Moral Distress (3.27.2026)
Dr. Jack Cush reviews the journal reports and news from RheumNow.com. This week we discuss moral distress, FM in PsA, Lyme Vax is back & hidden but tangible benefits of the MDHAQ.
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A retrospective cohort study of 195 renal Bx from 135 Lupus Nephritis pts, Mod-Severe interstitial fibrosis and tubular atrophy (IFTA) strongly assoc w/non-renal response & ESRD progression (HR 8.9) (also w/ age, SLE duration, prior LN flares, higher chronicity index) https://t.co/773xsk6IHZ
Dr. John Cush @RheumNow( View Tweet )
Real-world safety of tofacitinib vs biologics in 48,167 #PsA pts Rx w/ TOFA (3,166); TNFi (27K); IL-17Ai (20K); risankizumab (4,381); ustekinumab (4,499). Crude IRs/100 PY were 1.78-2.53 for serious infxn, 0.27–0.61 MI/stroke, 0.17–0.42 VTE, & 0.74–1.06 cancer. TOFA had signif https://t.co/Z5wZTGc5gB
Dr. John Cush @RheumNow( View Tweet )
NEJM: Polymyalgia Rheumatica
Drs. Dejaco and Matteson have published and update and review of polymyalgia rheumatica (PMR) in the NEJM. They lay out the initial approach to diagnosis, initial steroid dosing, management over time and when to use steroid sparing therapy.
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#Glucocorticoid-induced #osteoporosis results from direct suppression of osteoblast & osteocyte function, a transient stimulation of osteoclast formation & activity, catabolic effects on #bone matrix & muscle protein, and metabolic alterations https://t.co/ZmMFAOJkmw
#OpenAccess https://t.co/6CubKRbjin
Links:
The Lancet Diabetes & Endocrinology @TheLancetEndo( View Tweet )
Systemic Treatments for Chronic Plaque Psoriasis
JAMA Dermatology has published a review of the pharmacologic landscape on managing adults with moderate to severe plaque psoriasis. Armstrong et al
Spotty Medicare Coverage for Newer Rheumatoid Arthritis Meds
MedPage Today
Medicare coverage of targeted disease-modifying anti-rheumatic drugs (DMARDs) for rheumatoid arthritis (RA) -- both under Medicare Advantage and in separate Part D plans -- is likely to leave many patients wanting, researchers found.
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phase 3 VALOR trial of 6-valent OspA-based Lyme dz vaccine (LB6V) vs placebo; 4 doses given @ Mos 0, 2, 5-9, & 12 mos later. LB6V reduced Lyme Dz risk by 73.2% @28d after 4th dose. But it was only 15.8% effective (falling short of prespecified 20%) because of fewer than expected https://t.co/TcX0GV05gY
Dr. John Cush @RheumNow( View Tweet )
Mortality in Rheumatoid Arthritis: A Story of Decline, Delay, or Plateau? Dr. Elena Myasoedova
https://t.co/YoQmrXHZif https://t.co/7v82hHvvZv
Dr. John Cush @RheumNow( View Tweet )
Predictors of Response in Lupus
A systematic review suggests that traditional measures (serologies and disease activity) are superior to biomarkers in predicting response to biologics in systemic lupus erythematosus (SLE) patients.
https://t.co/7YuYpoDctR https://t.co/J5VLrkDQ6G
Dr. John Cush @RheumNow( View Tweet )
Long-Term Bimekizumab Safety Data
Adverse effects from bimekizumab through 2 years or more of treatment for psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) were about as expected from shorter-term data, results from long-term extension studies indicated. https://t.co/AaJxewNQmQ
Dr. John Cush @RheumNow( View Tweet )
EULAR 2025 Update for Behçet’s syndrome
EULAR has updated its recommendations for the management of Behçet’s syndrome, the last being published in 2018. The current update carries no recommendations from the previous version: seven recommendations have content modifications, four have minor wording amends, and one is entirely new
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Prednisone use in Alberta primary care 546 #RA pts - 40% of PCP RA Rx w/ 1 or more prednisone Rx. 41% Rx w/ both Pred + DMARD, w/ 44% on Pred median 124 day before DMARD. 66% continued Pred >1 yr after DMARD initiation. https://t.co/wrxQRP2TWN https://t.co/XxWpjafBsk
Links:
Dr. John Cush @RheumNow( View Tweet )
A retrospective cohort study of 195 renal Bx from 135 Lupus Nephritis pts, Mod-Severe interstitial fibrosis and tubular atrophy (IFTA) strongly assoc w/non-renal response & ESRD progression (HR 8.9) (also w/ age, SLE duration, prior LN flares, higher chronicity index) https://t.co/3JGLi5R5Fs
Dr. John Cush @RheumNow( View Tweet )
RA pt on 7.5 mg/d Prednisone need hip replacement. What do you advise re: pred dose before TKR?
Dr. John Cush @RheumNow( View Tweet )
Pitfalls of autoimmune serologic testing
Misuse of laboratory testing may lead to misdiagnoses and mismanagement; this is particulary prevalent when clinicians consider the use of the diagnostic use of serological autoimmune markers.
https://t.co/QDWTRgdlOh https://t.co/3hvM1OBcMC
Dr. John Cush @RheumNow( View Tweet )
NEJM: Obinutuzumab in Active Systemic Lupus Erythematosus
A phase 3 trial of obinutuzumab, an anti-CD20 monoclonal antibody, showed potent B-cell depletion and clinical efficacy active systemic lupus erythematosus without evidence of nephritis.
https://t.co/OEuNAZlgzp https://t.co/yjUmJITAmQ
Dr. John Cush @RheumNow( View Tweet )
FDA Approves Icotrokinra for Plaque Psoriasis
The FDA approved an oral IL-23 inhibitor, icotrokinra (Icotyde), for use in moderate-to-severe plaque psoriasis in adults and children 12 years of age and older who are candidates for systemic therapy or phototherapy, according to a https://t.co/q5b3TceFHx
Dr. John Cush @RheumNow( View Tweet )
Retrospective Japanese study of 544 pts w/ GPA or microscopic polyangiitis (MPA) followed > 48 wks; only 29 (5.3%) achieved steroid free remission (GFCR) at wk 48. Predictors of GFCR: rituximab induction (OR 3.9) & avacopan use (OR 24.3). MP pulse RX had lower likelihood of GFCR https://t.co/EMRqA5oHJQ
Dr. John Cush @RheumNow( View Tweet )
Rheumatology Pitfalls (3.20.2026)
Dr. Jack Cush reviews the regulatory actions, news and journal reports from this past week on RheumNow.com.
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Prospective multinational cohort of 1180 lupus pts, followed ~2.7 yrs. 37% had renal biopsies (Class III/IV 56%). They achieved mCRR 46%, mPERR 53%, LLDAS 60%, & REMission 46% at least once. renal response highest @ 2 yrs. New organ damage 11% @ 1yr; 33% by 5yr. https://t.co/ugh60M08Xf
Dr. John Cush @RheumNow( View Tweet )
Hydralazine and the Rare Risk of Vasculitis
Since the 1980s, hydralazine has been a notable cause of drug-induced lupus, and inferred to cause vasculitis as well. A retrospective cohort study from Canada has shown that vasculitis resulting from hydralazine is possible, but https://t.co/ewqCesatbm
Dr. John Cush @RheumNow( View Tweet )
Urinary biomarkers improve w/ anifrolumab in TULIP-LN (lupus nephritis) trial; 112 pts, 197 uriniary proteins assessed. Urinary CD163 and MCP-1 signif improved as early as wk 12. Anifrolumab reduced the proteomic inflammatory signature, regardless of responder status https://t.co/n6fIJVDCN1
Dr. John Cush @RheumNow( View Tweet )
FDA Approves Icotrokinra for Plaque Psoriasis
Today the FDA approved an oral IL-23 inhibitor, icotrokinra (Icotyde), for use in moderate-to-severe plaque psoriasis in adults and children 12 years of age and older (who weigh at least 40 kg) who are candidates for systemic therapy or phototherapy.
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Pitfalls of autoimmune serologic testing
Misuse of laboratory testing may lead to misdiagnoses and mismanagement; this is particulary prevalent when clinicians consider the use of the diagnostic use of serological autoimmune markers.
https://t.co/VKosO3bVL2 https://t.co/4FTvTcrGJa
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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Recent Blogs
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.
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Podcasts
ACR 2025 Daily Podcasts Day2d
EULAR 2021 - Day2b00:35:57
