Gout Cavalcade (7.10.2026)
Dr. Jack Cush reviews the news, journal articles and regulatory decisions from the past week. July is Gout: More than Flares month.
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FDA Delays Gout Drug NASP with Complete Response Letter
On June 26, 2026, SOBI received a Complete Response Letter (CRL) from the U.S. Food and Drug Administration (FDA) that will delay a decision on NASP, pending the company's answer to questions regarding the drugs https://t.co/NmPbWmYd0p
Dr. John Cush @RheumNow( View Tweet )
Non-gout drugs that may lower uric acid – losartan, amlodipine, ACE inhibitors, fenofibrate, atorvastatin, leflunomide, vitamin C, estrogen, and high-dose ASA.
For more gout content, follow our Gout: More than Flares campaign at https://t.co/xnBVBN5IXZ, https://t.co/vmNvqojAcS
Dr. John Cush @RheumNow( View Tweet )
Problems with treatment adherence in the management of gout
Compared to common medical conditions such as hypertension, type 2 diabetes, hyperlipidemia or osteoporosis, where the reported drug adherence rates are between 50% to 70%, the drug adherence for gout is 37%. This https://t.co/OoLh0HUUH2
Dr. John Cush @RheumNow( View Tweet )
Netherlands pragmatic open-label RCT from 8 rheum centres tested T2T vs Sx Rx in 308 Gout pts starting ULT (87% male; 66 yrs). Remission (no flares & pain < 2) betw 18-24 mos was more in T2T pts (39% vs 24%; p=0.02), but more AE w/ Sx driven Rx (53 vs 42%) https://t.co/5g2dY5y900
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Do we need Better Strategies to Prevent Osteoporotic Fractures?
In a recent JAMA Viewpoints article, Dr. Susan Ott addresses several controversies in preventing osteoporosis (OP) related fractures.
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NEJM Retracts Pivotal ADVOCATE Trial of FDA-Approved Avacopan
The New England Journal of Medicine (NEJM) retracted the pivotal study supporting FDA's approval of avacopan (Tavneos) for severe forms of anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis. https://t.co/GOVyk5poNq
Dr. John Cush @RheumNow( View Tweet )
FDA Delays Gout Drug NASP with Complete Response Letter
At the end of June, Sobi was awaiting an FDA decision on its Biologics License Application (BLA) for NASP (nanoencapsulated sirolimus plus pegadricase) for the treatment of adult patients with uncontrolled gout. On June 26, 2026, SOBI received a Complete Response Letter from the U.S. FDA that
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Problems with treatment adherence in the management of gout
Compared to common medical conditions such as hypertension, type 2 diabetes, hyperlipidemia or osteoporosis, where the reported drug adherence rates are between 50% to 70%, the drug adherence for gout is 37%.
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Whats the BEST FIRST Rx in DMARD-Naive #RA - Tofacitinib or MTX. RCTs (ORAL Start, RA-BEGIN, SELECT-EARLY, FINCH 3) prove JAKi > MTX. A recent 116 RCT from China also shows Tofa > MTX by SDAI50 (94% v 75%) @3 mos & Tofa was more cost effective. https://t.co/KL2qlDgF6D https://t.co/wNVBgQkaMI
Dr. John Cush @RheumNow( View Tweet )
NEJM Retracts Pivotal ADVOCATE Trial of FDA-Approved Avacopan
MedPage Today
The New England Journal of Medicine (NEJM) retracted the pivotal study supporting FDA's approval of avacopan (Tavneos) for severe forms of anti-neutrophil
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Long term F/U of Gout (CARES) trial (febuxostat vs allopurinol) shows remission increased from 37% (1,593/4,259) 1st Yr to 63% (322/510) at year 6. Over the 6 years, ~60 achieved remission at least once; more likely based on age, race, dz severity, comorbidities, & febuxostat
Dr. John Cush @RheumNow( View Tweet )
DMARD Efficacy in RA-ILD
A network meta-analysis in the Journal of Autoimmunity reviews the pharmacologic options for rheumatoid arthritis–associated interstitial lung disease (RA-ILD). RA-ILD guidelines were recently presented by ERS/EULAR, but these were mainly conditional, low-certainty recommendations.
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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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RHEUM SURVEY>> Which Gout drugs lower the risk of cardiovascular death? Answer here: https://t.co/1OY1B3ET7B https://t.co/MRJP5OOtXb
Links:
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Uric Acid: Is Lower Better?
Lowering serum urate and urate crystals in the body is indispensable for long-term management of gout. The pathophysiology is simple and powerful: no urate crystals, no gout flares. However, this simplicity in goal belies a nuanced consideration in management: how low should serum
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RheumIQ: Per the 2025 EULAR RA recommendations, if a csDMARD strategy fails, which drug class requires careful risk assessment before use? Test your knowledge this week at https://t.co/z8mLbcgE5D. https://t.co/r61gvyMHPS
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 )
RT @jiharheum
MTX PO split dose MTX (15mg AM + 10mg PM) vs SC in early seropositive #RA in SCOOT RCT (n=252): SC MTX had better EULAR response at 16 wks (OR 0.55, p=0.049) and ↑ transaminitis with oral split. SC MTX remains the preferred route above 15mg/wk. #EULAR2026 OP0206
Dr. John Cush @RheumNow( View Tweet )
RT @aurelierheumo
A long release version of xanthine oxidase inhibitor in gout
-442 pts 36 wks
-HR091506 vs febuxostat
-SUA <300 μmol/L: 63.8% vs 40.7% (Δ +22.9%, p<0.0001)
-higher SUA reduction vs baseline
-Similar overall TEAEs (~90%)
A molecule to keep an eye on!
#LB0008
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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EULAR26: Vasculitis updates: Glucorticoid use in AAV and GCA
EurekAlert!
EULAR recommends a combination of glucocorticoids with either rituximab or cyclophosphamide for remission induction in life-threatening or organ-threatening AAV, followed by gradual tapering of glucocorticoids.
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ICYMI: Worldwide Trends in Hyperuricemia
A Lancet Rheumatology systematic review shows the prevalence of hyperuricaemia has risen markedly over the past two decades in both men and women, owing to population growth, aging, and increasing age-specific rates
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EULAR26: GLP-1 Agonist Use in the RISE Registry
EurekAlert!
At EULAR 2026, McCormick and Curtis et al presented data from the American College of Rheumatology’s (ACR) Rheumatology Informatics System for Effectiveness (RISE) registry on the use of GLP-1 agents in rheumatic diseases (RMD).
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ICYMI: Glucocorticoid Injections in Knee Osteoarthritis
A randomized clinical trial of 60 patients found that glucocorticoid injections into the infrapatellar fat pad (IPFP) did not significantly reduce pain scores in patients with inflammatory knee osteoarthritis (compared to placebo).
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Lupus Nephritis
Sponsored by RheumNow
View our six video perspectives on lupus nephritis, including Management of CKD in Lupus Nephritis.
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EXXELERATE: New Thoughts on High RF Titer
Sponsored by: UCB
Two leading rheumatologists share insights into why RF levels are important to consider when identifying treatment options for patients with RA.
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Recent Blogs
At first, it seemed similar to many other such sessions – a circle of folding chairs, a group of colleagues whose visages exuded understanding and acceptance – but this was special. I started the meeting…. “Hi, my name is Artie.”
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Dr. Jack Cush reviews Gout in this continuing series for Advanced Practice Rheum. Review the companion slide deck here.
Podcasts
RA Topic Podcast compilation
PsA Topic Podcast compilation
EULAR 2026 Daily Podcast Day 4a
