IL-6

purpura

Guidelines for Adult-Onset IgA Vasculitis

Jack Cush, MD

A EUVAS-sponsored expert panel of 37 specialists across rheumatology, nephrology, dermatology and pathology has published evidence-based guidelines for adult-onset IgA vasculitis (IgAV), which behaves very differently in adults compared to usually self-limited childhood form.

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steroid prednisone lab

Glucocorticoids: Use vs.Toxicity

Jack Cush, MD

This review article addresses the recognition, prevention and management of glucocorticoid toxicity in rheumatic patients.

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Retrospective Medicare comparison 450 paired #PMR cohorts Rx w/ IL-6 inhib or csDMARDs. At 1 yr, IL-6i pts (vs csDMARD) had signif more GC D/C (adj HR 1.28) or minimal GC use (<3mg/d) (aHR 1.28). Hosp. infxn 2X higher in IL-6i (12.2 vs 5.7 per 100 PY) in year 1, but not year 2 https://t.co/G4eIusHDPa
Dr. John Cush @RheumNow( View Tweet )
Retrospective Medicare comparison 450 paired #PMR cohorts Rx w/ IL-6 inhib or csDMARDs. At 1 yr, IL-6i pts (vs csDMARD) had signif more GC D/C (adj HR 1.28) or minimal GC use (<3mg/d) (aHR 1.28). Hosp. infxn 2X higher in IL-6i (12.2 vs 5.7 per 100 PY) in year 1, but not year 2 https://t.co/YgqLjD9nvM
Dr. John Cush @RheumNow( View Tweet )
Fever,temp,man,HA,thermometer

Misdiagnosis of Still's Disease

Jack Cush, MD

High fever, strange rashes, scary labs often lead to a consideration of Still's disease (AOSD or systemic JIA). Yet the dramatic onset of a systemic disorder may overlap with another, and possibly as rare, systemic disorder that should not be misdiagnosed or mistreated. A current case review by

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ZEUS Trial: IL-6 Inhibition Fails to Cut Cardiovascular Events The phase 3 ZEUS trial tested the IL-6 ligand inhibitor ZVK in over 6,000 patients with ASCVD, CKD, and elevated hsCRP. Although ZVK significantly lowered IL-6 and CRP levels, it did not improved outcomes (HR 0.99 https://t.co/jf2gAtvmpZ
Dr. John Cush @RheumNow( View Tweet )
Substudy of 131 Still’s dz pts from the Autoinflammatory Dz (AIDA) registry. 38% underdosed w/ canakinumab (CAN) vs 62% appropriately dosed (300 mg q4wks or 4 mg/kg). Underdosed CAN had lower odds of long-term remission & D/C CAN (3.9% vs 19%) https://t.co/l94zB9NkKv https://t.co/FQTrCWZLQI

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Dr. John Cush @RheumNow( View Tweet )
cardiac2.jpg (keep)

ZEUS Trial: IL-6 Inhibition Fails to Cut Cardiovascular Events

Jack Cush, MD

The phase 3 ZEUS trial (published in JAMA Dec. 2025)  tested the IL-6 ligand inhibitor ziltivekimab in over 6,000 patients with atherosclerotic cardiovascular disease, chronic kidney disease, and elevated hsCRP—a population enriched for an inflammatory driver of risk.

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Substudy of 131 Still’s dz pts from the Autoinflammatory Dz (AIDA) registry. 38% underdosed w/ canakinumab (CAN) vs 62% appropriately dosed (300 mg q4wks or 4 mg/kg). Underdosed CAN had lower odds of long-term remission & D/C CAN (3.9% vs 19%) https://t.co/l94zB9NkKv https://t.co/D8FNUXS0nv

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Dr. John Cush @RheumNow( View Tweet )
lung.ILD.MD

DMARD Efficacy in RA-ILD

Jack Cush, MD

A network meta-analysis in the Journal of Autoimmunity reviews the pharmacologic options for rheumatoid arthritis–associated interstitial lung disease (RA-ILD). RA-ILD guidelines were recently presented by ERS/EULAR, but these were mainly conditional, low-certainty recommendations.

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From Cytokine Endotypes to Clinical Reality in Still’s Disease Recent EULAR 2026 data highlight a paradigm shift in Still’s disease from syndromic management to biologically informed precision therapy. https://t.co/fBtkDLPJNE https://t.co/y8NBW6VHHa

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Dr. John Cush @RheumNow( View Tweet )
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Do You Zoster Vaccinate? (6.19.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal reports and best ways to review EULAR 2026.

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From Cytokine Endotypes to Clinical Reality in Still’s Disease Recent EULAR 2026 data highlight a paradigm shift in Still’s disease from syndromic management to biologically informed precision therapy. https://t.co/FrghBJdlXj https://t.co/CbHYDKbnK9

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Dr. John Cush @RheumNow( View Tweet )
Kyoto U. cohort study of 55 relapsing polychondritis pts (503 Pt-yrs) Rx w/ TNFi, IL-6i or none -- Crude relapse rates were 46.9/100PYs NoBio, 22.4 TNFi, & 12.5 IL-6Ri. Adjusted relapses signif lower w/ TNFi (IRR 0.4) & IL-6Ri (IRR 0.2) vs no biologic. Estimates for hospitalised https://t.co/h6IcVWjqfp
Dr. John Cush @RheumNow( View Tweet )
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EULAR 2026 Rheumatology RoundUp

Jack Cush, MD

It’s time for Rheumatology RoundUp from EULAR 2026 from London, UK. Drs. Artie Kavanaugh and Jack Cush review their choice presentations from the meeting, offering their perspectives on impact and applicability.

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#OP0209 #EULAR2026 SPECIFI-RA Balinatunfib, oral selective TNFR1 inhibitor designed to preserve TNFR2 signalling in RA. Phase 2b trial missed primary ACR20 endpoint, but 200mg QD arm showed signals for higher ACR50, ACR70 and DAS28 low disease activity & reduced IL-6. @RheumNow https://t.co/emxNQy0cPx

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Mrinalini Dey @DrMiniDey( View Tweet )
#EULAR2026 Recommendations: Vasculitis -Confirm diagnosis with imaging and biopsy - Start GC early but with taper plan - For major flare again confirm dx and restart GC - Consider IL-6 or UPA - MTX may be option if biologics not available @RheumNow https://t.co/DqLZtW630y

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Jiha Lee @JihaRheum( View Tweet )
Emapalumab in MAS secondary to stills disease 39 pts, median age 12, 2 pooled prospective, open label, single arm studies. Endpoint complete resolution at week 8-. Around 60% and partial resolution nearly 100% 67% had concomitant anakinra @RheumNow ##EULAR2026 #EULARBest https://t.co/sGm43C3LfH

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Bella Mehta @bella_mehta( View Tweet )
light bulb idea

Three Abstracts That May Shape the Future of RA Treatment

Aurelie Najm, MD, PhD

Our therapeutic armamentarium in RA keeps on growing. New studies and new molecules, new mechanisms of action or new ways of using old drugs are presented every year at conferences. But which are the ones who can have an impact on our practice? Here is my selection of 3 abstracts presented at

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Window of opportunity in stills disease is early. With IL1 / IL6 agents #sJIA and #AOSD are the same disease. - may need a standard new crieteria IL18 measuremnet should be encouraged. @RheumNow #EULAR2026 plenary https://t.co/EQbs9mDYjS

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Bella Mehta @bella_mehta( View Tweet )
What to use in #RA #IL6i v #abatacept post #TNFi-IR? H2H #TCZ v #Abatacept Same on primary outcome #CDAI change wk26 BUT If #monoRx TCZ better Better retention #TCZ So you decide which is better! Equal v some advantages w #tocilizumab #EULAR2026 @RheumNow @eular_org #OP0205 https://t.co/xdOx4kQCTC

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Janet Pope @Janetbirdope( View Tweet )
Is there a ‘window Of opportunity’ for Rx #GCA w #IL6i 🤞 Obtain a better response Rx GCA #GC #TCZ #Upadacitinib #MTX Study tries to answer if effects of #tocilizumab early vs >8wks is diff N=471, 19% new GCA Early vs late TCZ no dif ❎No Not RCT POS0624 #EULAR2026 @RheumNow

Janet Pope @Janetbirdope( View Tweet )

safety data

JAK Safety Debate Continues: Stronger VTE signal, less clear cancer signal

Mrinalini Dey, MBBChir, MA(Hons) Cantab., MRCP, FHEA

Few topics in rheumatology have reshaped prescribing behaviour as dramatically as the safety concerns surrounding JAK inhibitors following ORAL Surveillance and the subsequent FDA and EMA warnings.

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Review of Ruxolitinib in 7 pts w/ refractory systemic JIA complicated by macrophage activation (MAS) (ages 1.6-11 yrs; 3M: 4F). 5 achieved complete remission; 2 partial remission. 2 relapsed w/ GC tapering (remission after adding canakinumab). No deaths https://t.co/j4Cm3UYB9c https://t.co/YIupsBank5

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Dr. John Cush @RheumNow( View Tweet )
NLRP3 inflammasome activation triggers PAD (2, 4) release from human neutrophils, increasing citrullination of intracellular proteins (CCPs) and driving the pathogenesis of #RA. Further proof: , PAD concentrations and PAD activity correlate with IL-1β.https://t.co/pRQy0ECG5d https://t.co/HExIhebJ4u

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Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

rheumthought

Overlap Syndrome with ILD

Jack Cush, MD
Cush RheumThought ILD

How would you manage a patient with Overlap (anti-synthetase) syndrome, ILD, polyarthritis and myositis?

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Advancing PMR

Eric L. Matteson, MD, MPH
Dr. Eric Matteson
Even though polymyalgia rheumatica is not perceived by many physicians as a severe diagnosis, its diagnosis and management actually propose significant challenges. I'd like to talk about those challenges, and what directions our path forward can include to advance our understanding and improve the treatment of patients who have PMR.
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What Goes Wrong with the Immune System in PMR?

Kornelis van der Geest, MD, PhD
PMR,pathogenesis.JIM2022
Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease. The exact trigger for PMR onset remains unknown. However, immunology studies and clinical trials with biological DMARDs now shed light on the immune pathways involved in PMR.
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