Drug Safety

hospital,surgery

Variability of Guidelines on the Perioperative Use of DMARDs in Rheumatic Diseases Patients

Jack Cush, MD

More effective treatments in patients with rheumatic diseases have resulted in less need for major surgery, yet a substantial number of RMD patients will undergo surgery often in the setting of DMARDs use. A scoping review looked at numerous clinical practice guidelines/recommendations for the

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NHANES study (2007 to 2020) of 19,904 participants (≥ 20 years), including 1,477 RA pts. Prevalence of kidney stones was higher in RA (17% vs. 8%, p < 0.001) (OR = 1.77) https://t.co/0NZKQdQWR8 https://t.co/BRZ1RTNh5W

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Dr. John Cush @RheumNow( View Tweet )
No Increased Malignancy Risk with Ixekizumab A pooled analysis of 25 randomized clinical trials affirms the safety of ixekizumab (IXE) when used to treat patients with psoriasis (PsO), psoriatic arthritis (PsA), or axial spondyloarthritis (axSpA). The observed incidences of https://t.co/7dAoQyeq5x
Dr. John Cush @RheumNow( View Tweet )
RABBIT (German biologics register) study shows overall small increase in malignancy w/ JAKi vs bDMARDs. Risks greatest in those ≥ 60 yrs, w/ Hi Dz activity, on ≥3 prior csDMARDs. 2285 JAKi vs 4259 bDMARDs: 88 vs 135 malignancies CAs (IRs 11.6 vs 8.9; adj HR 1.40). JAKi risk https://t.co/PRn0G94CB0
Dr. John Cush @RheumNow( View Tweet )
Rheums! Question or case for Jack Cush? Record it here and we may feature it on an upcoming podcast. https://t.co/HsqM9xLNtP https://t.co/voONsOLeSK

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Study of 176 anti-MDA5-DM patients and 55 controls found anti-IFN-α Abs in 18% of MDA5-DM pts, higherin those >60 yrs. IFN-α Ab-positivity assoc w/ RP-ILD (68% vs. 41%) & pulmonary infxn (74% vs. 46%, esp fungi), Mortality (p = 0.006). https://t.co/6w6S3nozPI https://t.co/FoXEIuLBEk

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Dr. John Cush @RheumNow( View Tweet )
Swedish Medical Birth Register study of pregnancy in systemic sclerosis (SSc) shows increased risk of preeclampsia (RR 3.8; 1.8-7.8), preterm birth (3.3; 1.8-6.1), & caesareans (2.5; 1.8-3.5) esp w/ 1st pregnancy -- but not incr. maternal or neonatal death, nor stillbirth https://t.co/SNSK5947zO
Dr. John Cush @RheumNow( View Tweet )
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Hmmm Really? (7.11.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week - some obvious, other new thoughts and some - hmmm, reallly?

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Despite 2024 HHS proposal to reschedule CANNABIS to Schedule III, it remains Schedule I -having "no accepted medical use" and "high abuse potential".There's lots of use (legal in 24 states, DC, decriminalized in 7 states), but no evidence, research or guidelines. https://t.co/KumpvMHdhC
Dr. John Cush @RheumNow( View Tweet )
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No Increased Malignancy Risk with Ixekizumab

Jack Cush, MD

A pooled analysis of 25 randomized clinical trials affirms the safety of ixekizumab (IXE) when used to treat patients with psoriasis (PsO), psoriatic arthritis (PsA), or axial spondyloarthritis (axSpA). The observed incidences of malignant neoplasms were consistent with the US general

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1 yr study of falls studied in 100 RA & 80 PsA pts. 33% of RA & 46% of PsA reported falls, w/ a higher frequency in PsA Pts (p=0.02). Falls associated w/ disease duration and HAQ score. As falls are assoc w/ high morbidity & mortality risk, pts should be questioned about FALLS https://t.co/tP7zmGCZcw
Dr. John Cush @RheumNow( View Tweet )
Case–control study RA pts > 65yrs in US. SEER (cancer) database (2014–2019). Overall cancer risk not associated with use of JAKi (adjOR 1.04), TNFi (0.98) or other bDMARDs (0.98). But, JAKi use was assoc w/ incr risk of lung CA (OR 1.40), esp in Males (2.12) & >2 yrs JAKi. Lower https://t.co/u2psafyN1I
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Biologic experienced ankylosing spondylitis patient show better retention on TNF compared to IL-17 inhibitors. 148 AS pts (F/U 31 mos), IL-17i drug survival trended better but only signif after 3yrs. More D/C w/ higher BASDAI (HR: 1.3) & ^# prior biologics (HR 1.62) https://t.co/5HXGsV4xol
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Cancer Survival Outcomes in Autoimmune Skin Disease Patients

Jack Cush, MD

Patients with autoimmune skin diseases (ASDs) with cancer had significantly better cancer survival outcomes than those without ASD, suggesting coexistant autoimmune or inflammatory disease does not adversely affect a cancer prognosis.

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Granzyme expression is upregulated in RA, esp early RA. Blood & synovium from early arthritis & TNFi nonresponders (R4RA RCT) gene expression five granzymes, perforin, & serglycin determined by bulk RNA-sequencing data. GZM A, B, H, K, M, PRF-1, SRGN was higher in lymphoid https://t.co/v1rdFZHuuh
Dr. John Cush @RheumNow( View Tweet )
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Reducing Progression of Psoriasis to Psoriatic Arthritis

MedPage Today

Tumor necrosis factor (TNF) inhibitor therapy was effective in reducing the likelihood that psoriasis would progress to psoriatic arthritis (PsA), a retrospective study indicated.

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RABBIT (German biologics register) study shows overall small increase in malignancy w/ JAKi vs bDMARDs. Risks greatest in those ≥ 60 yrs, w/ Hi Dz activity, on ≥3 prior csDMARDs. 2285 JAKi vs 4259 bDMARDs: 88 vs 135 malignancies CAs (IRs 11.6 vs 8.9; adj HR 1.40). JAKi risk https://t.co/AlK2SWn6UR
Dr. John Cush @RheumNow( View Tweet )
#RA linked to 40% incr risk of serious dental Infx. National Inpatient Sample (2016-2022) retrospective study of ~15 million adult inpatient records, 10.7K (0.07%) had oral Infx Hosp. Risk factors included RA (1.9%; OR 1.4, male (1.79), Black (1.23), smoking (1.33) https://t.co/pr4Uf6ywJ7
Dr. John Cush @RheumNow( View Tweet )
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Early DMARD Initiation Benefits in Psoriatic Arthritis

Jack Cush, MD

Mease et al has published the results of a cohort study showing early initiation of disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis (PsA) resulted in better outcomes compared to late initiation.

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Immunomodulators in the Treatment of Autoimmune Hepatitis

EurekAlert!

Autoimmune hepatitis (AIH) is a chronic, progressive inflammatory liver disease driven by autoimmune mechanisms, characterized by elevated serum aminotransferases, hypergammaglobulinemia, and interface hepatitis on histology. With an annual global incidence of 1.37 per 100,000, AIH can lead

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Review of 104 irAE pts rx w/ JAK inhib. (82% tofacitinib). Checkpoint inhib was for Lung (20%), gastric (17%) & melanoma (16%). JAKi indications: myocarditis (70%), myositis (33%), hepatitis (24%). JAKi potentially effective esp in irAE pts unresponsive to cytokine Rx. https://t.co/8ezpAOzpRh
Dr. John Cush @RheumNow( View Tweet )
Efficacy and safety of deucravacitinib up to week 52 in the POETYK PsA-2 study •ACR20 at W16: 54.2% (deucravacitinib) vs 39.4% (placebo), p=0.0002 •PASI75: 40.9% vs 15.4%, p<0.0001 •MDA: 25.6% vs 14.7%, p=0.0007 •FACIT-F: +2.5 vs +1.8 •SAE: 1.9% (low) TYK2 inhibition shows https://t.co/PLJytueZDt
Dr. John Cush @RheumNow( View Tweet )
🎩REGENCY: Obinutuzumab + standard therapy improved renal outcomes in #lupus nephritis across all tested response definitions (REGENCY, BLISS-LN, AURORA-1). Week 76 CRR consistently 13–16% higher vs placebo. Results hold despite variable thresholds. @RheumNow #EULAR2025 #OP0006

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What happens in pre-RA when you stop #abatacept after 1 yr Rx At 6 yrs approx 60% on #Placebo V 50% who initially got #ABA Prolonged damped effect of development of #RA NNT for 1 yr is ~10 with a range as low as 6 #EULAR2025 @RheumNow @eular_org Abst#OP0004 https://t.co/eCXEWQhvWM
Dr. John Cush @RheumNow( View Tweet )
Early intensive therapy in PsA. STAMP RCT in early PsA: •ACR50 at 3mo: 43% (early secukinumab) vs 22% (SoC) •MDA at 3mo: 48% vs 25% •PASI90 at 3mo: 60% vs 22% By 12months: outcomes similar, but early secukinumab led to faster control and fewer therapy escalations. https://t.co/Mn0uW3cckf
Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

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. 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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