A Patient’s Plea for a New Paradigm in Autoimmune Disease
A current article in Nature Reviews Rheumatology has a patient boldly asking why we rheumatologists aren't more like her oncologists?
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Taiwan, real-world study 267 RA new DMARD starts w/ tofacitinib (145) or TNFi (122). Post adjustments; no significant difference in Efficacy, AEs, Serious AE (20 v 21%), MACE (0 v 0.8%), CA (2% vs 0.8%), deaths (1.4% vs 3.3), SIE (13% vs 8.2%) or H zoster (12% v 3%) https://t.co/XLsdfKyeGx
Dr. John Cush @RheumNow( View Tweet )
Breaking the Rules: Dual-Advanced Combinations in Rheumatology
For decades, the standard of care in rheumatology has been combination therapy - pairing methotrexate (MTX) with an advanced biologic or synthetic agent to achieve optimal outcomes.
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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/cq3CuIuMKX
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Dr. John Cush @RheumNow( View Tweet )
Metabolic Syndrome Predicts Cardiovascular Outcomes in Inflammatory Arthritis
Chronic inflammatory arthritis (CIA) is associated with elevated cardiovascular risk. While metabolic syndrome (MetS) is prevalent, how much it contributes to adverse clinical outcomes is unclear.
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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/fKGgYF3yWA
Dr. John Cush @RheumNow( View Tweet )
COVID Virus Persistence with DMARD Use
Drugs commonly used to treat systemic autoimmune rheumatic diseases (SARDs) may prolong SARS-CoV-2 circulation after COVID-19 infection in patients with these conditions, with researchers documenting substantially increased viral antigen https://t.co/szeILIbmjF
Dr. John Cush @RheumNow( View Tweet )
FDA Targeting the Safety of Avacopan
The future of avacopan is up in the air. In April, the FDA issued a drug safety warning, previously requesting that Amgen to pull its rare disease drug Tavneos from the market. Now, there appears more pressure to remove it from the market. https://t.co/Otl0WQaOqo
Dr. John Cush @RheumNow( View Tweet )
Anifrolumab (Saphnelo) approved in the US for subcutaneous self-administration as a new autoinjector for the treatment of systemic lupus erythematosus based on SC-TULIP study. Presumeably, all prior CRL issues resolved to FDA satisfaction... https://t.co/ZtZmJLcGYa https://t.co/4B2YDpFaep
Dr. John Cush @RheumNow( View Tweet )
FDA Targeting the Safety of Avacopan
The future of avacopan is up in the air. In April, the FDA issued a drug safety warning, previously requesting that Amgen to pull its rare disease drug Tavneos from the market. Now, there appears more pressure to remove it from the market. https://t.co/4PyIoqwNIL
Dr. John Cush @RheumNow( View Tweet )
APR: Steroids
https://t.co/FxqGaijo6w https://t.co/OrybGNXsdf
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Dr. John Cush @RheumNow( View Tweet )
COVID Virus Persistence with DMARD Use
MedPage Today
Drugs commonly used to treat systemic autoimmune rheumatic diseases (SARDs) may keep the SARS-CoV-2 circulating after COVID-19 infection in patients with these conditions, with researchers documenting substantially increased viral antigen persistence compared with other post-COVID patients.
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Review of GLP-1 Receptor Agonists in Psoriasis
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed cardiometabolic medicine and are now attracting intense interest in inflammatory disorders.
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True or False: Low-dose aspirin given at giant cell arteritis diagnosis is associated with a lower risk of major adverse cardiovascular events. Put your answer to the test in the latest RheumIQ quiz at https://t.co/XLPVoyCbLB. https://t.co/C5CSwuv5mF
Dr. John Cush @RheumNow( View Tweet )
FDA Targeting the Safety of Avacopan
The future of avacopan is up in the air. In April, the FDA issued a drug safety warning, previously requesting that Amgen to pull its rare disease drug Tavneos from the market. Now, there appears more pressure to remove it from the market.
The FDA’s concern is that the data, orginally
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Smoking is most established environmental risk factor for RA- Dz risk, severity, & RA-ILD. Role of other airborne pollutants is mixed: particulate matter & nitrogen dioxide show inconsistent associations w/ RA https://t.co/Fkemc5hAUB
Dr. John Cush @RheumNow( View Tweet )
Neoplasia and Autoimmune Disease
Malignancy rivals cardiovascular disease as a leading cause of death in patients with systemic autoimmune diseases. Chronic inflammation and immune dysregulation can drive oncogenesis, while antitumor immune responses can trigger autoimmune phenomena (paraneoplastic syndromes, checkpoint
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TRACE study of 90 axSpA pts Rx w/ either TNFi or secukinumab (150 or 300 mg)- at wk 56, 59% achieved clinical-remission & 43% achieved w56-MRI-remission (SPARCC) w/ benefits by wk 4. Predictors of clinical remission: ASDAS & BMI (@wk16); none @wk56 https://t.co/CEsAeRMvUE https://t.co/SfSAm3u4IM
Dr. John Cush @RheumNow( View Tweet )
Switch or Cycle - Upadacitinib vs Adalimumab in Refractory RA
After the first tumour necrosis factor inhibitor (TNFi) failure, patients with active rheumatoid arthritis (RA) responded by switching to upadacitinib, compared to cycling to a second TNFi, adalimumab.
FDA has accepted Genetech application for obinutuzumab (Gazyva) to treat SLE (currently only approved for lupus nephritis) - based on Phase III ALLEGORY study w/ Gazyva showing signif reduced dz activity https://t.co/louTYyN6bN https://t.co/Hy1gGliamn
Dr. John Cush @RheumNow( View Tweet )
Severe thrombocytopenia (TP) assoc w/ severe APS & increased mortality. Retro study of 432 #APS pts - 142 w/ TP (33%): 13% severe TP (<50L G/L). Severe TP assoc w/ ITP & CAP -had higher mortality https://t.co/7f8VpIcEJy
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Dr. John Cush @RheumNow( View Tweet )
TriNetX study of 7,929 RA pts Rx w/ bDMARDs (n 2668) w/in 6 mos of elective hand surgery - perioperative bDMARD continuation (34%) was not associated with significant increases in risks of wound healing failures (1.4% vs 1.4%) or SSI (2% vs 1.5%) https://t.co/NY6l2jRswb https://t.co/IxoYtLNGvf
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Dr. John Cush @RheumNow( View Tweet )
Mortality in Rheumatoid Arthritis: A Story of Decline, Delay, or Plateau? Dr. Elena Myasoedova
In this https://t.co/4UQlqwujiR 2026 podcast, Dr. Elena Myasoedova examines mortality trends in RA, exploring whether we are seeing continued decline, delayed impact, or a concerning https://t.co/yUob3Tv0tR
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Dr. John Cush @RheumNow( View Tweet )
Follow the Money (4.23.2026)
Dr. Jack Cush follows the money and all the news that fits the Rheumatology Gab for this past week.
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DESIR axSpA inception cohort study of 631 pts (no HTN), found no signif association between NSAID use & incident HTN. Over 10 YRs, 88 developed HTN (HR 1.01, 1.00–1.02) https://t.co/Gs9mPwthEj https://t.co/4sfpHmFTsu
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Dr. John Cush @RheumNow( View Tweet )
Therapeutic Updates
Lupus Nephritis
Sponsored by RheumNow
View our six video perspectives on lupus nephritis, including Management of CKD in Lupus Nephritis.
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