Drug Safety

Korean claims study of 60 315 adult #RA pts (matched 1:5 controls), found risk for nontuberculous mycobacteria pulmonary disease was 3 fold higher in RA (0.23% vs 0.06%; 0.54 vs 0.14/1000PYs). Mostly in seropositive RA (OR 3.77), also males, obese, EtOH use. https://t.co/xPPHvtwxIB
Dr. John Cush @RheumNow( View Tweet )
muscle%20aches.jpg

Low Dose Naltrexone for Fibromyalgia Pain - Use it or Lose it?

Jack Cush, MD

Medscape recently reviewed off-label use of low dose naltrexone (LDN) in fibromyalgia (FM) and found it is deemed effective by some clinicians and patients, but 1) there is no FDA indication for LDN use in FM and 2) the data supporting its use is limited.

Read Article
Retrospective cohort study of 546 DM or clinically amyopathic DM pts. 5 factors were signif assoc w/ cancers (1 point ea): 1) TIFF-1-γ Ab (OR 3.8), poikiloderma (OR 3.1), DM subtype (2.8), anemia (2.4), but ILD was protective (OR 0.39). Markedly elevated DM cancer risk seen w/ https://t.co/r564RbZys2
Dr. John Cush @RheumNow( View Tweet )
Hematologic Malignancies Increased in Systemic Sclerosis Swedish national study found that among a cohort of systemic sclerosis (SSc) patients a two-fold increase risk of hematological malignancies was seen. https://t.co/BypsCRUthe https://t.co/lfLJhSqn9e

Links:

Dr. John Cush @RheumNow( View Tweet )
Korean claims study of 60 315 adult #RA pts (matched 1:5 controls), found risk for nontuberculous mycobacteria pulmonary disease was 3 fold higher in RA (0.23% vs 0.06%; 0.54 vs 0.14/1000PYs). Mostly in seropositive RA (OR 3.77), also males, obese, EtOH use. https://t.co/hJgoD8mnhv
Dr. John Cush @RheumNow( View Tweet )
Taiwan Health Insurance study of 5749 #RA pts Rx w/ b/tsDMARD, followed >2.5 yrs - 268 (4.7%) had serious infx (1.3 SIE/100PYs); 51% pneumonia, 25% UTI, 10% TB). 60% had b/tsDMARDs dose reduction- not assoc w/ increase SIE (3.4% v 4.2%), but D/C increased SIE (35% v 26%) https://t.co/6J8rB3IyFR
Dr. John Cush @RheumNow( View Tweet )
PSA2L.jpg

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.

Read Article
Scandinavian study of > 13.6 million PYs shows NO increased risk of myositis after SARS-CoV-2 (mRNA & adenoviral vector) vaccines. Data from 101 myositis events in 7,002 398 unvaccinated PYs. Adj IRR 180d risk was 0.84 (0.63–1.11) and 1.31 (0.72–2.36) respectively https://t.co/D5KVyvXaot
Dr. John Cush @RheumNow( View Tweet )
Cancer.risk_.jpg

Hematologic Malignancies Increased in Systemic Sclerosis

Jack Cush, MD

Swedish national study found that among a cohort of systemic sclerosis (SSc) patients a two-fold increase risk of hematological malignancies was seen.

Read Article
CBC & Psoriasis - case–control study 60 pts: 30 PsA & 30 PSO pts showed that PsA showed elevated WBCs, neutrophils, monocytes & inflammatory markers (NLR, MLR, SII, SIRI, & decr PMR (all p < 0.001). NLR 100% Dx accuracy (AUC = 1.000). WBC > 6.7, MLR > 0.17, & PMR ≤ 503 were https://t.co/AB7iFiMuSM
Dr. John Cush @RheumNow( View Tweet )
Taiwans insurance claims, Maternal Database, & BirthRegistry examined 42,493 births to fathers w/ autoimmune Dz, 14.3% exposed to immunosuppressants or biologics. MTX posed no risk, but Cyclosporin, AZA, JAKi may be assoc w/ adverse preg outcomes, but event #s small. https://t.co/6JXaZ2HdAF
Dr. John Cush @RheumNow( View Tweet )
Zantac is Back! Ranitidine has been off the market for 5yrs, withdrawn over concerns about N-nitrosodimethylamine (NDMA) impurity affecting shelf-life. The FDA has approved reformulated ranitidine tablets - the drug has the same prior efficacy and safety label. https://t.co/ktTz5EO2Ja
Dr. John Cush @RheumNow( View Tweet )
Retrospective study of 39 pts w/ MDA5 + DM-ILD Rx w baricitinib. 31 (79.5%) had improvement in Gottron’s, heliotrope, dyspnea, HRCT score, ferritin, LDH, steroid dose & 6 mo survival (87% vs. 70%, p = 0.047). https://t.co/RCTbBsCkeV https://t.co/dF8I0gF4Dy

Links:

Dr. John Cush @RheumNow( View Tweet )
RheumNow Podcast square

Turkey Tryptophan (11.28.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and reports from this past week on RheumNow.com, including reports on FDA resurrections, FM seasonal worsening, and do you fight switch or swap biologics in PsA TNFi nonresponders?

Read Article
Stills,continuum

Treating Refractory Still's Disease

Jack Cush, MD

A full read systematic review article examined treatment options for difficult to manage systemic juvenile idiopathic arthritis, or Still’s disease. It classified these refractory disease patients as those with either (1) persistent arthritis, (2) recurrent or difficult-to-treat

Read Article
Zantac is Back! Ranitidine has been off the market for 5yrs, withdrawn over concerns about N-nitrosodimethylamine (NDMA) impurity affecting shelf-life. The FDA has approved reformulated ranitidine tablets - the drug has the same prior efficacy and safety label. https://t.co/j655eiCvgf
Dr. John Cush @RheumNow( View Tweet )
hospital,surgery

Managing Perioperative DMARDs with Arthroplasty

Jack Cush, MD

Postoperative complications with arthroplasty may be related to chronic inflammation and immunosuppressive therapy. Yet a recent retrospective study total ankle arthroplasty in end-stage RA patients shows that early postoperative wound complications are unaffected by the continued use of their

Read Article
Retrospective analysis of 2614 FM pts in the Italian Fibromyalgia Registry underscores the seasonal changes in FM pain, w/ signif. differences in FM assessment tools WPI p=0.042 & FASmod p=0.037); these changes were only seen in female patients, not males https://t.co/LqXnTgGIMB https://t.co/ihw1yJqKLC

Links:

Dr. John Cush @RheumNow( View Tweet )
Retrospective study of 39 pts w/ MDA5 + DM-ILD Rx w baricitinib. 31 (79.5%) had improvement in Gottron’s, heliotrope, dyspnea, HRCT score, ferritin, LDH, steroid dose & 6 mo survival (87% vs. 70%, p = 0.047). https://t.co/8whN2I1hXh https://t.co/voSVzPQWUI

Links:

Dr. John Cush @RheumNow( View Tweet )
In 2024, 77 pts referred to Rheum for possible PMR were ultimately Dx w/ B19 viral infx. 96% had arthralgia & 7% had PMR-like features (5/5 w/ BL shoulder/neck. prolonged AM stiff, fever & Hi CRP/ESR - none had hip pain. 4/5 were male, w/ mean age of 55 yrs. None were RF/CCP+ https://t.co/lIX4gDLjqd
Dr. John Cush @RheumNow( View Tweet )
Lupus Nephritis study of 136 pts followed 121 mos. Median time to wean GC to 7.5 mg/day, 5 mg/day & D/C was 9, 12 & 29 months post-Dx. Predictors of shorter time to D/C= Sustained CR/SLEDAI-2K≤4, membranous LN, & HCQ. Prolonged GC & renal flares increase damage accrual

Dr. John Cush @RheumNow( View Tweet )

New quadrivalent modRNA influenza vaccine is more efficacious than conventional inactivated quadrivalent influenza vaccine. Really interesting excited to see mRNA technology transforming therapies. https://t.co/ZM13ojQUCl

Links:

Alberta Hoi @alberta_hoi( View Tweet )

No risk of MACE seen w/ initiation of IL-17(R)A inhib. French study of 34 241 ipts Rx IL-17(R)Ai and 381 MACEs. MACE risk was not elevated (OR, 1.25 [95% CI, 0.75-2.08] vs TNF-α inhibitors. https://t.co/WcjgRhr8mj https://t.co/Gp54eLlXSI

Links:

Dr. John Cush @RheumNow( View Tweet )
APEX Study: Inhibition of structural damage progression with Guselkumab in PsA Guselkumab, a human IL-23 inhibitor, was evaluated in patients with active PsA and shown to have both clinical and radiographic benefits at weeks 24 and 48. https://t.co/iNEziysnVZ https://t.co/XgFGFfGf3b

Links:

Dr. John Cush @RheumNow( View Tweet )
RheumNow Podcast square

Vitamin D and Lupus Outcomes (11.21.2025)

Jack Cush, MD

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

Read Article

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
How well do you know this week's rheumatology news?
Take the rheumIQ quiz
Take the RheumIQ Quiz

×