoster vaccine data, and new perspectives on vaccination in patients taking novel immunosuppressants. Five overarching principles and 10 vaccine recommendations follow.
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Late-Breaking Studies at EULAR 2026
MedPage Today
Late-breaking abstracts presented at the European Alliance of Associations for Rheumatology's (EULAR) annual meeting, held here last week, addressed a wide range of clinical
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Long-term Cancer Risk with Targeted Therapy in SpA
Dr. Antoni Chan reports on abstract OP0238 presented at EULAR 2026 in London
https://t.co/f67SvKI6Vk https://t.co/fPp2H0aMoK
Dr. John Cush @RheumNow( View Tweet )
Imaging in SpA: are we seeing a clearer picture?
As EULAR2026 comes to a close, practical learnings take precedence as clinicians head back to their clinics. Among them, the 2026 EULAR Update on Imaging Recommendations in SpA stands out.
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5-Year Results of an IL-23 Inhibitor in Patients With PsA
Sponsored by AbbVie Medical Affairs + Health Impact
Dr. Alvin Wells and Dr. Shikha Singla share their clinical perspectives on using an IL–23 inhibitor to manage patients with PsA throughout their treatment journey in the context of 5-year data from the KEEPsAKE trial program.
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The Impact of Obesity on Psoriatic Arthritis
Sponsored by Lilly Medical Affairs
Image alt text: A person indoors raises one arm in a flexed pose while holding the elbow with the opposite hand.
Is obesity common in your patients with PsA? Learn more about the intersection of disease pathogenesis between PsA and obesity and how weight intervention can affect PsA outcomes.
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Recent Blogs
Dr. Cush provides a systematic approach to evaluating musculoskeletal and rheumatic complaints in clinical practice.
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Imagine that 100 years from now, your great granddaughter, an eminent rheumatologist, reviews the history of rheumatoid arthritis mimics.
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With their publication in June 2022 (1), the 3rd iteration of the Group for Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Treatment recommendations for Psoriatic Arthritis (PsA) may have set a record or sorts.
Podcasts
EULAR 2026 Daily Podcast Day 4a
Day 4 Recap EULAR 2026-
EULAR 2026 Daily Podcast Day 3a
