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?
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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.
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Metabolic Syndrome Predicts Cardiovascular Outcomes in Inflammatory Arthritis
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
A systematic review demonstrated that smoking, obesity, fibromyalgia, and depression are significantly associated with difficult-to-treat rheumatoid arthritis (D2T-RA).
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
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
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
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
Dr. John Cush @RheumNow( View Tweet )
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
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
Dr. John Cush @RheumNow( View Tweet )
FDA Targeting the Safety of Avacopan
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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EULAR Recommendations for Physical Activity in Arthritis
EULAR has published a 2025 update for physical activity recommendations for patients with osteoarthritis (OA) and rheumatoid arthritis (RA).
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Neoplasia and Autoimmune Disease
Malignancy rivals cardiovascular disease as a leading cause of death in patients with systemic autoimmune diseases. Chronic inflammation and immune dysregulation can drive oncogenesis, while antitumor immune responses can trigger autoimmune phenomena (paraneoplastic syndromes, checkpoint
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Switch or Cycle - Upadacitinib vs Adalimumab in Refractory RA
After the first tumour necrosis factor inhibitor (TNFi) failure, patients with active rheumatoid arthritis (RA) responded by switching to upadacitinib, compared to cycling to a second TNFi, adalimumab.
Arthralgia w/ HIGH ACPA level >3x ULN) has a 30–50% probability of being diagnosed with RA within 3–5 years https://t.co/iJTyMQM480
Dr. John Cush @RheumNow( View Tweet )
Rheumatology Salaries 2025
Medscape has published its annual Physician Compensation report with physican salaries up roughly 3% and eight specialties earning more than $500,000 per annum.
https://t.co/DNe42EsxRW https://t.co/aegcNm8Pla
Dr. John Cush @RheumNow( View Tweet )
Does monotherapy work? network meta-analysis of 31 RCTs, 13 csDMARDs, Leflunomide, SSZ & gold were better than placebo & equal to MTX regarding annual xray progression scores. Evidence in favor BUT failed to study monoRx vs Combo Rx https://t.co/cMSZ4QHi5G https://t.co/o9ikhJu3UM
Dr. John Cush @RheumNow( View Tweet )
Mortality in Rheumatoid Arthritis: A Story of Decline, Delay, or Plateau? Dr. Elena Myasoedova
In this https://t.co/4UQlqwujiR 2026 podcast, Dr. Elena Myasoedova examines mortality trends in RA, exploring whether we are seeing continued decline, delayed impact, or a concerning https://t.co/yUob3Tv0tR
Links:
Dr. John Cush @RheumNow( View Tweet )
Follow the Money (4.23.2026)
Dr. Jack Cush follows the money and all the news that fits the Rheumatology Gab for this past week.
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Chinese target emulation trial of MDA-5+, dermatomyositis w/ ILD. 106 Rx w/ UPA & 328 w/ TOFA. 6-month lung transplantation-free survival 72% vs 67% (UPA v TOFA). UPA non-inferior to TOFA in MDA5+DM-ILD https://t.co/BBAfbM06AM https://t.co/QP8YdX7CcH
Dr. John Cush @RheumNow( View Tweet )
Twofold Mortality in SLE
Despite declining incidence of lupus, mortality for SLE was twice that of controls in this large incident cohort study.
Ethnicity is a strong predictor of incidence and outcomes in systemic lupus erythematosus (SLE) patients. This population study used the UK Clinical Practice
NSAIDs in Inflammatory Bowel Disease?
MedPage Today
At least some patients with inflammatory bowel disease (IBD) can safely use common drugs for musculoskeletal aches and pains, a large study of insurance claims data suggested, contradicting a widespread concern that these products can trigger IBD flares.
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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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Podcasts
Are your patients with moderate to severe RA getting the appropriate dose? Sponsored by Genentech, Inc
