Outcomes

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Chronic Low Back Pain Disappointments in a Randomized Trial

Jack Cush, MD

Annals of Internal Medicine reports that patients with chronic low back pain (cLBP), may benefit from physical therapy (PT); but other benefit therapies and cognitive behavioral therapy (CBT) as first-stage treatment and switching treatments versus
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Vitamin D in Rheumatic Disease - is it Good Enough?

Jack Cush, MD

Vitamin D deficiency or insufficiency of is highly prevalent and has been often associated with inflammatory rheumatic diseases, raising the question of whether inadequate vitamin D status contributes to immune dysregulation, incipient disease, increased disease activity, or poor skeletal
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CorEvitas RA registry study of 9601 RA pts starting b/tsDMARDs (52K yrs F/U) - 10.4% had eGFR<60 9CRI). Achieving CDAI remission was lower w/ CRI - 28% vs 19%(adj HR 0·76 [0·66–0·88]) https://t.co/E42N3PQHwG https://t.co/WNIGGCpCfZ

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Dr. John Cush @RheumNow( View Tweet )
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Influential Rheumatoid Factors (5.8.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com

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A Patient’s Plea for a New Paradigm in Autoimmune Disease A current article in Nature Reviews Rheumatology has a patient boldly asking why we rheumatologists aren't more like her oncologists? https://t.co/fJMwR864HW https://t.co/a6CJPpo4yq

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Dr. John Cush @RheumNow( View Tweet )
Breaking the Rules: Dual-Advanced Combinations in Rheumatology For decades, the standard of care in rheumatology has been combination therapy - pairing methotrexate (MTX) with an advanced biologic or synthetic agent to achieve optimal outcomes. https://t.co/4lyYTTwJUU https://t.co/sYpYbCjlzm

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Dr. John Cush @RheumNow( View Tweet )
Metabolic Syndrome Predicts Cardiovascular Outcomes in Inflammatory Arthritis In this prospective observational study 811 CIA patients analyze outcomes in patients with and without MetS, including cardiovascular death/hospitalization and all-cause death/hospitalization. https://t.co/WT3wTpeGPi
Dr. John Cush @RheumNow( View Tweet )
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A Review of Hydroxychloroquine Ocular Toxicity

Jack Cush, MD

While hydroxychloroquine (HCQ) is thought to be a very safe drug, its ocular risk profile is probably more serious than appreciated. A comprehensive review published in the Journal of Rheumatology discusses HCQ pharmacokinetics, mechanisms of retinal toxicity, risk stratification, and evidence-

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Gout Control Lowers Cardiovascular Events

Jack Cush, MD

A large target emulation trial suggests that gout patients prescribed urate-lowering treatment who achieve a serum urate level lower than 6 mg/dL significantly lower their risk of cardiovascular events.

Cohorts were derived from the Clinical Practice Research

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STEP Talk: Mitigating Surgical Risk with Dr. Susan Goodman Surgery is high stakes for rheum patients. Dr. Susan Goodman shares how to mitigate perioperative risk and optimize outcomes at #RheumNowLive 2026. Smart prep = better recovery. https://t.co/AM1N3SimiY #Rheumatology https://t.co/wk99ytXZKl

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Dr. John Cush @RheumNow( View Tweet )
Global trends in systemic sclerosis (SSc) mortality. Betw 2001-23, in 74 countries, 85,291 SSc deaths (79% females). While SSc-Crude mortality increased from 1.97 (2001) to 2.34 (2023), the age-standardized mortality decreased from 1.58 to 1.29. declining in Americas & Europe. https://t.co/lvHbF5HLPY
Dr. John Cush @RheumNow( View Tweet )
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A Patient’s Plea for a New Paradigm in Autoimmune Disease

Jack Cush, MD

A current article in Nature Reviews Rheumatology has a patient boldly asking why we rheumatologists aren't more like her oncologists?

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Breaking the Rules: Dual-Advanced Combinations in Rheumatology

Jack Cush, MD

For decades, the standard of care in rheumatology has been combination therapy - pairing methotrexate (MTX) with an advanced biologic or synthetic agent to achieve optimal outcomes. 

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Metabolic Syndrome Predicts Cardiovascular Outcomes in Inflammatory Arthritis

Jack Cush, MD

Chronic inflammatory arthritis (CIA) is associated with elevated cardiovascular risk. While metabolic syndrome (MetS) is prevalent, how much it contributes to adverse clinical outcomes is unclear.

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More Comorbidity in Difficult to Treat RA

Jack Cush, MD

A systematic review demonstrated that smoking, obesity, fibromyalgia, and depression are significantly associated with difficult-to-treat rheumatoid arthritis (D2T-RA).

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Steroids Corticosteroids remain a cornerstone of rheumatologic therapy — rapidly effective but chronically dangerous, as their power to suppress inflammation through inhibition of prostaglandins, lipoxygenase, pro-inflammatory cytokines, and proteases comes at the cost of a https://t.co/fKGgYF3yWA
Dr. John Cush @RheumNow( View Tweet )
RCT 120 mod-severe hip OA (KL 2-4) pts Rx w/ THA +rehab or exercise. @12 mos. THA had signif. better pain, function & HRQoL vs exercise program alone (WOMAC total -30.9 vs -3.7). (38% of exercise/conservative grp needed THA) https://t.co/6vvRAr6isf https://t.co/VOYgS3PPwr

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Dr. John Cush @RheumNow( View Tweet )
Among 1074 #PsA tested annually, RF positivity was found in 16.1% overall (5.1% RF+ at baseline). RF+ rediced odds of MDA (OR 0.53) w/ incr risk of bDMARD discontinuation (OR 2.65) https://t.co/AmG6hkWABW https://t.co/MYhkfxAh0r

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Dr. John Cush @RheumNow( View Tweet )
True or False: In a meta-analysis, RA was associated with a significantly increased risk of osteoporotic fractures in female patients but not in male patients. See if you got it right in the latest RheumIQ quiz at https://t.co/HCxOwRl2Tq. https://t.co/O9WRKQKmu4

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Dr. John Cush @RheumNow( View Tweet )
Switch or Cycle - Upadacitinib vs Adalimumab in Refractory RA After the first tumor necrosis factor inhibitor (TNFi) failure, patients with active rheumatoid arthritis (RA) responded by switching to upadacitinib, compared to cycling to a second TNFi, adalimumab. https://t.co/Cml3Z7ZyQP
Dr. John Cush @RheumNow( View Tweet )
Prospective study of 305 Consecutive newly diagnosed axSpA pts (55% male; Dx delay 6 yrs; 75% B27+). 56% w/ r-axSpA more male w/ hi CRP. nr-axSpA had more inflam LBP, +FHx SpA. SpA Dx made without sacroiliitis in 12%; only 2/38 later developed sacroiliitis https://t.co/xPlGwZ7Kjk https://t.co/2TBQALvxsG

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Dr. John Cush @RheumNow( View Tweet )
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COVID Virus Persistence with DMARD Use

MedPage Today

Drugs commonly used to treat systemic autoimmune rheumatic diseases (SARDs) may keep the SARS-CoV-2 circulating after COVID-19 infection in patients with these conditions, with researchers documenting substantially increased viral antigen persistence compared with other post-COVID patients.

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Review of GLP-1 Receptor Agonists in Psoriasis

Jack Cush, MD

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed cardiometabolic medicine and are now attracting intense interest in inflammatory disorders.

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True or False: Low-dose aspirin given at giant cell arteritis diagnosis is associated with a lower risk of major adverse cardiovascular events. Put your answer to the test in the latest RheumIQ quiz at https://t.co/XLPVoyCbLB. https://t.co/C5CSwuv5mF

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Dr. John Cush @RheumNow( View Tweet )
Tavneos

FDA Targeting the Safety of Avacopan

Jack Cush, MD

The future of avacopan is up in the air. In April, the FDA issued a drug safety warning, previously requesting that Amgen to pull its rare disease drug Tavneos from the market. Now, there appears more pressure to remove it from the market.

The FDA’s concern is that the data, orginally

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Recent Blogs

rheumthought

CNS Lupus (NPSLE)

Jack Cush, MD
Cush RhTh CNS
29 yr. old woman with SLE and transverse myelitis. Is this NPSLE; how to diagnose?
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Hydroxychloroquine for Everyone

Jack Cush, MD
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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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Choice Overload (and the Way Out)

Jack Cush, MD
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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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