Drug Safety

Israel study 264,858 pregnancies- 1st trimester NSAID exposure had no risk of congenital malformations (MCM). 8% exposed vs unexposed: overall MCM 8.2% v 7%; aRR 0.99). MCMs not incr = MSK, CV, CNS, cleft palate, GI, GU, nonsignif MSM aRR from 0.77- 1.05 https://t.co/ytYhBFl44o https://t.co/1fq4D1KykM

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HCQ target dosing using bullseye imagery

Hydroxychloroquine: 5 mg/kg/day Is Only the Starting Point

Donald E Thomas Jr  Shirvani Garg, MD, PhD

Hydroxychloroquine (HCQ) is one of the most important drugs in rheumatology, especially for systemic lupus erythematosus (SLE). It reduces flares, organ damage, cardiovascular events, and pregnancy complications, and it improves survival. Yet many clinicians still prescribe HCQ as

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In this week's RheumIQ quiz: An RA patient has a current or new cancer. With which cancer should you avoid/stop the use of a TNF inhibitor? See if you got it right at https://t.co/DTabBEfjj9 https://t.co/tVYUEjAPy3

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FDA has approved benralizumab (Fasenra) for the treatment of adult and pediatric patients w/ hypereosinophilic syndrome (HES); based on the NATRON Phase III trial https://t.co/qqPsjhUClP https://t.co/lCZNoTh9fv

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ANCA-Assoc. Vasculitis has great Rx optionis, BUT still no reliable biomaker to predict relapse or renal outcomes, this includes IL-6. But there is hope for CD163 in the future. https://t.co/lFyfTPj5vG https://t.co/wLfOPz76JC

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Registry of 587 #SLE pts. 30% were RNP+ --> more dz activity than RNP- (SLEDAI-2 8.0 vs 4.0) and more Rx use (daily GC 6.8 vs 3 mg). RNP+  more renal, skin & serologic activity & less likely to LLDAS (20% vs 32%) or REM (12% vs 23%). RNP + 18-fold more likely to be Sm+ https://t.co/9i3BBGA0uu
Dr. John Cush @RheumNow( View Tweet )
Meet the RheumNow #EULAR2026 Reporting Team Delivering real-time insights from the forefront of rheumatology: 🩺 Dr. Antoni Chan (@synovialjoints) 🩺 Dr. Mrinalini Dey (@DrMiniDey) 🩺 Dr. Jiha Lee (@JihaRheum) 🩺 Dr. Aurelie Najm (@AurelieRheumo) 🩺 Dr. Janet Pope https://t.co/zpIeGWpL6P
Dr. John Cush @RheumNow( View Tweet )
Toll-Like Receptor Drugs Effective in Cutaneous Lupus Enpatoran, an investigational oral drug that inhibits Toll-like receptors (TLR) 7 and 8, was superior to placebo in relieving lupus skin manifestations in a dose-finding phase II trial. https://t.co/R1wbJHXwjD https://t.co/65HtG0Te94

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Lupus Mortality Risk in Young Women New research using death certificate data from 52,942 females, reveals that systemic lupus erythematosus (lupus) is a leading cause of years of potential life lost among young women in the United States, underscoring the disease’s significant https://t.co/2FSINr6gZN
Dr. John Cush @RheumNow( View Tweet )
Branebrutinib (Bruton's tyrosine kinase inhibitor) was studied in phase 2 RCT of 85 RA pts for 12 weeks and was safe but failed to achieve an ACR50 response (19% BTK vs 33% PBO; p=0·16). https://t.co/gTjLJm9iIW https://t.co/GN9p1P8ZNJ

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Dr. John Cush @RheumNow( View Tweet )
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Infectious Rheumatology (5.15.2026)

Jack Cush, MD

Dr. Jack Cush discusses his favorite journal articles from the past week on RheumNow.com.

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ArthritisPower Registry (now PatientSpot) survey study of 351 RA pts (age 60, F 84%); reported 439 nonserious infx. 27% total infx, 14%w/ MD visist & Abx. Infx incr w/ GC ≥10 mg/d (OR 1.94), but Biologics & JAKi not assoc. w/ greater NSIE risk vs cs DMARDs https://t.co/bHqFnoY0Ud
Dr. John Cush @RheumNow( View Tweet )
SI AS SpA ACR

Another IL-17A inhibitor (Vunakizumab) for active Ankylosing Spondylitis

Jack Cush, MD

Vunakizumab, a novel anti–interleukin (IL) 17A monoclonal antibody, was studied in patients with active radiographic axial spondyloarthritis [r-axSpA] and found to be effective

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Registry of 587 #SLE pts. 30% were RNP+ --> more dz activity than RNP- (SLEDAI-2 8.0 vs 4.0) and more Rx use (daily GC 6.8 vs 3 mg). RNP+  more renal, skin & serologic activity & less likely to LLDAS (20% vs 32%) or REM (12% vs 23%). RNP + 18-fold more likely to be Sm+ https://t.co/3J0Uew48OS
Dr. John Cush @RheumNow( View Tweet )
Femoral BMD & osteoporosis are independent predictors (nverse relationship) of all-cause mortality in postmenopausal women. NHANES study(2005-2018) of 2,977 postmenopausal F, OP yielded 47% incr mortality (HR 1.47) https://t.co/67Jv63X0Hx https://t.co/4vbFDydTY7

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lupus.skinbx.jpg

Toll-Like Receptor Drugs Effective in Cutaneous Lupus

MedPage Today

Enpatoran, an investigational oral drug that inhibits Toll-like receptors (TLR) 7 and 8, was superior to placebo in relieving lupus skin manifestations in a dose-finding phase II trial.

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No link between pregnancy tylenol & autism. JAMA Pediatrics data from 1.5 million Danish children( 1997 -2022); ~2% were tylenol exposed during preg. 2% of these Dx w/ Dx w/ autism (vs. 3% not exposed) https://t.co/Pp1tE54Dic https://t.co/qu61jKolpN

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Dr. John Cush @RheumNow( View Tweet )
FDA has published final guidance on Postapproval Pregnancy Safety Studies; how to study outcomes in pregnant women exposed to drugs & biologics- updates on registries,statistical methods, complementary studies, rare Rx exposures https://t.co/NWxrgB0dPQ https://t.co/ckyaJ07MQ0

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Dr. John Cush @RheumNow( View Tweet )
ANCA assoc. pachymeningitis (AAP) is rare. 230 systemic vasculitis, from 177 reports (108 MPO+, 71 PR3+); age~60; HA & cranial neuropathy (hearing/visual loss, diplopia) common. 89% w/ systemic Sxs (ENT, lungs, orbits, kidneys). Look for abnl ESR/CRP, CSF https://t.co/bHQegYYl5V https://t.co/hpfu8iaIkx

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Dr. John Cush @RheumNow( View Tweet )
CorEvitas RA registry study of 9601 RA pts starting b/tsDMARDs (52K yrs F/U) - 10.4% had eGFR<60 9CRI). Achieving CDAI remission was lower w/ CRI - 28% vs 19%(adj HR 0·76 [0·66–0·88]) https://t.co/E42N3PQHwG https://t.co/WNIGGCpCfZ

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Dr. John Cush @RheumNow( View Tweet )
A Review of Hydroxychloroquine Ocular Toxicity While HCQ is thought to be a very safe drug, its ocular risk profile is probably more serious than appreciated. A comprehensive review published in the Journal of Rheumatology discusses HCQ pharmacokinetics, mechanisms of retinal https://t.co/BrENoaBAVx
Dr. John Cush @RheumNow( View Tweet )
JAMA Review of acute and chronic Hepatitis B infection. "All ...on immunosuppressive Rx should be tested for HBsAg, HBsAb, and HBc Ab. HBV DNA measured in HBsAg+ & those w/ isolated Ab HBcAg https://t.co/LTecQlSMX3 https://t.co/SgVyk9fSCd

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Steroids Corticosteroids remain a cornerstone of rheumatologic therapy — rapidly effective but chronically dangerous, as their power to suppress inflammation through inhibition of prostaglandins, lipoxygenase, pro-inflammatory cytokines, and proteases comes at the cost of a https://t.co/PKdnFi1XSr
Dr. John Cush @RheumNow( View Tweet )
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Influential Rheumatoid Factors (5.8.2026)

Jack Cush, MD

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

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Medicare analysis of RA pts w/ metastatic nonsmall cell lung CA (mNSCLC) looked at 663 ICI-treated pts - 46% Rx w/ glucocorticoids (median Pred 6.6 mg/d). GC use was not associated with survival outcomes https://t.co/mwQeAgyKTC https://t.co/SR2XRD5Rhx

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Dr. John Cush @RheumNow( View Tweet )

Therapeutic Updates

Lupus Nephritis

Sponsored by RheumNow
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

Steroids

Jack Cush, MD
STEROIDS COVER
In this Advanced Practice Rheum, Dr. Jack Cush reviews steroids.
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Advanced Practice Rheum

Difficult to Treat Rheumatoid Arthritis

Jack Cush, MD
D2T RA Cover
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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