Anti-Rheumatic Rx

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Autoimmune Disease Impact Report

Jack Cush, MD

Integrated Benefit Institute, a nonprofit independent research organization, has published its 2025 Autoimmune Disease Impact Report, which examines the health and productivity impacts of five prevalent and costly autoimmune conditions: rheumatoid arthritis, multiple sclerosis,

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Targeting Obesity in Rheumatic Disease Patients

Jack Cush, MD

Sattar et al. has published an informative overview of the effect of obesity on rheumatic and musculoskeletal diseases (RMDs). They estimate that nearly 70% of RMD patients are overweight or obese.

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Mizoribine Effective in Lupus Nephritis A randomized clinical trial has shown that oral mizoribine, a common immunosuppressant in Japan, was noninferior to intravenous cyclophosphamide (CTX) as induction therapy in patients with active lupus nephritis. https://t.co/OWnGly4TUX https://t.co/zbPPH1n4lU

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Glucocorticoid Toxicity Index Dr. John Stone has led the effort to develop the GTI - glucocorticoid toxicity index. In this review article he acknowledges the need and benefit of steroids, but details a novel means to identify and limit the untoward effects of glucorticoids https://t.co/foTaoYrfDn
Dr. John Cush @RheumNow( View Tweet )
Comprehensive review of the management of knee osteoarthritis - topicals, analgesics, narcotics, intraarticular, metabolic, nutraceuticals, TENS, acupuncture and biologics. https://t.co/3UjPQeZut9 https://t.co/kpGsVFDzAV

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Dr. John Cush @RheumNow( View Tweet )
2024 Rheumatology Year in Review 2024 was a year of surprising new growth in technology, with the expansion of new therapeutic options for many patients and clinicians. https://t.co/JjG8oYTkKQ https://t.co/YgHMMiAQ9Z

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ERA, APPs, & Alpha GAL (3.21.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.  Listen in for 2 new case questions - Ask Cush Anything.

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Systematic review of colchicine and pregnancy in #FMF pts included 25 studies. Miscarriage was not increased w/ colchicine in FMF (RR 0.87). Birth defects were similar to unexposed pts (range 0.6% to 4.0%). Colchicine showed no effects (men/women) on fertility. 1 study reported… https://t.co/axiH9jhEJr https://t.co/oBpew71fZw
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Increasing Prevalence of Osteoporosis

Jack Cush, MD

Research published in Osteoporosis International studied NHANES data showed increasing trends in osteoporosis in the United States of America. The key findings showed statistically significant results.

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Spatial transcriptomic profiling on pre- and post-Rx synovial tissue Bxs from RA - Tx naive pts on DMARDs or adalimumab. Rx refractory patients had high expression of COMP, and fibroblast TGFβ signaling driving synovial tissue fibrosis https://t.co/1xFVvoddCD https://t.co/kYvhyX8VuS

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Dr. John Cush @RheumNow( View Tweet )
Mizoribine Effective in Lupus Nephritis A randomized clinical trial has shown that oral mizoribine, a common immunosuppressant in Japan, was noninferior to intravenous cyclophosphamide (CTX) as induction therapy in patients with active lupus nephritis. https://t.co/OS3yaJlEm7 https://t.co/1YcyfarF09

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Dr. John Cush @RheumNow( View Tweet )
renal.adrenal.pills.steroid

Adrenal Dysfunction after Steroids in PMR and GCA Patients

Jack Cush, MD

JAMA has published a study of PMR and GCA patients who stopped glucocorticoid (GC) therapy and noted a low (1.2%) risk of GC-induced adrenal insufficiency after planned cessation.

GC are widespreadly and chronically used in rheumatology, often with the

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PAFLAR Guidelines for Polyarticular Juvenile Idiopathic Arthritis

Jack Cush, MD

The Pediatric African League against Rheumatism (PAFLAR) initiative has published its guidelines for the diagnosis and treatment of polyarticular juvenile idiopathic arthritis (pJIA

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Glucocorticoid Toxicity Index Dr. John Stone has led the effort to develop the GTI - glucocorticoid toxicity index. In this review article he acknowledges the need and benefit of steroids, but details a novel means to identify and limit the untoward effects of glucorticoids… https://t.co/xR8D4Jpjfv https://t.co/LyfHrbneTO
Dr. John Cush @RheumNow( View Tweet )
Comprehensive review of the management of knee osteoarthritis - topicals, analgesics, narcotics, intraarticular, metabolic, nutraceuticals, TENS, acupuncture and biologics. https://t.co/SEyG4IQ0bh https://t.co/f6UY4hEl18

Links:

Dr. John Cush @RheumNow( View Tweet )
2024 Rheumatology Year in Review 2024 was a year of surprising new growth in technology, with the expansion of new therapeutic options for many patients and clinicians. https://t.co/XuEG8Hrc9e https://t.co/ja5OoZXdWo

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Dr. John Cush @RheumNow( View Tweet )
Stelara Biosimilar Steqeyma Launches at 85% Discount https://t.co/2ZR7LMq1JT https://t.co/coHj1jh8JB

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Dr. John Cush @RheumNow( View Tweet )
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Mizoribine Effective in Lupus Nephritis

Jack Cush, MD

A randomized clinical trial has shown that oral mizoribine, a common immunosuppressant in Japan, was noninferior to intravenous cyclophosphamide (CTX) as induction therapy in patients with active lupus nephritis. 

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With GLP-1 agonists, is there a risk of aspiration during gen. anesthesia. Most advise against elective surgery/anesthesia unless the GLP-1 is held for 1-2 weeks. Based on MOA of delayed gastric emptying - 7/8 studies show Incr residual gastric contents in GLP-1, but none… https://t.co/BMeYVaBmIy https://t.co/DpTqKhb1Sg
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Are Combination Biologics Safe? Real-life data from a French observational study suggests the overall risk of severe adverse events (SAE) with combotherapy does not seem to be increased (vs monotherapy), but certain combinations warrant caution. https://t.co/zcmo9mTRoS https://t.co/Q1lB0LvymF

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Dr. John Cush @RheumNow( View Tweet )
Meta-analysis shows the combination therapy bDMARD with MTX in #PsA pts yields better bDMARDs drug survival, especially with TNFi. 20 observational studies, 30,634 PsA pts. Insufficient data for non-TNFi bDMARDs. But adding MTX to bDMARDs had better TNFi survival (HR=0.79… https://t.co/aU8j4d6pei https://t.co/Ft99jwzPB3
Dr. John Cush @RheumNow( View Tweet )
Available the first time: https://t.co/4UQlqwujiR 2025 On Demand! On Demand gives you access to all lectures, Q & A panels, and STEP talks, and all speaker slides and handouts — all packed with insights you won’t find anywhere else. Non-CME, practical, and finally here.… https://t.co/qZb8OKjPpw https://t.co/Exr8u6QkNc

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Channeling Bias and Cancer Risk with Biologic or Targeted Synthetic DMARDs

Jack Cush, MD

A retrospective US administrative claims cohort study of RA patients on tumor necrosis factor inhibitors (TNFis), non-TNFi biologics, or Janus kinase inhibitors (JAKis) found a statistically significantly higher risk of incident cancer in patients receiving rituximab, abatacept, or JAKis (

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Earlier ACL reconstruction and a lower risk of knee osteoarthritis

EurekAlert!

A preclinical study by HSS investigators found that earlier anterior cruciate ligament (ACL) reconstruction led to lower immune cell activity, less inflammation and fewer joint changes associated with knee osteoarthritis compared to delayed surgery. The research team shared their study

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With GLP-1 agonists, is there a risk of aspiration during gen. anesthesia. Most advise against elective surgery/anesthesia unless the GLP-1 is held for 1-2 weeks. Based on MOA of delayed gastric emptying - 7/8 studies show Incr residual gastric contents in GLP-1, but none… https://t.co/U690OmeqJm https://t.co/Q6kyv9fyVJ
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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