Anti-Rheumatic Rx

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Is High Dose Aspirin Needed in Kawasaki Disease?

Jack Cush, MD

Does aspirin add any advantage to intravenous immunoglobulin (IVIG) alone in children with Kawasaki disease (KD)? A randomized clinical trial IVIG alone was not inferior to IVIG plus aspirin, suggesting that high-dose aspirin during initial IVIG treatment did not reduce coronary artery

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Should Lupus Nephritis Receive PJP Prophylaxis? A current review article suggests that the need for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in patients with systemic lupus erythematosus (SLE) and lupus nephritis will need to be individualized based on therapies and https://t.co/zzRIVG0Sq3
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FDA reports higher rate of allergic/hypersensitivity type reactions w/ certainlots of Immune Globulin Intravenous (IGIV) and Immune Globulin Subcutaneous (IGSC) ; these have voluntarily withdrawn by the manufacturers https://t.co/N73Cc8rfAS https://t.co/OTROyomvv8

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Uveitis Risk with Slow Adalimumab Weaning Patients with pediatric non-infectious uveitis (NIU) who achieved remission on adalimumab (Humira) had lower recurrence rates when the drug was withdrawn more gradually, a retrospective cohort analysis indicated. https://t.co/KgQsK6fVnr
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2nd Opinions in Rheumatology https://t.co/R4CjJHEaL4 https://t.co/0quDwdANyU

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Dr. John Cush @RheumNow( View Tweet )
Summary of the updated BSR Axial Spondyloarthritis for biological and targeted synthetic DMARD guidelines 2025 @RheumatologyUK #axialspondyloarthritis Full paper available at: https://t.co/LytDiHjawi https://t.co/iaHzD1BQRe

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Antoni Chan MD (Prof) @synovialjoints( View Tweet )
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EMR Messaging Woes (4.11.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal reports and regulatory approvals from this past week on RheumNow.com

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Does DMARD Rx affect neurocognitive function in older pts? bDMARDs targeting TNF-α & IL-6 may mitigate neuroinflammation & preserve cognitive function. But, cognitive impact of csDMARDs (MTX) is complex, w/ conflicting reports on its role in vascular dementia. https://t.co/u3kSKHRvpI
Dr. John Cush @RheumNow( View Tweet )
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Should Lupus Nephritis Receive PJP Prophylaxis?

Jack Cush, MD

A current review article suggests that the need for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in patients with systemic lupus erythematosus (SLE) and lupus nephritis will need to be individualized based on therapies and risk factors. 

There are no clear guidelines

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MMWR: While PRE-overdose opioid prescribing is a risk marker for fatal overdose from opioids alone, stimulants alone, or both; PRE-overdose stimulant prescribing might not be a risk marker for fatal overdose attributable to stimulants. https://t.co/ReVbpligeT https://t.co/PnjeqaCySX

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Dr. John Cush @RheumNow( View Tweet )
EMA's EudraVigilance (safety) database study of 10,319 MTX reports (age: 62 yrs, 73% F). Adverse rxns (ADR): 365 kidney & 1,082 liver related. MTX renal ADRs were older, w/ comeds (NSAIDs, Tylenol, metamizole, steroids). More deaths w/ renal ADRs than liver(21% vs 6%); mostly w/ https://t.co/tQ9PSOTtyx
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EMA has approved upadacitinib (Rinvoq) for use in the EU to treat adult patients with giant cell arteritis (GCA) - approval is based on data from the Phase 3 SELECT-GCA trial demonstrating sustained remission and key secondary endpoints https://t.co/Y2tyZPC9Et https://t.co/SHPz2Q94Vs

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hands pregnant

Pregnancy-Related Deaths in the US

Jack Cush, MD

A CDC cross-sectional national study showed an increase in pregnancy-related deaths in the US from 2018 to 2022, with highest rates among American Indian, Alaska Native women, and non-Hispanic Black women. 

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Yoga vs Strengthening Exercise in Knee Osteoarthritis

Jack Cush, MD

A randomized clinical trial in knee osteoarthritis (KOA) patients showed both yoga and strengthening improved knee pain over 12 weeks, with no difference between groups.

There is limited evidence on the comparative effectiveness of yoga and strengthening

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Does DMARD Rx affect neurocognitive function in older pts? bDMARDs targeting TNF-α & IL-6 may mitigate neuroinflammation & preserve cognitive function. But, cognitive impact of csDMARDs (MTX) is complex, w/ conflicting reports on its role in vascular dementia. https://t.co/6uMmOOdRoF
Dr. John Cush @RheumNow( View Tweet )
EMA has approved upadacitinib (Rinvoq) for use in the EU to treat adult patients with giant cell arteritis (GCA) - approval is based on data from the Phase 3 SELECT-GCA trial demonstrating sustained remission and key secondary endpoints https://t.co/ycPNuB8C8y https://t.co/MCJNltn8Lj

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Dr. John Cush @RheumNow( View Tweet )
pediatric eye uveitis

Uveitis Risk with Slow Adalimumab Weaning

MedPage Today

Patients with pediatric non-infectious uveitis (NIU) who achieved remission on adalimumab (Humira) had lower recurrence rates when the drug was withdrawn more gradually, a retrospective cohort analysis indicated.

Read Article
EMA's EudraVigilance (safety) database study of 10,319 MTX reports (age: 62 yrs, 73% F). Adverse rxns (ADR): 365 kidney & 1,082 liver related. MTX renal ADRs were older, w/ comeds (NSAIDs, Tylenol, metamizole, steroids). More deaths w/ renal ADRs than liver(21% vs 6%); mostly w/ https://t.co/sZYZla0q1X
Dr. John Cush @RheumNow( View Tweet )
Weed, THC

ACP: Best Practice Advice on Cannabis or Cannabinoids Use for Chronic Noncancer Pain

Jack Cush, MD

The American College of Physicians published a best practice advisory on cannabis or cannabinoids in the Annals of Internal Medicine.

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Steroids, Prophylaxis and Pneumocystis Pneumonia A case-control study has shown that glucocorticoids and tapering glucocorticoids are risk factors for the development of Pneumocystis jirovecii pneumonia (PJP). The authors provide guidance on the optimal timing for prophylaxis https://t.co/0nKVEKOEex
Dr. John Cush @RheumNow( View Tweet )
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An Epidural Letdown (4.4.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.

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South Korean nationwide cohort study of 888,909 newly diagnosed #OA pts compared NSAID safety. Nephrotoxicity varied: lowest w/ meloxicam (aHR=1.22 [0.68–2.19]), higher w/ loxoprofen (aHR=3.9 [1.56–10.00]), celecoxib (aHR=2.4 [1.68–3.53]), naproxen (aHR=4.7 [2.16–10.24]) https://t.co/wfWIdoRQGO
Dr. John Cush @RheumNow( View Tweet )
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Vamorolone: a New Steroid on the Horizon?

Jack Cush, MD

Vamorolone is a potentially new alternative to traditional glucocorticoids for use in inflammatory diseases. It is a dissociated steroidal compound with reduced side effects, and in an animal model of inflammation has shown effective antiinflammatory properties and reduced systemic

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Steroids, Prophylaxis and Pneumocystis Pneumonia

Jack Cush, MD

A case-control study has shown that glucocorticoids and tapering glucocorticoids are risk factors for the development of Pneumocystis jirovecii pneumonia (PJP). The authors provide guidance on the optimal timing for prophylaxis use and withdrawal.

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1st Line Biologics vs. csDMARDs in Adult Still's Disease A German multicentre, retrospective study assessed the first-line efficacy of biologics and conventional synthetic DMARD therapy in patients with adult-onset Still's disease (AOSD) and found biologic agents were https://t.co/EeSuBiYx5Q
Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

Overlap Syndrome with ILD

Jack Cush, MD
Cush RheumThought ILD

How would you manage a patient with Overlap (anti-synthetase) syndrome, ILD, polyarthritis and myositis?

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Best of 2023: New ACR RA-ILD Treatment Guidelines – What Were They Smoking!?

Richard Conway, MBBChBAO, PhD
Lungs ILD
Rheumatoid arthritis related interstitial lung disease (RA-ILD) is common, with symptomatic RA-ILD affecting approximately 8% of RA patients. There is a very limited evidence base supporting treatment and therefore the recent release of ACR guidelines is to be welcomed. However, the published guidelines appear discordant with the best available evidence base.  Read Post
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