Novel Rx

Review of Emerging Treatments for Vitiligo an immune mediated dz that affects QOL & has psychosocial impact. JAKi only ruxolitinib is FDA-approved, but Tofa & Bari show promise. Emerging therapies include simvastatin, afamelanotide, and metformin https://t.co/Rp2yYx6SyZ https://t.co/pBo1IDe8pQ

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Dr. John Cush @RheumNow( View Tweet )
Systematic review of JAK inhibitor use in systemic sclerosis - 18 articles/87 SSc pts (80%F; ages 13–78 yrs). JAKi (83% tofa) mostly used for ILD & Skin Dz (45%) or GI+Skin Dz (39%). 87.5% improved, w/ 6% relapsed. Adverse events in 50% (20% infx). We need RCTs! This could be a https://t.co/VXFuHGpDjB
Dr. John Cush @RheumNow( View Tweet )
SLE Treatment Landscape: Abundance or Overload? Imagine a world where the multiple drugs in Phase 2 and 3 trials actually get approved, and we get access to them? I know you may be thinking that I am overly optimistic, but there are so many drugs in development in lupus that we https://t.co/1SsSMqfZWz
Dr. John Cush @RheumNow( View Tweet )
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Methotrexate Fails in Knee Osteoarthritis

MedPage Today

We'll be blunt: methotrexate flopped in a randomized placebo-controlled trial among patients with osteoarthritis (OA) of the knee.

Contrary to results from a previous trial in hand OA, the old-line disease-modifying anti-rheumatic drug (DMARD) failed to bring any improvement relative to placebo

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Do SGLT2 and GLP-1 therapies have a role in Lupus? Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) and Glucagon-like peptide-1 receptor agonists (GLP1-RA), initially developed to lower glucose in Type 2 Diabetes, also provide cardiovascular and renal protection for patients https://t.co/8JEfcv2BUz
Dr. John Cush @RheumNow( View Tweet )
A retrospective VEXAS cohort study of 59 pts receiving 71 targeted Rx - 98%male, mean 71 yrs & 46% had myelodysplastic syndr. Treatments included tocilizumab(19), anakinra (13), azacitidine(13), baricitinib (11), & pred only (10). Best responses w/ azacitidine & tocilizumab https://t.co/jqDmKinPDt
Dr. John Cush @RheumNow( View Tweet )
Using publicly available FAERS safety data, drug-induced photosensitivity (DIP) - among 17+ million safety reports, there 20,236 linked to DIP. The most common wereimmunosuppressants, monoclonal Abs, neoplastic agents, including adalimumab, adapalene, secukinumab, fingolimod https://t.co/QWg8FVvrZb
Dr. John Cush @RheumNow( View Tweet )
Choices

SLE Treatment Landscape: Abundance or Overload?

Janet Pope, MD, MPH, FRCPC

Imagine a world where the multiple drugs in Phase 2 and 3 trials actually get approved, and we get access to them? I know you may be thinking that I am overly optimistic, but there are so many drugs in development in lupus that we may have true difficulty choosing what to use.

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Do SGLT2 and GLP-1 therapies have a role in Lupus?

Maya Shumyatcher, MD  Arpitha Haranahalli Shivarudrappa, PhD ,  Jennifer H. Anolik, MD, PhD

Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) and Glucagon-like peptide-1 receptor agonists (GLP1-RA) were initially developed as glucose-lowering agents for the treatment of Type 2 Diabetes. Since their introduction, they have been noted to have a myriad of other benefits, including

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Belimumab in SLE with Mucocutaneous or Vasculitis Findings

Jack Cush, MD

A post hoc analysis of a belimumab (BEL) inn systemic lupus erythematosus (SLE) study showed lupus mucocutaneous and vasculitic manifestations improve with BEL and standard care.

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Dafna Gladman

50 Year Perspective on Lupus

Dafna Gladman, MD

An observational cohort study was started in Toronto by Dr. Murray Urowitz in 1970. The program was set up as a specialized clinic to provide care for patients with lupus, to study clinical laboratory correlations in the disease, and to better understand long-term outcomes of the disease. What

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A retrospective VEXAS cohort study of 59 pts receiving 71 targeted Rx - 98%male, mean 71 yrs & 46% had myelodysplastic syndr. Treatments included tocilizumab(19), anakinra (13), azacitidine(13), baricitinib (11), & pred only (10). Best responses w/ azacitidine & tocilizumab https://t.co/fBdfrrZt1M
Dr. John Cush @RheumNow( View Tweet )
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2025 ACR Guideline for the Treatment of SLE

Jack Cush, MD

The ACR has released its 2025 Systemic Lupus Erythematosus (SLE) treatment guidelines and consensus-based good practice statements, applicable to children and adults with SLE. 

Overall, the goals of SLE management are to achieve remission or a low level disease activity, reduce

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IL2 low dose in #SLE seems to + alter immune regulation Multiple targets to explore in #lupus Unravelling pathophysiology in SLE CD40L TLR7,8 #rapamycin type drugs CAR-T w novel CARS Etc #LUPUS2025 @RheumNow https://t.co/jeycgg4ZhT

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Janet Pope @Janetbirdope( View Tweet )
>200 genes 🧬 implicated in #SLE Complex indeed! And ▶️ 7 clusters of signalling pathways So we have to have many Rx options Ab patterns vary LN flares can have v diff pathways between Pts #LUPUS2025 @RheumNow Unravelling #LUPUS2026 https://t.co/LEKN363194

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Janet Pope @Janetbirdope( View Tweet )
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Diagnosing Neuropsychiatric SLE (5.23.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from RheumNow.com - including views on the vagus nerve, NPSLE and CAR-T mania.

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Systematic review and meta-analysis confirms modest efficacy of infliximab for pulmonary sarcoidosis and promising but limited evidence for adalimumab, tofacitinib and efzofitimob in specific sarcoid manifestations. https://t.co/XaqSiAVQTa https://t.co/DTGbIiPT3a

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Dr. John Cush @RheumNow( View Tweet )
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Shifting the Management Paradigm for SLE and Lupus Nephritis

Karen Costenbader, MD, MPH

The paradigm for treating patients with systemic lupus erythematosus (SLE) is rapidly shifting and our patients will surely benefit with improved outcomes.

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Emerging therapies targeting the NLRP3-inflammasome (active in Autoinflammatory Dz, Gout, neurodegenerative Dz/Alzheimers). Currently no FDA approved drugs, but many in trials. eg, Oxidized DNA (DAMP) activates NLRP3 & may be blocked by repurposed glycosylase inhibitors to reduce https://t.co/CJv50LVKhy
Dr. John Cush @RheumNow( View Tweet )
CAR-T and cellular depletion therapies gone wild! Currently there are over 85 different therapeutic candidates aiming to reset the immune system in >380 clinical trials. Review article looks at indications, targets, modalities & outlook. https://t.co/yleR4B48IY https://t.co/WwSPzIPomk

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Dr. John Cush @RheumNow( View Tweet )
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Moving Targets in Lupus and Lupus Trials

Joan T. Merrill, MD

Clinical trial data quality is a moving target. Lupus is also a moving target. Can we address the moving target of lupus pathology with the moving targets of quality clinical trials and scientific treatment selection?

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Biologics in Pregnancy Patients With Autoimmune Disease

Jack Cush, MD

A large cohort, claims data study shows that among pregnant women receiving biologic therapies for autoimmune conditions, 72% continued their biologics pregnancy, more so among inflammatory bowel disease (IBD) patients than those with rheumatoid arthritis (RA), psoriasis (PsO) or psoriatic

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Deep remission in SLE – what is it, and can we achieve it? Recent reports on lupus patients treated with CAR-T cells targeting CD19+ B lymphocytes have sparked excitement. This is due to the patients experiencing ongoing clinical remission without further treatment after two https://t.co/rdBkIhfWWd
Dr. John Cush @RheumNow( View Tweet )
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Panacea of Prednisone & Cannabis (5.16.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal and regulatory reports from this week on RheumNow.com.  Interesting trends and results with prednisone in lupus, cannabis in RA and opioid deaths too!

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FDA approved the chikungunya virus vaccine (Ixchiq) in 11/23, but recently announced caution and pause use while it investigates Postmarketing Safety Reports of 17 SAE (cardiac & neurologic) & 2 deaths. 6 SAE in the USA, elderly w/ chronic med conditions. ~80K doses of Ixchiq https://t.co/XadqMEmSuD
Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

Hydroxychloroquine for Everyone

Jack Cush, MD
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Nearly 25 years ago, while lecturing on best therapies for rheumatoid arthritis (RA), I loudly stated that hydroxychloroquine was “useless” and, deservedly, I was “boo-ed” off stage. My point then was that rheumatologists needed to be aggressive, if not overly aggressive, in treating all RA patients. And my view was that HCQ was representative of under-treatment. I have reconsidered the use of HCQ in RA substantially in the last few years, based on its merit. Read Post

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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