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The Great Unknowns (8.5.2022)

Jack Cush, MD
Aug 05, 2022

Dr. Jack Cush reviews the news, FDA approvals, journal articles from the past week on RheumNow; plus viewer questions. This week great hopes for vitamin D, the great unknows of CSA and the great big mess that is the gout.




  1. 521 clinically suspect arthralgia (CSA) pts were

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ACR guidance

ACR Updated Guideline on Vaccinations for Rheumatic Patients

Jack Cush, MD
Aug 04, 2022

The ACR has posted a new ACR Clinical Practice Guideline Summary providing recommendations on the use of vaccinations for children and adults with rheumatic and musculoskeletal diseases (RMDs).



This guideline builds on past

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Upadacitinib in non-radiographic Axial Spondyloarthritis

Jack Cush, MD
Aug 01, 2022

The janus kinase inhibitor, upadacitinib, has been shown to significantly improve the signs and symptoms of non-radiographic axial spondyloarthritis (nr-AxSpA), extending the efficacy of UPA beyond classic ankylosing spondylitis.

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The FDA has extended its indications for ustekinumab (Stelara) for use in pediatric psoriatic arthritis aged 6 years and older. Pediatric PsA makes up 6% of all pediatric inflammatory arthritis pts. https://t.co/vTM4x53n7k https://t.co/aQcuMury2k

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Dr. John Cush @RheumNow( View Tweet )
Aug 01, 2022
Have you checked out our new sister-site, Still's Now? A new site for Still's disease, autoinflammatory & febrile disorders.https://t.co/oWEugnOB6k https://t.co/5jwiP2Xqrz

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Dr. John Cush @RheumNow( View Tweet )
Jul 26, 2022
Rheums: Got a Rheumatology question or case for Jack Cush? Record it here and we'll feature it on an upcoming podcast. Tell us your name and where you practice rheumatology.https://t.co/QUTIbK3r89 https://t.co/FZcTLREida

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Dr. John Cush @RheumNow( View Tweet )
Jul 22, 2022
Rheumatologist Survey: What do you rely on MOST in diagnosing Still’s disease? Sxs? Labs? Both? Criteria? Fever? Vote here:https://t.co/oANKpKqJA5 https://t.co/LIjRSBHNBi

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Dr. John Cush @RheumNow( View Tweet )
Jul 21, 2022
Ustekinumab (IL-12/23i) phase 2 study was successful in #SLE; but the phase 3 LOTUS study of 512 pts, UST was NOT superior to PBO (SRI-4 44% v 56%) at 1 year. Study was halted for lack of efficacy (but no safety concerns). https://t.co/uMY5uPPabA https://t.co/nG2RO6oEJQ

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Dr. John Cush @RheumNow( View Tweet )
Jul 17, 2022
2021,year

ICYMI: 2021 Rheumatology Year in Review

Jack Cush, MD
Jul 08, 2022

For 2022, let's look our top 10 list of advances, game-changers, worries and those better medical practices that evolved during 2021.

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GRAPPA,PsA,guideline

New Updated GRAPPA Psoriatic Arthritis Recommendations

Jack Cush, MD
Jun 29, 2022

The GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) treatment recommendations have been updated and the 2021 evidence-based guidance is rich in treatment recommendations based on the key disease "domains" - peripheral arthritis, axial disease, enthesitis,

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FDA approved Abbvies risakizumab-rzaa (Skyrizi) as the 1st interleukin-23 inhibitor for use in adults with moderately to severely active Crohn's disease (600 mg IV at wk 0, 4, 8, &q8wk @ 360 mg SC). Approval based on ADVANCE, MOTIVATE & FORTIFY RCTs https://t.co/OMYNB1yr2R https://t.co/QMn9GWlYm9

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Dr. John Cush @RheumNow( View Tweet )
Jun 26, 2022
Treatment of pyoderma gangrenosum is clinically empiric. Full read ref w/ Graded Rx Recommendations: - 1st line: Steriods or Cyclosporin - Consider biologics: TNFi, IL-1, IL-12/23, IL-17, IL-23 - Others: MTX, MMF, AZA, Dap, colchic, thalidomide, IVIG https://t.co/uMJyfFzsRB https://t.co/vw4VqbjZWh

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Dr. John Cush @RheumNow( View Tweet )
Jun 25, 2022
FDA approved Abbvies risakizumab-rzaa (Skyrizi) as the 1st interleukin-23 inhibitor for use in adults with moderately to severely active Crohn's disease (600 mg IV at wk 0, 4, 8, &q8wk @ 360 mg SC). Approval based on ADVANCE, MOTIVATE & FORTIFY RCTs https://t.co/Y6FVcjHGr2 https://t.co/eTYedqiScE

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Dr. John Cush @RheumNow( View Tweet )
Jun 20, 2022
JAK Janus

JAK/STAT pathway in pyoderma gangrenosum: a new therapeutic highway?

Aurelie Najm, MD, PhD
Jun 16, 2022

Pyoderma gangrenosum (PG) is rare, but often associated with different forms of arthritis, in particular rheumatoid arthritis and inflammatory bowel diseases. 

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covid coronavirus virus

Spondyloarthritis and COVID-19

Robert Chao, MD
Jun 15, 2022

There are still questions surrounding COVID-19, and some common questions I receive from patients revolve around what to do with their current DMARDs or should they even start treatment during this pandemic. Two studies focused on this question. 

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Studies suggest that the IL-23/Th-17 axis is one of the key pathways involved in the pathogenesis of plaque psoriasis and psoriatic arthritis. Learn more here: https://t.co/oj00pk4dLT Sponsored by Janssen @JanssenUS https://t.co/4IhyX6sF7p

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Dr. John Cush @RheumNow( View Tweet )
Jun 10, 2022
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Key Psoriatic Arthritis topics and updates at EULAR 2022

Antoni Chan, MD, PhD
Jun 04, 2022

At EULAR 2022, I have been looking at topics and presentations in psoriatic arthritis (PsA).  Here are my top picks from this year's meeting.

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In vitro study shows Upadacitinib inhibits enthesis T cell derived TNFa and IL-17A, disrupting the prominent IL-23/IL-17/TNFa axis driving SpA. @RheumNow #EULAR2022 ABST#POS0331 https://t.co/pNL3Zlgmt7
Robert B Chao, MD @doctorRBC( View Tweet )
Jun 04, 2022
Kohm et al. Efficacy of IL12/23i ustekinumab independent of MTX in PsA. No additive benefit of MTX on joint, skin, QoL, function @RheumNow #EULAR2022 POS1059

Richard Conway @RichardPAConway( View Tweet )

Jun 04, 2022
Magrey et al. IL23i Risankizumab improves enthesitis in PsA @RheumNow #EULAR2022 POS1057 https://t.co/BjuYj6xUdZ
Richard Conway @RichardPAConway( View Tweet )
Jun 04, 2022
Dr Coates @DrLauraCoates et al. Domains contributing to MDA achievement in guselkumab treated PsA. Physican assessed improved faster than patient assessed. Age, fatigue, BMI, baseline domain score determinants @RheumNow #EULAR2022 POS1067 https://t.co/vPsmeyPjzG
Richard Conway @RichardPAConway( View Tweet )
Jun 04, 2022
Dr Nash @drpnash Baseline determinants of pain response in IL23i guselkumab. Gus improved pain by week 2. Higher baseline pain, lower fatigue, lower TJC + predictors, NSAID use - predictor @RheumNow #EULAR2022 POS1070 https://t.co/4aNz9IQySj
Richard Conway @RichardPAConway( View Tweet )
Jun 04, 2022
High markers at baseline of IL23 pathway better predict ACR20 response to #deucracitinib in #PsA #psoriatic arthritis. Analysis of RCT @eular_org @RheumNow #POS0005 Good proof of concept of TYK2 efficacy https://t.co/yyH5niUEEU
Janet Pope @Janetbirdope( View Tweet )
Jun 04, 2022
Kristensen et al. IL23i Risankizumab improves fatigue, health related quality of life, work productivity in PsA. @RheumNow #EULAR2022 POS1042 https://t.co/fnoCZCpwNM
Richard Conway @RichardPAConway( View Tweet )
Jun 03, 2022
Nash @drpnash et al. IL23i guselkumab improves pain in PsA. Good to see as it is a really important PRO, but there is still significant work to do, week 24 - 60% had <50% and 37% had <20% improvement in pain @RheumNow #EULAR2022 POS1044 https://t.co/H92r4leslT
Richard Conway @RichardPAConway( View Tweet )
Jun 03, 2022

Recent Blogs

2021 GRAPPA Recommendations - Looking Back, Looking Forward

Artie Kavanaugh, MD
Jul 11, 2022
reflections,ripple
With the recent publication of the third iteration of the GRAPPA Psoriatic Arthritis (PsA) treatment recommendations, it seems to be an auspicious time to reflect on some key considerations that arose during the development of the recommendations, as well as to look towards what the future may hold.Read Post

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