Prescribing Lessons (4.17.2026)
Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.
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JAMA Guideline on the Management of Crohn Disease
https://t.co/GV0lICS8Sn https://t.co/aFWH5Tl4Jv
Dr. John Cush @RheumNow( View Tweet )
JAMA Guideline on the Management of Crohn Disease
JAMA has published a current Clinical Guidelines Synopsis on the Management of Crohn Disease (CD) in Adults.
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FDA has issued a drug safety warning for avacopan (Tavneos), dentifying 76 cases of drug-induced liver injury, including 7 cases of rare vanishing bile duct syndrome (VBDS). There were 8 deaths https://t.co/2GkYNg1Apn https://t.co/fW2qafKCew
Dr. John Cush @RheumNow( View Tweet )
What’s New PsA? (4.3.2026)
Dr. Jack Cush reviews the news and major articles from this week, including FDA safety warnings, reports from AAD, PsA trials.
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FDA Safety Warning: Avacopan and Serious Liver Injury
Yesterday the FDA issued a Drug Safety Communication alerting patients and health care professionals about postmarketing identification of serious (drug induced) liver injury, including fatal cases, associated with the use of avacopan (Tavneos) in patients with ANCA- associated vasculitis.
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The Mucosal Hypothesis of Rheumatoid Arthritis. Dr. Kristin Demoruelle
In this https://t.co/4UQlqwujiR 2026 podcast, Dr. Kristin Demoruelle explores the mucosal origins of RA and its implications.
🎧 Listen here: https://t.co/QxldIpYQC8
#Rheumatology #Autoimmunity #RNL2026 https://t.co/nz2dbwll14
Dr. John Cush @RheumNow( View Tweet )
Diacerin, an IL-1β blocker, compared to placebo in a 262 pt RCT of knee pain, Knee #OA w/ inflammation. After 24 wks, 88% completed the trial & (vs PBO) diacerein did not improve knee pain (−19.9 vs −18.6 mm). 42% had AE/ GI Sxs were more w/ diacerein (42% vs 25% PBO https://t.co/P2d6IhFw2I
Dr. John Cush @RheumNow( View Tweet )
Diacerin, an IL-1β blocker, compared to placebo in a 262 pt RCT of knee pain, Knee #OA w/ inflammation. After 24 wks, 88% completed the trial & (vs PBO) diacerein did not improve knee pain (−19.9 vs −18.6 mm). 42% had AE/ GI Sxs were more w/ diacerein (42% vs 25% PBO https://t.co/QabS3xLN85
Dr. John Cush @RheumNow( View Tweet )
Antimitochondrial antibodies (AMA)in systemic sclerosis? Retro study of 165 SSc pts (20% diffuse, 33% ILD, 7% PAH); 51% centromere AB+; 29% topoisomerase I+, 12% RNA polymerase III+)-- 22% AMA-positive: assoc w/ GI vascular dz(OR 13.3), gastric antral vascular ectasia (OR 8) & https://t.co/FRhn9qIfOW
Dr. John Cush @RheumNow( View Tweet )
Antimitochondrial antibodies (AMA)in systemic sclerosis? Retro study of 165 SSc pts (20% diffuse, 33% ILD, 7% PAH); 51% centromere AB+; 29% topoisomerase I+, 12% RNA polymerase III+)-- 22% AMA-positive: assoc w/ GI vascular dz(OR 13.3), gastric antral vascular ectasia (OR 8) & https://t.co/epMgfbj5uW
Dr. John Cush @RheumNow( View Tweet )
Can I Use JAK Inhibitors During Pregnancy?
In 2020, the ACR Recommendations on Reproductive Health notably avoided firm guidance on the use of JAK inhibitors (JAKi) during pregnancy stating, "There is no available evidence regarding use or safety of the new small- molecule agents, tofacitinib, baricitinib, and apremilast, during
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RT @gibson_rheumPAC
Helicobacter pylori Update: H. Pylori remains the most common chronic bacterial infection worldwide, acquired in childhood and lifelong if untreated. Its clinical impact spans far beyond dyspepsia—from ulcers to malignancy. #RNL26 tis
Dr. John Cush @RheumNow( View Tweet )
Emergencies, Independence & Hemorrhage (1.23.2026)
Dr. Jack Cush reviews the news and reports from the past two weeks on RheumNow.Com
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Hidden in Plain Sight: IBD
As a PA with six years of experience in rheumatology and a background in gastroenterology, today I'm discussing the clinical overlap between inflammatory arthritis—particularly psoriatic arthritis and spondyloarthropathies—and inflammatory bowel https://t.co/Aatc4jkbpH
Dr. John Cush @RheumNow( View Tweet )
Hidden in Plain Sight: IBD
As a PA with six years of experience in rheumatology and a background in gastroenterology, today I'm discussing the clinical overlap between inflammatory arthritis—particularly psoriatic arthritis and spondyloarthropathies—and inflammatory bowel disease. Visit our
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Study of 177 #SSc pts (116 w/ SSc-ILD vs 61 without ILD). SSc-ILD had more dcSSc, Raynaud’s & GI Dz. SSc-ILD predicted by triad of elevated NLR, PT, anti-SCL-70 (AUC of 0.879; sensitivity 82.6%; specificity 85.0%). NLR: neutrophil to lymphocyte ratio; PT: prolonged prothrombin https://t.co/iI6ZnZgJE7
Dr. John Cush @RheumNow( View Tweet )
Turkey Tryptophan (11.28.2025)
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?
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20-40% of Autoimmune hepatitis (AIH) is associated with other autoimmune diseases - lead by autoimmune thyroiditis, type 1 DM, ulcerative colitis, Crohn disease, & celiac (but less so for RA, PBC, SLE, Sjögren syndrome, vitiligo). AIH Dx Abs include ANA, ASMA, LKM1. https://t.co/FphWZwwohx
Dr. John Cush @RheumNow( View Tweet )
ACR 2025 Rheumatology Round Up
Drs. Jack Cush & Arthur Kavanaugh, two of rheumatology’s most trusted voices, provide a breakdown of the latest breakthroughs and hottest topics in rheumatology from the 2025 ACR Convergence meeting in Chicago.
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Fighting fire with butyrate 🔥🚒
♦️probiotics and prebiotics
Dr. Nisha Manek on inflammation and butyrate - it reduces gut inflamm thru the NFKB pathway
#ACR25 @RheumNow https://t.co/19XTrKn1iN
sheila @RHEUMarampa( View Tweet )
Microbiome may hold key to methotrexate response in RA
Methotrexate (MTX) remains the cornerstone of rheumatoid arthritis (RA) treatment, yet it remains unclear as to how to predict who will respond to it. Two studies presented at ACR (Abstracts 2639 and 2643) suggest the answer may be hiding in the gut.
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Gut microbiome on Urate metabolism study- 1500 men and women.
From 3 cohorts- Framingham, nurses health and men's lifestyle with blood and stool data
Focused on 5 urate metbolizing genes
Abst#2590 #ACR25 @RheumNow https://t.co/YxBb3WfcbB
Bella Mehta @bella_mehta( View Tweet )
Dr. John Stone on IgG4RD
⬆️ common in males
⬆️internal organ involvement
🔸Mimics cancer
🔸Indolence makes it dangerous —-> organ complications
Diagnosis highly dependent on the rheumatologist based on clinical features, serologies, imaging & pathological data
#ACR25 @Rheumnow https://t.co/St4EbA7Dcj
sheila @RHEUMarampa( View Tweet )
In case you have a (gut) feeling something’s off…
Abstract 2315: The gut microbiome in #SpA 🔬
⬆️ Proteobacteria (incl. Escherichia spp)
⬇️ Firmicutes (“good” bacteria)
Higher disease activity ↔️ lower alpha diversity
@RheumNow #ACR25
Akhil Sood MD, MS @AkhilSoodMD( View Tweet )
Recent Blogs
Interactions of the gut microbiota in humans promote the release of a variety of metabolites with profound effects on human health and immune regulation.
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Until the publication of the SEAM trial, evidence in the medical literature for the efficacy of the most commonly used drug for psoriatic arthritis worldwide, methotrexate, has been lukewarm at best. Yet we all employ it commonly, either as monotherapy or in combination with biologic or targeted synthetic DMARD treatment. It is inexpensive and widely available, and only modestly toxic.
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With their publication in June 2022 (1), the 3rd iteration of the Group for Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Treatment recommendations for Psoriatic Arthritis (PsA) may have set a record or sorts.
Podcasts
ACR2022 - Day 1.100:29:38
