Top Four and More (4.10.2026)
Dr. Jack Cush reviews the news and journal reports from RheumNow.com this week - including his top four favorite subjects.
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Italian retrospective study 411 IIM pts classified cancer risk per IMACS criteria: 44% high-, 38% intermed- 18% standard-risk. 9.2% had CA w/in 3yrs. Signif more in high-risk (OR 4.05). CA predictors: TIF1γ (OR 12.3), SAE1 (OR = 11.9) https://t.co/j4gA0g79bI https://t.co/Pt5nMs89bl
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Opioids Down, Gabapentins Up
The number of U.S. patients prescribed long-term opioid therapy declined from 2015 to 2023, but co-prescribing of opioids with gabapentinoids increased, prescription data showed.
In 2023, 4.2 million people had an active long-term opioid therapy episode, defined as a period of opioid
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From 2015 to 2023, long-term opioid therapy declined in the USA. Approximately 4 million to 5 million patients were prescribed long-term opioid therapy in 2023. Long term opioid use remains a challenge https://t.co/N5s7mYvXSw https://t.co/YHdTbHLB4q
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Malignancies Not Increased with Biologic Therapies
The risk of malignancy in rheumatoid arthritis (RA) patients receiving biologic agents was evaluated by metanalysis of randomized controlled trials (RCTs) and found no significant increased risk of malignancy compared with other disease-modifying antirheumatic drugs (DMARDs) or with placebo
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Single-centre retrosp study of established 257 PMR pts. 98 referred by GPs were for Dx uncertainty (51 vs 14%), less for relapse (27%) or recurrence (11%). PMR Dx accuracy better by Rheums vs PCPs (83% v 62%, P < 0.05) https://t.co/DvTKeuGa4Q https://t.co/wQDXR46k5F
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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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COMMON - Incidental Rotator Cuff Abnormalities on MRI
In this cross-sectional study of 602 Finnish adults undergoing bilateral shoulder magnetic resonance imaging (MRI) and clinical assessment, found abnormalities in nearly everyone over age 40yrs, regardless if asymptomatic or symptomatic.
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Predictors of Calcinosis Cutis in Systemic Sclerosis
Calcinosis cutis (CaC) is a common and disabling non-lethal manifestations in systemic sclerosis (SSc). This study used SSc patients from the EUSTAR database to clinically characterize patients and identify risk factors for CaC development.
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CDC: In 2023, age-adjusted prevalence of U.S. adults (>20 yrs) with obesity was 40.3% (9.7% with severe obesity; 31.7% overweight). BMI data from NHANES, & the National Center for Health Statistics https://t.co/kH9ajbUJ2m https://t.co/utbGWf4D12
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Machine learning predicts macrophage activation syndrome in adult Still's disease - 312 AOSD - XGBoost model had 5 predictors: ferritin, splenomegaly, Plt#, cholesterol, & ESR (AUC 0.839, sensit 0.824, specificity 0.710. https://t.co/QrogaCYPCT https://t.co/Z6WgCnFTfx
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VEXAS Syndrome - A Review
Beck et al has published a review of the VEXAS syndrome in The Lancet, focusing on the pathogenesis, spectrum, and treatment strategies.
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Danish real-world study anifrolumab use in 36 #SLE pts. SLEDAI-2K decreased from 8 (baseline) to 2 @ mos 3; @6 mos 52% had SLEDAI-2K=0. 87% had PGA ≤0.5 w/ LLDAS, & 70% DORIS remission. Pred use declined by >50%. Herpes infx were most freq AE https://t.co/tbMOyOioeU https://t.co/jDJgImjgQt
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Phase 1b trial shows transdermal Curcumin Gel (VAS-101) in was effective in Knee Osteoarthritis. Enrolled 60 KOA pts 45–75 yrs Rx w/ PBO or gel qd x 28d w/ signif improvement in pain & KOOS scores https://t.co/yNiNocZxa4 https://t.co/3W7j1bIvBc
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UK Our Future Health study of 1,563,155 finds affective Dz (depression, bipolar, anxiety) signific higher (p<0.001)in autoimmune pts vs gen. pop. (29% vs 18%) - dx by PHQ-9, GAD-7. (OR 1.86), even after adjustments income and pain, etc. https://t.co/HoKBeAZxbS https://t.co/LnC4lqqgq7
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Korean study 50600 adult RA pts (Dx 2010-2020) shows Sustained high-income was assoc w/ reduced mortality, esp in younger pts (adj HR 0.50 <65 years vs 0.74 ≥65 years). Amplifed by Rural residence https://t.co/DUZoNsPSHj https://t.co/PV3Umlrgvv
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1/3 of American adults have poor sleep. New survey from Amer. Academy Sleep Medicine shows 45% of pts never discuss sleep issues with their doctors; only 15% discussed it with a sleep specialist. https://t.co/uvlHjpuVs8 https://t.co/fDOtp9rxOn
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Open label RCT in 116 DMARD-naïve #RA pts Rx w/ tofacitinib or MTX (after 1 IM steroid injx). @3 mos, TOFA signif better than MTX for >50% SDAI improv(94 v 75%), CDAI[14.5 v 7.3), DAS28-CRP[1.7 v 1.2] https://t.co/smOuLlVFyX https://t.co/xGvbiu62OB
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Japanese ANSWER study Rx 7268 RA pts initiating bDMARDs or JAKi by orthos or Rheums. Vs Rheums, Ortho Rx RA had longer Dz duration, more seropositivity, functional impairment, less comorbidity, more MTX/GC/TNFi, less AE D/Cs - responses & outcomes were similar https://t.co/1ryA8C2p1b
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Updated CRA/SPARCC Recommendations for Axial Spondyloarthritis
In 2024, the Canadian Rheumatology Association (CMA) and the Spondyloarthritis Research Consortium of Canada (SPARCC) published a comprehensive set of 56 treatment recommendations for the management of axial spondyloarthritis. This first update is focused on the reassessment of IL-17i
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TENS Efficacy in Fibromyalgia
A randomized clinical trial of transcutaneous electrical nerve stimulation (TENS) in fibromyalgia showed meaningful improvement in pain for 6 months when combined with physical therapy (PT).
https://t.co/Gm81FWoTQN https://t.co/2gq2cDFUh7
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Target trial emulation: biologics or JAK vs RTX in RA-ILD -- abatacept (n=694), JAKi (156), IL-6i (389), or TNFi (734), PS-matched =# RTX; no significant differences (HR 0.74-1.09 NS) in outcomes of resp hosp, lung transplant & death. But ABA (HR 0.84) & JAKi (HR 0.62) had less https://t.co/c9IVwQYwMN
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What's it like to have RA? LISA: "It only took me three short years to go from rock climbing to a power wheel chair and that stage of the disease was frightening and painful and you feel hopeless and as if your life plan is being stolen from you. Once I was able to start https://t.co/d49htc8k4m
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Retrospective study of 1st SLE pregnancies from LUNA Registry. Fetal loss was associated w/ aPL (OR 2.46) & pulse steroids (2.46), but not w/ SSA Abs (1.32). 247 pregs, 194 live births, 53 fetal loss. Ro+ vs Ro- no difference in live births or preterm births https://t.co/bsMMvVyffw
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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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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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I recently overheard a very good practicing rheumatologist complain, “why do I need yet another drug for psoriatic arthritis? I have more treatment choices than I have actual PsA patients who need a new or better drug”.
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