Drug Safety

Claims data 2,751 #AAV patients - 6.2% developed #PJP infx. w/ predictors: age, max GC dose, rituximab, CTX, & PJP prophylaxis had Good concordance (0.70) @2mos & 0.66@1yrs. W/ monthly risk of 1.0%, prophylaxis yielded 34 potentially preventable PJP cases https://t.co/c2ObDnmfYp https://t.co/0JRd1k0R2R

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Dr. John Cush @RheumNow( View Tweet )
Danish real-world study anifrolumab use in 36 #SLE pts. SLEDAI-2K decreased from 8 (baseline) to 2 @ mos 3; @6 mos 52% had SLEDAI-2K=0. 87% had PGA ≤0.5 w/ LLDAS, & 70% DORIS remission. Pred use declined by >50%. Herpes infx were most freq AE https://t.co/gNIAoXplMt https://t.co/D6xhQrY8ep

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Dr. John Cush @RheumNow( View Tweet )
Among neuro-ophthalmic complications of Immune Checkpoint Inhibitors, myasthenia gravis (often with concomitant myositis) is most common irAE, followed by optic neuropathy (often as optic neuritis) https://t.co/7pxqSKY3M1 https://t.co/bisbShFHIc

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Dr. John Cush @RheumNow( View Tweet )
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Opioids Down, Gabapentins Up

Jack Cush, MD

The number of U.S. patients prescribed long-term opioid therapy declined from 2015 to 2023, but co-prescribing of opioids with gabapentinoids increased, prescription data showed.

In 2023, 4.2 million people had an active long-term opioid therapy episode, defined as a period of opioid

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5 yr Italian study of hospitalized autoimmune pts(2018-23) 4,896 IMID pts compared to 301,126 non-IMIM. IMID had signif higher risk cancer (adj OR 1.32) highest 1st yr. Decreased from 1.83 @ yr 1 to 1.2 @5+ yrs. IMID had more lung & bladder CA, leukemia lymphoma & melanoma https://t.co/UXqDHQtzv0
Dr. John Cush @RheumNow( View Tweet )
From 2015 to 2023, long-term opioid therapy declined in the USA. Approximately 4 million to 5 million patients were prescribed long-term opioid therapy in 2023. Long term opioid use remains a challenge https://t.co/N5s7mYvXSw https://t.co/YHdTbHLB4q

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Dr. John Cush @RheumNow( View Tweet )
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Malignancies Not Increased with Biologic Therapies

Jack Cush, MD

The risk of malignancy in rheumatoid arthritis (RA) patients receiving biologic agents was evaluated by metanalysis of randomized controlled trials (RCTs) and found no significant increased risk of malignancy compared with other disease-modifying antirheumatic drugs (DMARDs) or with placebo

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Claims data 2,751 #AAV patients - 6.2% developed #PJP infx. w/ predictors: age, max GC dose, rituximab, CTX, & PJP prophylaxis had Good concordance (0.70) @2mos & 0.66@1yrs. W/ monthly risk of 1.0%, prophylaxis yielded 34 potentially preventable PJP cases https://t.co/c2ObDnmfYp https://t.co/Ljr5maHZcr

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Dr. John Cush @RheumNow( View Tweet )
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JAMA Guideline on the Management of Crohn Disease

Jack Cush, MD

JAMA has published a current Clinical Guidelines Synopsis on the Management of Crohn Disease (CD) in Adults.

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Korean Insurance claims nested case–control study of 27,410 RA pts - 5482 w/ > comorbid Dsx Vs 21,928 w/ < 10 comorbd Dz. Having >10 signif incr Serious infx (OR 1.44), opportunistic (21.9)& Hzoster (1.18); mainly skin & soft tissue infx - NOT fatal infx. https://t.co/qDrU3BXYzd
Dr. John Cush @RheumNow( View Tweet )
What’s New PsA? (4.3.2026) Dr. Jack Cush reviews the news and major articles from this week, including FDA safety warnings, reports from AAD, PsA trials. https://t.co/Ew1wAFDfa1 https://t.co/AJfqqEAdik

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Dr. John Cush @RheumNow( View Tweet )
Vexas

VEXAS Syndrome - A Review

Jack Cush, MD

Beck et al has published a review of the VEXAS syndrome in The Lancet, focusing on the pathogenesis, spectrum, and treatment strategies.

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Danish real-world study anifrolumab use in 36 #SLE pts. SLEDAI-2K decreased from 8 (baseline) to 2 @ mos 3; @6 mos 52% had SLEDAI-2K=0. 87% had PGA ≤0.5 w/ LLDAS, & 70% DORIS remission. Pred use declined by >50%. Herpes infx were most freq AE https://t.co/tbMOyOioeU https://t.co/jDJgImjgQt

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Dr. John Cush @RheumNow( View Tweet )
UK Our Future Health study of 1,563,155 finds affective Dz (depression, bipolar, anxiety) signific higher (p<0.001)in autoimmune pts vs gen. pop. (29% vs 18%) - dx by PHQ-9, GAD-7. (OR 1.86), even after adjustments income and pain, etc. https://t.co/HoKBeAZxbS https://t.co/LnC4lqqgq7

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Dr. John Cush @RheumNow( View Tweet )
ILD in RA - Recent Advances. Dr. Jeffrey Sparks ILD in RA – Dr. Jeffrey Sparks In this https://t.co/4UQlqwujiR 2026 podcast, Dr. Jeffrey Sparks reviews the latest advances shaping diagnosis and management of ILD in RA. 🎧 Listen here: https://t.co/R3hWpqxo8q #Rheumatology #ILD https://t.co/XsA6hiiTrd

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Dr. John Cush @RheumNow( View Tweet )
Open label RCT in 116 DMARD-naïve #RA pts Rx w/ tofacitinib or MTX (after 1 IM steroid injx). @3 mos, TOFA signif better than MTX for >50% SDAI improv(94 v 75%), CDAI[14.5 v 7.3), DAS28-CRP[1.7 v 1.2] https://t.co/smOuLlVFyX https://t.co/xGvbiu62OB

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Dr. John Cush @RheumNow( View Tweet )
Japanese ANSWER study Rx 7268 RA pts initiating bDMARDs or JAKi by orthos or Rheums. Vs Rheums, Ortho Rx RA had longer Dz duration, more seropositivity, functional impairment, less comorbidity, more MTX/GC/TNFi, less AE D/Cs - responses & outcomes were similar https://t.co/1ryA8C2p1b
Dr. John Cush @RheumNow( View Tweet )
Canada.maple.leaf

Updated CRA/SPARCC Recommendations for Axial Spondyloarthritis

Jack Cush, MD

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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What's it like to have RA? MARY: "I can manage the pain, the exhaustion, and side effects of the meds. The hard part is grief. I grieve for me, the adventurer that decided what she wanted and boldly went after it, no matter what. I trusted myself to handle whatever came. Now https://t.co/GakWIy2XCt
Dr. John Cush @RheumNow( View Tweet )
FDA has issued a drug safety warning for avacopan (Tavneos), dentifying 76 cases of drug-induced liver injury, including 7 cases of rare vanishing bile duct syndrome (VBDS). There were 8 deaths https://t.co/2GkYNg1Apn https://t.co/fW2qafKCew

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Dr. John Cush @RheumNow( View Tweet )
Myocarditis causes 17,000 deaths/Yr worldwide. Causes include A) iatrogenic/autoimmune: checkpoint inhibitors & gene therapy; B) High income countries: parvo B19, herpesvirus 6; C) low income: dengue, HIV, malaria and Trypanosoma cruzi (Chagas disease) https://t.co/0FjPyXygpz https://t.co/04J23AiqtK

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Dr. John Cush @RheumNow( View Tweet )
Target trial emulation: biologics or JAK vs RTX in RA-ILD -- abatacept (n=694), JAKi (156), IL-6i (389), or TNFi (734), PS-matched =# RTX; no significant differences (HR 0.74-1.09 NS) in outcomes of resp hosp, lung transplant & death. But ABA (HR 0.84) & JAKi (HR 0.62) had less https://t.co/c9IVwQYwMN
Dr. John Cush @RheumNow( View Tweet )
What's it like to have RA? LISA: "It only took me three short years to go from rock climbing to a power wheel chair and that stage of the disease was frightening and painful and you feel hopeless and as if your life plan is being stolen from you. Once I was able to start https://t.co/d49htc8k4m
Dr. John Cush @RheumNow( View Tweet )
Retrospective study of 1st SLE pregnancies from LUNA Registry. Fetal loss was associated w/ aPL (OR 2.46) & pulse steroids (2.46), but not w/ SSA Abs (1.32). 247 pregs, 194 live births, 53 fetal loss. Ro+ vs Ro- no difference in live births or preterm births https://t.co/bsMMvVyffw
Dr. John Cush @RheumNow( View Tweet )
5 Retrospective cohorts of PM/DM pts showed IIM (myositis) had signif higher risks of IIM patients HTN w/ pregnancy (OR 2.73), & C-section (OR 2.03). Also more preterm birth (3.7), SGA/IUGR (1.9) https://t.co/w6qymR0I2w https://t.co/ovtwdleRfE

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Dr. John Cush @RheumNow( View Tweet )

Therapeutic Updates

Lupus Nephritis

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Management of CKD in Lupus Nephritis Patients
View our six video perspectives on lupus nephritis, including Management of CKD in Lupus Nephritis.
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Recent Blogs

Advanced Practice Rheum

Difficult to Treat Rheumatoid Arthritis

Jack Cush, MD
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Dr. Cush addresses the management of difficult-to-treat rheumatoid arthritis (D2TRA).
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Advanced Practice Rheum

Methotrexate

Jack Cush, MD
APR MTX Cover
In this session, Dr. Jack Cush reviews methotrexate.
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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.
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