Drug Safety

Moving Targets in Lupus and Lupus Trials In the 1990s, developing lupus treatments became a priority, but success was elusive for 20 years. Belimumab was approved by showing only small differences from placebo in trials with 867 patients globally. Its efficacy was confirmed by https://t.co/TekxzTJjwC
Dr. John Cush @RheumNow( View Tweet )
Steroids in Lupus Nephritis: No Free Lunch https://t.co/yPQuZcnRLH https://t.co/V8GZoslSqV

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Dr. John Cush @RheumNow( View Tweet )
JAK inhibitors reduce inflammation while potentially exacerbating the propagation viral infections. They suppress transcription of IFN-stimulated genes in non-infected cells (usually triggered by type I IFNs produced by infected cells) Thus facilitating viral propagation https://t.co/BDzz8pHKxL
Dr. John Cush @RheumNow( View Tweet )
Dafna Gladman

50 Year Perspective on Lupus

Dafna Gladman, MD

An observational cohort study was started in Toronto by Dr. Murray Urowitz in 1970. The program was set up as a specialized clinic to provide care for patients with lupus, to study clinical laboratory correlations in the disease, and to better understand long-term outcomes of the disease. What

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Checklist survey

Contemporary lupus nephritis treatment

Janet Pope, MD, MPH, FRCPC

Outcomes in lupus nephritis are akin to the glass half full. Serial monotherapy is out, as the percentage who achieved a complete renal response was very low and some went to end stage kidney disease (ESKD). Solutions?

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A retrospective VEXAS cohort study of 59 pts receiving 71 targeted Rx - 98%male, mean 71 yrs & 46% had myelodysplastic syndr. Treatments included tocilizumab(19), anakinra (13), azacitidine(13), baricitinib (11), & pred only (10). Best responses w/ azacitidine & tocilizumab https://t.co/fBdfrrZt1M
Dr. John Cush @RheumNow( View Tweet )
SLE.organ_.jpg

2025 ACR Guideline for the Treatment of SLE

Jack Cush, MD

The ACR has released its 2025 Systemic Lupus Erythematosus (SLE) treatment guidelines and consensus-based good practice statements, applicable to children and adults with SLE. 

Overall, the goals of SLE management are to achieve remission or a low level disease activity, reduce

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Using publicly available FAERS safety data, drug-induced photosensitivity (DIP) - among 17+ million safety reports, there 20,236 linked to DIP. The most common wereimmunosuppressants, monoclonal Abs, neoplastic agents, including adalimumab, adapalene, secukinumab, fingolimod https://t.co/zA9UdYASKB
Dr. John Cush @RheumNow( View Tweet )
JAMA CME review of Immune Thrombotic Thrombocytopenic Purpura (iTTP) - thrombotic microangiopathy w/ hemolytic anemia (MAHA) & thrombocytopenia. iTTP incidence is 2-6 per million. Caused by Abs to ADAMTS13), w/ low ADAMTS13 activity vWF multimers bind platelets https://t.co/kwKXUciBd1
Dr. John Cush @RheumNow( View Tweet )
pregnancy,embryo,fetal

IMPACT Study - Certolizumab Efficacy in APS Pregnancies

Jack Cush, MD

A pilot trial assessed the safety and value of tumour necrosis factor α inhibitor treatment with certolizumab in patients with high-risk pregnancies with antiphospholipid syndrome (APS
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Hydroxychloroquine for Everyone 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, https://t.co/qKnObzr5ib
Dr. John Cush @RheumNow( View Tweet )
Why DORIS or LLDAS #remission 🤔 ⬇️mortality ⬇️damage ⬆️QoL Dr Nikpour at On Rheum Assoc Shows Remission > LLDAS no pred ✅ best @RheumNow https://t.co/uuwnvjJr3R

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Janet Pope @Janetbirdope( View Tweet )
Does ADDING an #immunesuppressive To #belimumab in #SLE give more benefit? ❎ NO #RWE from Spain suggests no added improvement adding IS to Belimumab Should you switch Rx then? 🤷‍♀️ @RheumNow #LUPUS2025 poster110 #ClinicalPearl https://t.co/C3ydArMx7x

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Janet Pope @Janetbirdope( View Tweet )
Treat to target 🎯 #SLE #recommendations Considerations are nuanced and Impt Lowest clinical disease activity is goal Try for remission 🎯 Get patients off #glucocorticoids If not ⬇️low dose #prednisone @RheumNow #LUPUS2025 https://t.co/HlBeh2FLxP

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Janet Pope @Janetbirdope( View Tweet )
Lupus Unlocked: Pregnancy & SLE 📅 May 27, 2025 6:00 PM CT | 7:00 PM ET | 4PM PT Join us for our final Lupus Unlocked webinar this month on pregnancy and SLE. In this webinar, panelists will discuss issues such as congenital heart block, lupus nephritis treatment, teratogenic https://t.co/gouTN7uzCo
Dr. John Cush @RheumNow( View Tweet )
IL2 low dose in #SLE seems to + alter immune regulation Multiple targets to explore in #lupus Unravelling pathophysiology in SLE CD40L TLR7,8 #rapamycin type drugs CAR-T w novel CARS Etc #LUPUS2025 @RheumNow https://t.co/jeycgg4ZhT

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Janet Pope @Janetbirdope( View Tweet )
We are not (yet) in #SLE Getting 👇 Correct drug In right pt At right time At correct individual dose Even more problematic is in a renal bx - 2 glomeruli beside each other have v different cytokine expressions Unravelling #LUPUS2025 @RheumNow https://t.co/yGBvhFkPKY

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Janet Pope @Janetbirdope( View Tweet )
Here’s who flares in #SLE least to most Persistently neg antiDNA Persistently + antiDNA conversion of neg to + antiDNA So are we over ordering antibodies in 1st 2 groups 🤷‍♀️ Unravelling #LUPUS2025 @RheumNow https://t.co/1Feau7f199

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Janet Pope @Janetbirdope( View Tweet )
controversy re 👇 Monitoring for +Ro pregnant re #congenital #heart #block 87% Y echo is possibly too late No ideas if flourinated #steroids work But many thing we should do something Guidelines differ on recommendations Would fetal home HR be better #LUPUS2025 @RheumNow https://t.co/MY0oPjLnGs

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Janet Pope @Janetbirdope( View Tweet )
T2T in #SLE Lots of #rheumatologists do NOT do a validated measure so #DORIS remission may be over estimated But great algorithm for #lupus #Rx ⁦@RheumNow⁩ #LUPUS2025 https://t.co/mGoopRtK2F

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Janet Pope @Janetbirdope( View Tweet )
Monitoring for #HCQ #retinal #toxicity 2 tests beyond visual fields are better than 1 OCT Etc But suggestion if low risk to do only every 5 yrs I don’t agree as risk ⬆️ w disease duration We do Annual fields and either OCT or retinal photography #LUPUS2025 @RheumNow https://t.co/TdPJ47jYEL

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Janet Pope @Janetbirdope( View Tweet )
No Cancer Recurrence with Biologic DMARDs in RA A prospective Danish rheumatoid arthritis (RA) registry study look at the risk of recurrence when a biological disease-modifying antirheumatic drugs (bDMARDs) was ued in patients with a a prior solid cancer (in remission) and https://t.co/T7G96cAlE6
Dr. John Cush @RheumNow( View Tweet )
RheumNow Podcast square

Diagnosing Neuropsychiatric SLE (5.23.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from RheumNow.com - including views on the vagus nerve, NPSLE and CAR-T mania.

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Tocilizumab vs. Methotrexate in Rheumatoid Arthritis A large randomized rheumatoid arthritis (RA) clinical trial compared subcutaneous tocilizumab (TCZ) vs oral methotrexate (MTX) vs. the combination of subcutaneous TCZ and MTX, and showed that TCZ was superior to MTX, either https://t.co/AS8MJaujIE
Dr. John Cush @RheumNow( View Tweet )
Why follow antiDNA and complements in #lupus #nephritis #LN #LUPUS2025 panel said To detect flare ?to consider after 3 to 5 yrs of remission to taper Rx ?but not for early response to Rx Just info from the panel with my opinion salted in @RheumNow https://t.co/bFUfN0PsFF

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Janet Pope @Janetbirdope( 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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