Drug Safety

GCs have potent anti-inflammatory effects but it’s long term complications can be catastrophic. In SLE pts, it shows a 3-fold increased risk of organ damage for each addtl 1mg of Pred/day. 📌Aim for short duration of use with lowest effective dose @RheumNow #APLAR25 https://t.co/UugrcX073Z

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JAK Janus

Equal Safety of JAK Inhibitors and TNF Inhibitors

Jack Cush, MD

JAMA has published a systematic review and meta-analysis of head-to-head studies showing there was no meaningful difference in safety events observed when taking either JAK inhibitor (JAKi) vs TNF antagonist (TNFi) therapies for the treatment of immune-

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Target trial emulation looked at CV (MACE) events in 18,120 propensity score–matched adults with gout starting allopurinol who were given NSAIDs or colchicine for prophylaxis. MACE & CV death were signif. higher w/ NSAIDs vs Colchicine (HRs of 1.56 and 2.50), respectively. https://t.co/0T8slmPBng
Dr. John Cush @RheumNow( View Tweet )
Hospital for Special Surgery (HSS) reports that ear acupuncture applied during hip replacement surgery reduces pain and lessens opioid use over the weeks to follow. https://t.co/lOrwb1DzW5 https://t.co/6rkHNTwaAl

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Dr. John Cush @RheumNow( View Tweet )
SMART study - Single vs. Split Dose Methotrexate in RA Split dose weekly, oral methotrexate (MTX) was shown to be superior to single dose MTX in treating active rheumatoid arthritis (RA) patients. https://t.co/JN5wPGNjao https://t.co/lizsrtVHwf

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Dr. John Cush @RheumNow( View Tweet )
early.ra_.2.jpg

STOP-RA: Hydroxychloroquine Fails in ACPA+ Arthralgia

Jack Cush, MD

Deane et al has published the results of the STOP-RA trial, demonstrating that 12 months of hydroxychloroquine (HCQ) did not prevent the development of clinical RA at 36 months. 

The fate of Individuals elevated anti-cyclic citrullinated peptide (anti-CCP) antibodies and

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‼️More reasons why we should avoid steroids in #lupus patients @RheumNow #APLAR25 https://t.co/a5IeutJ5mi

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Lessons Learned in Neuropsychiatric SLE Dr. Sheila Reyes, The Philippines, reports highlights from a session on neuropsychiatric systemic lupus erythematosus, presented at the APLAR 2025 Congress in Fukuoka, Japan. https://t.co/Dh1GQnBhvg https://t.co/wX5FgpIq7C

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Dr. John Cush @RheumNow( View Tweet )
STOP-RA results published in A&R. 144 at risk, CCP+ pts were enrolled to received HCQ vs PBO for 12 mos, w/ 24 mos F/U. Progression to RA seen in 30.4% on HCQ vs 32.9% on PBO (NS; P=0.52). Also IA, Jt Sxs, severity & adverse events were similar between groups.

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AbbVie's US patent protection for Rinvoq (upadacitinib) will run till April 2037. SEC filing shows AbbVie has reached an agreement with generic manufacturers challenging Rinvoq patents. UPA is their 2nd leading product with nearly $3.75 billion worldwide sales in 1st 1/2 of

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Target

Hitting the Target: T2T Therapy in SLE

Sheila Reyes, MD

Treat-to-target strategies are not a new concept in rheumatology. It has shown to improve patient outcomes and quality of life in RA and PsA, and is now being increasingly adopted not only in SLE research but also in clinical practice. This article reviews key highlights from Dr. Eric Morand’s

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In #scleroderma pts with cardiac involvement, the presence of ventricular ectopy is assocd w/ ⬆️risk of mortality & SCD. ☝️these arrythmias present late so consider it in pts w/established dse who develop new-onset cardiac symptoms @RheumNow #APLAR25 @rheumarhyme @marklagacmd https://t.co/MTDfxevqwb

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Remember! ☝️ Trabecular bone screening should not be routinely used in pre-menopausal women. @RheumNow #APLAR25 #osteoporosis https://t.co/hGMExyDYUX

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sheila @RHEUMarampa( View Tweet )
RheumNow Podcast square

RheumNow Podcast – Ro, Ro, Ro52 (9.12.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Are there benefits to diet or vegan diets? What's the effect of menopause on CTD?  Ro52 makes a big entrance with all our ILD coverage this month.

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3 yr study of FDA Adverse Event Reporting on anifrolumab shows following AEs- URIs, herpes zoster, infusion reactions, and potential new risks like dyspnea and pyrexia, not in the label. https://t.co/vP2YWGT2vR https://t.co/BruGBtXEBu

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Dr. John Cush @RheumNow( View Tweet )
MTX.box

SMART study - Single vs. Split Dose Methotrexate in RA

Jack Cush, MD

Split dose weekly, oral methotrexate (MTX) was shown to be superior to single dose MTX in treating active rheumatoid arthritis (RA) patients.

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Single center study of 47 RA-ILD pts (Dx Age 64.7 yrs; 30 mos F/U). Median 100 mos from RA Dx to RA-ILD. Nearly half (49%) recv Rx for RA-ILD; few w/ TCZ, nintedanib, pirfenidone. ~90% had RA-ILD stability/improve @ 6 & 12 mos. Progression assoc w/ tobacco use (P .025) @ 6 mos https://t.co/AK4zYgcxeK
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APLAR GRAY

SLE and Osteoporosis

Sheila Reyes, MD

In one of the SLE sessions at the APLAR 2025 Congress, Prof. Sandra Navarra discussed the assessment and management of osteoporosis in SLE patients, particularly glucocorticoid-induced osteoporosis (GIOP) and this article reviews the highlights and key takeaways from her talk.

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AI can Dx & predict HCQ retinopathy (HR). An International, Multi-center study used retrospective data from 409 pts (171 HR+, 238 HR-) & tested on 8251 SD-OCT scans. AI Dx 100% & predicted 98.7% mean 221 D before Dx. Sensitivity 100%; specificity 98%, PPV 94%; NPV 100% https://t.co/USABVO8Ss5
Dr. John Cush @RheumNow( View Tweet )
Long-term data from the 48-wk phase 2 SLEek study of upadacitinib +/- a BTK inhibitor elsubrutinib, in SLE pts, showed both arms effective (little added from BTK), @ 1yr, 127 pts maintained efficacy, GC dose and flare rates https://t.co/FbTHCGZ4pQ https://t.co/cATXVHsiXV

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Dr. John Cush @RheumNow( View Tweet )
ILD damage fibrosis path

Antifibrotics - A New Class of Therapies in Rheumatology?

Shervin Assassi, MD

Rheumatologists typically manage systemic autoimmune rheumatic diseases (SARD) and associated interstitial lung disease (ILD) with immunosuppressants. However, evidence increasingly supports also the use of antifibrotic agents in this setting. Pulmonologists have long used

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guidelines.recommendations.jpg

ERS/EULAR guidelines for CTD-related interstitial lung disease

Jack Cush, MD

The European Respiratory Society (ERS) and European Alliance of Associations for Rheumatology (EULAR) have published clinical practice guidelines for the evaluation and management of connective tissue diseases (CTD) associated interstitial lung disease (ILD) in two simultaneous publications in

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KNee.calcinosis.inflammatin

COLCHICORT Trial

Jack Cush, MD

The COLCHICORT trial in acute calcium pyrophosphate (CPP) crystal arthritis patients showed that colchicine was inferior to prednisone treatment and that responses were also influenced by other factors.

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Peter Taylor describing the range of potential benefits of Interception strategies in Pre-RA: A) From Ideal: full interception B) To Good outcome: stratified intervention based on high risk population for delay/interception C) To ?Beneficial: attenuate severity of established RA https://t.co/6mqA9tV7ME

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Aurelie Najm @AurelieRheumo( View Tweet )
Abatacept and Methotrexate may Lower Risk of Interstitial Lung Disease in RA A post hoc, pooled analysis of of rheumatoid arthritis (RA) clinical trials shows those received abatacept had a lower rate of Interstitial lung disease (ILD). https://t.co/3AISriCUeC https://t.co/nN03e4ZBDU

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Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

Hydroxychloroquine for Everyone

Jack Cush, MD
ra.hands2_.JPG
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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