Dermatology

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Consensus Definitions on Difficult to Treat Psoriatic Arthritis

Jack Cush, MD

A substantial number of patients with psoriatic arthritis (PsA), have difficult, persistent and hard-to-treat disease. A GRAPPA task force has developed a consensus terminology for two distinct states: complex-to-manage PsA and treatment-refractory PsA.

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DERM on RheumNow (November 2025) The Derm on RheumNow podcast is a collection of Citations and Content curated for dermatologists – addressing Psoriasis, PsA, CLE, vasculitis, HS, other CTD skin disorders. dermatology drugs, biiologics, JAKs - their use, efficacy and side https://t.co/mX0Hv1RRF9
Dr. John Cush @RheumNow( View Tweet )
Betw 1990 to 2021 the global psoriasis burden had a slight increase w/ little difference betw men & women, roughly 57-61 100 000 (10% increase). Risk highest in N.America & W.Europe. PSO risk highest with higher incomes. https://t.co/raruHn5Txx https://t.co/bp1rWyWS7y

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Dr. John Cush @RheumNow( View Tweet )
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Organ Involvement with Behçet’s

Jack Cush, MD

A review of patient data from the International AutoInflammatory Disease Alliance (AIDA) Network registry identifying those with mucocutaneous Behçet’s disease (BD) may progres to major organ involvement (MOI)m especially at later stages.

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Serious infections w/ adalimumab. Marketscan MarketScan claims study (1/17-12/20) of ADA Rx in Hidradenitis Supprativa (n 1650) or psoriasis(8699). Risk of SIE & hospitalization greater w/ HS (HR 1.53); esp for sepsis & GU infxn https://t.co/2qa7O2v6fm

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Dr. John Cush @RheumNow( View Tweet )

IL-23 Blockade Goes Oral A new player is entering the IL-23 arena — and it’s a tablet! Icotrokinra (ICO), a first-in-class peptide that binds and blocks the IL-23R, is showing encouraging efficacy and safety across a range of psoriasis (PSO) and psoriatic disease (PsD) studies. https://t.co/fYXULrMD16
Dr. John Cush @RheumNow( View Tweet )
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Treating During Pregnancy (11.14.2025)

Jack Cush, MD

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

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Hospital Mortality in Dermatomyositis

Jack Cush, MD

A cohort study shows that hospitalized patients with dermatomyositis have higher in-hospital mortality in the presence of active rash, interstitial lung disease, and elevated neutrophil to lymphocyte ratio at admission.

Dermatomyositis (DM) has significiant

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Genetic Risks and Severe Cutaneous Reactions to Allopurinol A matched cohort study shows that HLA-B*58:01 and HLA-A*34:02 are strongly associated with allopurinol-induced severe cutaneous adverse reactions (SCARs), these alleles were absent in more than one-third of those https://t.co/NLpHVhr9Ww
Dr. John Cush @RheumNow( View Tweet )
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Genetic Risks and Severe Cutaneous Reactions to Allopurinol

Jack Cush, MD

A matched cohort study shows that HLA-B*58:01 and HLA-A*34:02 are strongly associated with allopurinol-induced severe cutaneous adverse reactions (SCARs), these alleles were absent in more than one-third of those affected, suggesting these are strong but incomplete indicators of SCAR risk.

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IL-23 Blockade Goes Oral A new player is entering the IL-23 arena — and it’s a tablet! Icotrokinra (ICO), a first-in-class peptide that binds and blocks the interleukin-23 receptor (IL-23R), is showing encouraging efficacy and safety across a range of psoriasis (PSO) and https://t.co/7awBk16ZrQ
Dr. John Cush @RheumNow( View Tweet )
psoriasis,arms,pain

IL-23 Blockade Goes Oral

Aurelie Najm, MD, PhD

A new player is entering the IL-23 arena — and it’s a tablet! Icotrokinra (ICO), a first-in-class peptide that binds and blocks the interleukin-23 receptor (IL-23R), is showing encouraging efficacy and safety across a range of psoriasis (PSO) and psoriatic disease (PsD) studies.

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Secrets and Pearls in Rheumatology https://t.co/SwnlB8UbHO @Janetbirdope pearls in rheumatology. Sero negative inflammatory arthritis ? Or is it? Look at the toes for early signs of PsA. In my clinic ITS inflammatory arthritis to determine etiology . @RheumNow #ACR25

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Nouf Al hemmadi @NoufAhmedAlham2( View Tweet )

Can we catch PsA before it starts? My take on #ABSTRACT0877 for #ACR25 @RheumNow https://t.co/Rw2gJ4XSsz

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Aurelie Najm @AurelieRheumo( View Tweet )

Post-hoc analysis of CARE study comparing effect of Cenerimod 4mg vs. PBO Mos. 4-6: >10% improvement in alopecia w/Cenerimod Mos. 2-6: >10% improvement in mucosal ulcers w/ Cenerimod Early improvement in alopecia & ulcers w/Cenerimod Promising? #ACR25 @RheumNow Abs2440 https://t.co/mAqmIQashr

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sheila @RHEUMarampa( View Tweet )
Cutaneous vasculitis: who is most likely to have systemic disease? 430 pt w skin vasculitis examined in case-control Associated with risk for systemic vasculitis/CTD: - GI sx - ulcerating/necrotic lesions - constitutional sx - hematuria @RheumNow #ACR25 Abst 2525 https://t.co/lRjLKRYxDW

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Brian Jaros, MD @Dr_Brian_MD( View Tweet )
#1725 Functional NOTCH4 variants contribute to vasculopathy & fibrosis in SSc, particularly in African-American patients NOTCH4 hyperactivation disrupts angiogenesis & drives EndoMT; inhibition (including with FDA-approved Nirogacestat) restores vascular repair @RheumNow #ACR25

Mrinalini Dey @DrMiniDey( View Tweet )

#ACR25 Please find my video and take on Abstr#0646. Promising new Bi-specific T-cell engager (BiTE) other than Blinatumomab in #SLE @RheumNow https://t.co/5JrLG41nsD https://t.co/KeY6AkHUNK

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Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
Stress Raises the Risk of Psoriasis New longitudinal research reveals that severe stress caused by changes in family structure like divorce or separation experienced during the first year of life may triple the risk of developing psoriasis later in life. https://t.co/TSXoQKjRPN
Dr. John Cush @RheumNow( View Tweet )
X-sectional study by Dr Toledano et al showed that 20% (46/230) PsA pts had restless leg syndrome (RDS). Pts w/ RDS: - Polyarthritis ⬆️ Swollen jts ⬆️ Fatigue, anxiety, depression ⬆️ Dse activity Poor sleep quality Polyarthritis & Pso: assocd w/ RDS #ACR25 @RheumNow Abs1413 https://t.co/8Ds3TgLjs1

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sheila @RHEUMarampa( View Tweet )
In ICONIC-LEAD, adolescents (12 to <18 years) with moderate-to-severe psoriasis treated with icotrokinra (ICO) achieved Investigator Global Assessment (IGA) 0/1 in 84.1% vs 27.3% (placebo) and PASI 90 in 70.5% vs 13.6% at Week 16. Week 24 responses reached 88.6%. Safety profile https://t.co/L7h8BlnWaO

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Antoni Chan MD (Prof) @synovialjoints( View Tweet )
Icotrokinra, the new kid on the bloc! Targeted oral peptide IL-23R-inhibitor Effective in Ph2 and Ph3 in PSO Adults Data in Adolescents (12-18yo) with PSO ICO 200mg QD 44pts vs. PBO 22pts 16wks All pts received ICO wk16-wk24 Clear/Almost clear skin IGA 0/1 84% vs. 24% PASI 90 https://t.co/77YvXtdLi1

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Aurelie Najm @AurelieRheumo( View Tweet )
The severity of skin psoriasis increases the risk of psoriatic arthritis. Scher J @RheumNow #ACR25 https://t.co/EI0ACWACHy

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Antoni Chan MD (Prof) @synovialjoints( View Tweet )
A closer look in skin toxicity of GCs in RMDs GC Toxicity Index, LONG TOX prospective cohort Frequent: -Easy bruising 35% -Atrophy 22% -Hirsutism 17% -Acneiform rash 15% -Erosion/Tear 12% GC-related Neuropsychiatric toxicity highly associated with/ skin, something to look out https://t.co/NfxG8JkxSP

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Aurelie Najm @AurelieRheumo( View Tweet )
#ACR25 Abstr#802 In #SLE pts with CLASI-A ≥8, pooled post-hoc analysis of Phase 2 RCT showed enpatoran, oral small molecule toll-like receptor 7/8-i impoved cutaneous response vs PBO as early as WK4. First-in-class promising therapy & warrant investigation in Phase 3 @RheumNow https://t.co/rn6NXdiGjD

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Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )

Recent Blogs

A Domain-Based Approach to the GRAPPA Psoriatic Arthritis Treatment Recommendations

Laura Coates
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With their publication in June 2022 (1), the 3rd iteration of the Group for Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Treatment recommendations for Psoriatic Arthritis (PsA) may have set a record or sorts.

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Pain in Psoriatic Arthritis

Philip Mease, MD
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Pain is typically ranked by both patients and physicians as the most important symptom of psoriatic arthritis (PsA) to assess and treat. Although the predominant concept of the etiology of pain in PsA is that of inflammation in peripheral joints, entheses, and bone signaling through peripheral nociceptive fibers, perceived as pain in the central nervous system, it is actually more complex than that. The ability of a treatment to ameliorate pain is one of the principle measures of its effectiveness. Thus pain improvement or worsening are key determinants of shared decision making about treatment in PsA.  Read Post
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