Drug Safety

FDA & Administration are deregulating artificial intelligence & promote widespread use, includes use of wearables & other AI-enabled devices. Commissioner Marty Makary updated two guidance docs defining use general wellness devices, clinical decision support software https://t.co/KnkYqCiroa
Dr. John Cush @RheumNow( View Tweet )
Retrospective study of recombinant zoster vaccine Rheumatic (RMD) pts on DMARDs (32% JAKi) (114) vs 65 normals. HZoster reactivation: no controls vs 1in RMD. 1 Dz flare requiried steroids. Minor AE (ISR, HA, myalgia) seen in 17.5% & 21.5% w/ 1st & 2nd dose. RZV is safe in RMD https://t.co/Mu3OyA4EOD
Dr. John Cush @RheumNow( View Tweet )
Metanalysis of 21 clinical trials, 2,100 adults, shows cannabis-based medicines (vs placebo) over 2-26 weeks are not effective in treating chronic neuropathy nerve pain, regardless if given as THC of CBD. https://t.co/ZOJrcMGZkr https://t.co/nqCWoFmaWp

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Dr. John Cush @RheumNow( View Tweet )
In Dec 2025, the FDA qualified total hip bone mineral density (BMD) assessed by DXA as a validated surrogate endpoint for osteoporosis clinical trials. Previously OP trials required fracture endpoints as primary efficacy measures, necessitating large 2-5 yr studies https://t.co/5t9rftwX4A
Dr. John Cush @RheumNow( View Tweet )
ADJUST trial (248 JIA pts w/ Uveitis & inactive >6mos, either continued or weaned off adalimumab. ADA weaning resulted in more flares (68% vs 14%, mostly uveitis) w/ no protection from background DMARD Rx. Restarting ADA was mostly effective. https://t.co/ZWHfPl2UNl https://t.co/Fk1HES2UIc

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Dr. John Cush @RheumNow( View Tweet )
FIBROSCANS in 60 RA pts on #MTX for 5 yrs w/ liver studies. Mean age = 39.5yrs, w/ Dz Dur 8.2 yrs, mean BMI 24.4 & MTX 12.5–25 mg for ~8 yrs (cum dose 6728mg). All had normal AST, ALT, APRI, Abd US; fibroscan score = 170 ((steatosis grade 0). Only 4(6.7 %) had mild, fibrosis https://t.co/7SACsEYi37
Dr. John Cush @RheumNow( View Tweet )
2025

The 2025 Rheumatology Year in Review

Jack Cush, MD

The year 2025 presented numerous advances in rheumatology and related inflammatory and autoimmune disorders ranging from several new groundbreaking FDA approvals/indications, drug developments, game-changing guidelines and practices that will impact patient care for rheumatic diseases.

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Diffuse Alveolar Hemorrhage in Rheumatic Disease A retrospective, cross-sectional, single-center study of adult rheumatic disease patients with diffuse alveolar hemorrhage (DAH), demonstrates a high proportion have coexistent pulmonary infection and significant mortality risk. https://t.co/vpzF8Dnspr
Dr. John Cush @RheumNow( View Tweet )
Subcutaneous Anifrolumab in SLE Manzi et al. have published the results of the TULIP-SC trial that showed that weekly subcutaneous (SC) anifrolumab, when given to severe SLE patients, had comparable efficacy and safety to the approved intravenous (IV) anifrolumab. https://t.co/3DWNEXaO2x
Dr. John Cush @RheumNow( View Tweet )
Systematic review of cardiovascular death in systemic immune-mediated Dz (SIDs): 39 studies, 171,748 pts - SIDs assoc w/ signif. higher CV mortality (HR 1.26; 1.09-1.47; p = 0.002), especially for RA, SLE, GPA & females. 92% of CV deaths from acute coronary syndrome (ACS) https://t.co/ogLhqKMwON
Dr. John Cush @RheumNow( View Tweet )
Metanalysis of Tramadol included 19 PBO-RCTs, 6506 pts, showing a very modest benefit on chronic pain (low certainty of evidence), but a doubling of risk for serious adverse events (OR 2.13); including nausea (NNH 7), dizziness (NNH 8), constipation (NNH 9), somnolence (NNH 13) https://t.co/0ZEIoy1gqC
Dr. John Cush @RheumNow( View Tweet )
PSO.Palmoplantar.jpg

Advanced Practitioner Biologic Prescriptions for Psoriasis

Jack Cush, MD

Advanced practice clinicians (APCs; nurse practitioners and physician assistants) deliver a large share of US dermatologic care, accounting for 37% of clinicians and 27% of dermatology visits by 2020. A current JAMA Dermatology reports APC drug spending trends in dermatology, with a focus on

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US Overdose Deaths have dropped in 2024 & 2025!. Overdose (opioids, heroin, fentanyl) deaths peaked at ~110,000 in 2022, fell a little in 2023, but plummeted (27%) to 80,000 in 2024. Reported deaths highes in the N. East & Atlantic states. https://t.co/P3mgrOzGhr https://t.co/eGOBhIx7ZB

Links:

Dr. John Cush @RheumNow( View Tweet )
Retrospective study of recombinant zoster vaccine Rheumatic (RMD) pts on DMARDs (32% JAKi) (114) vs 65 normals. HZoster reactivation: no controls vs 1in RMD. 1 Dz flare requiried steroids. Minor AE (ISR, HA, myalgia) seen in 17.5% & 21.5% w/ 1st & 2nd dose. RZV is safe in RMD https://t.co/Hf7HaGOLXd
Dr. John Cush @RheumNow( View Tweet )
101 Meditteranean pregnant RA compared to 236 non-RA controls. HCQ & SSZ (45-73%) most used; biologics less (25%). RA had signif more adverse preg outcomes - LBW (OR 3), C-section (OR 2.55), fewer neonatal deaths (OR 0.38). RA had more miscarriages (20 v 1%) & fewer live births https://t.co/3nTdXEbBHI
Dr. John Cush @RheumNow( View Tweet )
In Dec 2025, the FDA qualified total hip bone mineral density (BMD) assessed by DXA as a validated surrogate endpoint for osteoporosis clinical trials. Previously OP trials required fracture endpoints as primary efficacy measures, necessitating large 2-5 yr studies https://t.co/q8a7QmoIXs
Dr. John Cush @RheumNow( View Tweet )
Subcutaneous Anifrolumab in SLE Manzi et al. have published the results of the TULIP-SC trial that showed that weekly subcutaneous (SC) anifrolumab, when given to severe SLE patients, had comparable efficacy and safety to the approved intravenous (IV) anifrolumab. https://t.co/yrAirr2R2Y
Dr. John Cush @RheumNow( View Tweet )
pregnant, pregnancy, mother, fertility

Antirheumatic drug use with rheumatoid arthritis pregnancies

Jack Cush, MD

A nationwide Norwegian registry study of rheumatoid arthritis (RA) pregnancies showed that while medication use increased during pregnancy, many discontinued treatment during pregnancy, only to resumed it after childbirth.

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Retrospective single center --103 EGPA pts finds 36 (35%) w/ cardiac involvement, having cardiac Sxs & biomarkers. Most common: pericarditis (77%), cardiomyopathy w/ CHF (55%), myocarditis (36%), cardiogenic shock (14%), cardiac arrest (6%), coronary v.asospasm (8%) https://t.co/JNdVNlVWvA
Dr. John Cush @RheumNow( View Tweet )
alveolar hemorrhage acute

Diffuse Alveolar Hemorrhage in Rheumatic Disease

Jack Cush, MD

A retrospective, cross-sectional, single-center study of adult rheumatic disease patients with diffuse alveolar hemorrhage (DAH), demonstrates a high proportion have coexistent pulmonary infection and significant mortality risk. 

DAH is an uncommon but

Read Article
ADJUST trial (248 JIA pts w/ Uveitis & inactive >6mos, either continued or weaned off adalimumab. ADA weaning resulted in more flares (68% vs 14%, mostly uveitis) w/ no protection from background DMARD Rx. Restarting ADA was mostly effective. https://t.co/ZWHfPl2UNl https://t.co/xodyrbaQOj

Links:

Dr. John Cush @RheumNow( View Tweet )
lupus SLE

Subcutaneous Anifrolumab in SLE

Jack Cush, MD

Manzi et al. have published the results of the TULIP-SC trial that showed that weekly subcutaneous (SC) anifrolumab, when given to severe SLE patients, had comparable efficacy and safety to the approved intravenous (IV) anifrolumab. 

TULIP-SC was a

Read Article
FIBROSCANS in 60 RA pts on #MTX for 5 yrs w/ liver studies. Mean age = 39.5yrs, w/ Dz Dur 8.2 yrs, mean BMI 24.4 & MTX 12.5–25 mg for ~8 yrs (cum dose 6728mg). All had normal AST, ALT, APRI, Abd US; fibroscan score = 170 ((steatosis grade 0). Only 4(6.7 %) had mild, fibrosis https://t.co/OOctcfI1sT
Dr. John Cush @RheumNow( View Tweet )
Systematic review of Apremilast in soriasis and Psoriatic Arthritis: 28 RCTs involving 6825 patients. Efficacy ( PASI 75 and ACR 20) observed at APR 30 mg or 20 mg bid (RR > 2) & both doses did not affect CRP levels. GI side effx most common (see figure) https://t.co/YqfaWPvmTm https://t.co/z8PfJqp0CJ

Links:

Dr. John Cush @RheumNow( View Tweet )
DANFLU-2 RCT of 332 438 elderly (43 881 w/ diabetes) tested high (HD-IIV) vs standard dose SD-IIV) flu vaccine. HD-IIV signif. reduced cardioresp., CV, CHF, influenza, hospitalizations vs SD-IIV, irrespective of DM status. Similar results previously seen in a Canadian RA pop. https://t.co/GGZPThoHrs
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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