Moral Distress (3.27.2026)
Dr. Jack Cush reviews the journal reports and news from RheumNow.com. This week we discuss moral distress, FM in PsA, Lyme Vax is back & hidden but tangible benefits of the MDHAQ.
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Retrospective TriNetX Network cohort study of adult PsA (N 123,031) pts, propensity- matched to non-PsA controls. PsA had signif higher CV morbidity: MACE (HR 1.74); mortality (HR 1.95); CHF (HR 1.96), MI (HR 1.71), & CVA (HR 1.49). bDMARDs reduced MACE (HR 0.95) & mortality (HR https://t.co/bHrq9KpwBM
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Outcomes of 87 VEXAS pts in the AutoInflammatory Disease Alliance (AIDA) - 75% had recurrent fever episodes. Fever episodes assoc w/ mortality, organ involvement (CV, GI, Lung), but not with complete response to biologics. https://t.co/j9vzBJNMj0 https://t.co/YGsE7LH3ml
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Single center prospective cohort study of 137 Takayasu’s arteritis (TAK) pts found the prevalence of coronary arteritis was 13 (9%). TAK coronary arteritis pts were not distinguished by demographics, angiographic patterns. 50% had complications from vascular grafts or stents https://t.co/xRR7TSi5FW
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ILD found in 3% of #PsA pts. Metanalysis of 6 studies, 14,272 pts found ILD pooled prevalence was 3% in PsA; highers ((6%) in studies w/ CT, HRCT. Smoking was a signif. risk factor for ILD in PsA (OR 2.94, 95% CI: 1.22–7.12; I2 = 1.8%). https://t.co/9mY4Eiqc9d
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Hydralazine and the Rare Risk of Vasculitis
Since the 1980s, hydralazine has been a notable cause of drug-induced lupus, and inferred to cause vasculitis as well. A retrospective cohort study from Canada has shown
Rheumatic Immune-related Adverse Effects with Checkpoint Inhibitor Therapy
A retrospective study of patients who developed rheumatic immune-related adverse events (R-irAEs) after receiving immune checkpoint inhibitors (ICIs) at two oncology centers in Spain suggests that early https://t.co/jKCbIvfebm
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Treat-to-Target and Cardiovascular Benefits in Gout
A new user cohort study of 109 504 gout patients, achieving a serum urate level less than 6 mg/dL, was associated with a significantly lower risk of cardiovascular events.
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UK Retrospective analysis of 2 RA cohorts, 2,701 pts (F/U 6 yrs) = 101 (3.7%) Dx with ILD. (12 @ baseline, 46 w/ F/U, 43 @ death). ILD Dx signif. assoc w/ onset age (aOR 1.03), seropositivity (aOR 2.58), ever smoking (aOR 1.7). https://t.co/Zvkb1Wjpa4 https://t.co/YMkWDc3rMr
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RT @RichardPAConway
ACR/Chest and EULAR/ERS guidelines for RA-ILD presented by Dr Sparks. I'm posting the one I use ;) #RNL26 https://t.co/fwTjB2bIqg
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RT @richardPAConway
Data from Scott Matson's group showing that immunosuppressing RA-ILD (agnostic to agent) results in stabilisation of the previous downward trajectory of pulmonary function tests. #RNL26 https://t.co/TMNeCsPDep
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RT @RichardPAConway
UIP pattern RA-ILD is where the big problem is. We are less good at treating this. Perhaps the newer agents such as nerandomilast will change this? #RNL26 https://t.co/lzKFulaomD
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RT @richardPAConway
Target trial emulation from Dr Sparks group in RA-ILD. Abatatacept and JAKi seem to be better than RTX. TNFi and IL-6i appear similar to RTX. Thought provoking! #RNL26 https://t.co/vmg7ot9m8b
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RT @richardPAConway
Data from Scott Matson's group showing that immunosuppressing RA-ILD (agnostic to agent) results in stabilisation of the previous downward trajectory of pulmonary function tests. #RNL26 https://t.co/MoYoM0K1cs
Dr. John Cush @RheumNow( View Tweet )
UK Biobank registry analyzed assoc. betw sleep duration, insomnia, & shift with osteoarthritis endpoints (KOA, HOA, TKA, THA) - all incr/highest in pts w/ <6 hrs nightly sleep. Night shift workers had 24% higher knee OA risk (HR=1.24) & 28% higher TKA risk (HR=1.28). https://t.co/UnxXH2I92R
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RT @richardPAConway
The new kid on the block in RA-ILD (and other PPF). Nerandomilast, an anti-fibrotic with additional anti-inflammatory/immunomodulating functions. Demonstrated significant mortality benefit in ILD. #RNL26 https://t.co/8DU3WyPQGy
Dr. John Cush @RheumNow( View Tweet )
RT @RichardPAConway
ACR/Chest and EULAR/ERS guidelines for RA-ILD presented by Dr Sparks. I'm posting the one I use ;) #RNL26 https://t.co/a6vwQWbjE7
Dr. John Cush @RheumNow( View Tweet )
Screening study of lung US (LUS) vs HRCT in 73 RA pts (DAS28 3.47) Chest HRCT identified ILD in 29%. LUS identified ILD in 22% of patients. LUS sensitivity was 59%; specificity 94%. ROC. This study demonstrates the good diagnostic performance of LUS in RA- ILD detection https://t.co/E8avnbvUiw
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RT @RichardPAConway
UIP pattern RA-ILD is where the big problem is. We are less good at treating this. Perhaps the newer agents such as nerandomilast will change this? #RNL26 https://t.co/Z0BXxyNrCI
Dr. John Cush @RheumNow( View Tweet )
Disease Modification, Disparities and the Next Therapeutic Frontier in Gout
Gout management has entered what Dr. Robert Terkeltaub MD from UC San Diego described as its “disease-modifying era,” during his talk at RheumNow Live 2026. In a recent comprehensive review of the past, present, and future of gout therapy, the central message was clear: “We can really apply
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RT @gibson_rheumPAC Gout flares are not benign. Recent flares double MI/stroke risk and markedly increase CV mortality—making flare prevention vital.#RNL26 https://t.co/gKvqo3vFYb
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RT @richardPAconway
We have improved RA mortality in many areas but respiratory (mainly ILD) and infectious issues remain stubbornly elevated. #RNL26 https://t.co/ViucOIOOzY https://t.co/3kIqPMeKKX
Links:
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RT @richardPAConway
AUC of various published screening strategies for RA-ILD. We often say 0.80 is an acceptable cut off but ideally would like a bit better #RNL26 https://t.co/L19uJ7ETwc
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RT @RichardPAConway
Odds ratios for ILD in early RA from SAIL-RA study. Again disease activity stands out. #RNL26 https://t.co/9cXjOFl3Th
Dr. John Cush @RheumNow( View Tweet )
Maui Potpourri (2.13.2026)
Dr. Jack Cush reviews the hot item takeaways from last week's RheumNow.Live 2026.
- Diet & Obesity Management in Rheumatology - Uzma Haque, MD
- Mitigating risk for Rheum patients undergoing orthopedic surgery - Susan Goodman, MD
- Paradoxical skin reactions – Joseph
Therapeutic Updates
Watch our 11-video series on ILD Treatment and Guidelines including videos on assessing ILD, guidelines caveats and concerns, and more.
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Recent Blogs
How would you manage a patient with Overlap (anti-synthetase) syndrome, ILD, polyarthritis and myositis?
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.
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Dr. Michael Putman (Milwaukee, WI) reviews his approach to screening for ILD and RA, the potential for overdiagnosis and how this impacts treatment choices. Does this differ from your approach?
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Podcasts
ACR Podcast - Day1A
EULAR 2021 - Day2c00:37:25
