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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Claims data 2,751 #AAV patients - 6.2% developed #PJP infx. w/ predictors: age, max GC dose, rituximab, CTX, & PJP prophylaxis had Good concordance (0.70) @2mos & 0.66@1yrs. W/ monthly risk of 1.0%, prophylaxis yielded 34 potentially preventable PJP cases https://t.co/c2ObDnmfYp https://t.co/0JRd1k0R2R
Dr. John Cush @RheumNow( View Tweet )
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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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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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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Update on Primary CNS Angiitis
The Journal of Neurology has posted a review and update of Primary CNS vasculitis (PCNSV), also termed primary angiitis of the CNS (PACNS). PCNSV is rare, potentially fatal, and highly treatable, making timely recognition and accurate diagnosis https://t.co/cjGX1ig8Lp
Dr. John Cush @RheumNow( View Tweet )
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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Brepocitinib in Dermatomyositis
The NEJM reports that brepocitinib, an oral TYK2–JAK1 inhibitor, was studied in a phase 3 trial of refractory dermatomyositis (DM) patients and shown to have significant benefits at the higher dose.
https://t.co/gYLP5artRZ https://t.co/PHYXEzzM2j
Dr. John Cush @RheumNow( View Tweet )
FDA has issued a drug safety warning for avacopan (Tavneos), dentifying 76 cases of drug-induced liver injury, including 7 cases of rare vanishing bile duct syndrome (VBDS). There were 8 deaths https://t.co/2GkYNg1Apn https://t.co/fW2qafKCew
Dr. John Cush @RheumNow( View Tweet )
Large pharmaceutical companies reduced their workforces by more than 22,000 employees in 2025. Among 17 largest companies , only five logged a head count increase in 2025 https://t.co/VdtlUaF4Q3 https://t.co/2xsCs9O1Tw
Dr. John Cush @RheumNow( View Tweet )
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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AFFINITY Study - Combination Biologic Therapy in PsA
A pilot trial assessed the efficacy and safety of the guselkumab+golimumab (COMBO) combination versus GUS monotherapy in active PsA (failing a prior tumor necrosis factor inhibitor (TNFi-IR) and showed superiority in ACR 50 https://t.co/f2CB8FnZMB
Dr. John Cush @RheumNow( View Tweet )
FDA has issued a drug safety warning for avacopan (Tavneos), dentifying 76 cases of drug-induced liver injury, including 7 cases of rare vanishing bile duct syndrome (VBDS). There were 8 deaths https://t.co/WkBhs1rNpf https://t.co/ZXdHsAJUOQ
Dr. John Cush @RheumNow( View Tweet )
FDA Safety Warning: Avacopan and Serious Liver Injury
Yesterday the FDA issued a Drug Safety Communication alerting patients and health care professionals about postmarketing identification of serious (drug induced) liver injury, including fatal cases, associated with the use of avacopan (Tavneos) in patients with ANCA- associated vasculitis.
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Ixekizumab With Tirzepatide Efficacy in Obese Psoriatic Arthritis
The TOGETHER-PsA trial has demonstrated the efficacy and safety of ixekizumab (IXE) administered with tirzepatide (TZP) in adult active psoriatic arthritis (PsA) patients who were overweight or obese.
Brepocitinib in Dermatomyositis
The NEJM reports that brepocitinib, an oral TYK2–JAK1 inhibitor, was studied in a phase 3 trial of refractory dermatomyositis (DM) patients and shown to have significant benefits at the higher dose.
Read Article
AFFINITY Study - Combination Biologic Therapy in Psoriatic Arthritis
A pilot trial assessed the efficacy and safety of the guselkumab+golimumab (COMBO) combination versus guselkumab (GUS) monotherapy in active PsA (failing a prior tumor necrosis factor inhibitor (TNFi-IR) and showed superiority in ACR 50 responses but not
NEJM: Polymyalgia Rheumatica
Drs. Dejaco and Matteson have published and update and review of polymyalgia rheumatica (PMR) in the NEJM. They lay out the initial approach to diagnosis, initial steroid dosing, management over time and when to use steroid sparing therapy. https://t.co/CGXjcY0J3H
Dr. John Cush @RheumNow( View Tweet )
Systemic Treatments for Chronic Plaque Psoriasis
JAMA Dermatology has published a review of the pharmacologic landscape on managing adults with moderate to severe plaque psoriasis.
https://t.co/fJQDvZDdbs https://t.co/IYAsdujsMf
Dr. John Cush @RheumNow( View Tweet )
Spotty Medicare Coverage for Newer Rheumatoid Arthritis Meds
Medicare coverage of targeted disease-modifying anti-rheumatic drugs (DMARDs) for RA -- both under Medicare Advantage and in separate Part D plans -- is likely to leave many patients wanting, researchers found. https://t.co/CW6gIHtnIw
Dr. John Cush @RheumNow( View Tweet )
Moral Distress (3.27.2026)
Dr. Jack Cush reviews the journal reports and news from RheumNow.com. This week we discuss moral distress, FM in PsA, Lyme Vax is back & hidden but tangible benefits of the MDHAQ.
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NEJM: Polymyalgia Rheumatica
Drs. Dejaco and Matteson have published and update and review of polymyalgia rheumatica (PMR) in the NEJM. They lay out the initial approach to diagnosis, initial steroid dosing, management over time and when to use steroid sparing therapy.
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#Glucocorticoid-induced #osteoporosis results from direct suppression of osteoblast & osteocyte function, a transient stimulation of osteoclast formation & activity, catabolic effects on #bone matrix & muscle protein, and metabolic alterations https://t.co/ZmMFAOJkmw
#OpenAccess https://t.co/6CubKRbjin
Links:
The Lancet Diabetes & Endocrinology @TheLancetEndo( View Tweet )
Spotty Medicare Coverage for Newer Rheumatoid Arthritis Meds
MedPage Today
Medicare coverage of targeted disease-modifying anti-rheumatic drugs (DMARDs) for rheumatoid arthritis (RA) -- both under Medicare Advantage and in separate Part D plans -- is likely to leave many patients wanting, researchers found.
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phase 3 VALOR trial of 6-valent OspA-based Lyme dz vaccine (LB6V) vs placebo; 4 doses given @ Mos 0, 2, 5-9, & 12 mos later. LB6V reduced Lyme Dz risk by 73.2% @28d after 4th dose. But it was only 15.8% effective (falling short of prespecified 20%) because of fewer than expected https://t.co/TcX0GV05gY
Dr. John Cush @RheumNow( View Tweet )
Recent Blogs
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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Until the publication of the SEAM trial, evidence in the medical literature for the efficacy of the most commonly used drug for psoriatic arthritis worldwide, methotrexate, has been lukewarm at best. Yet we all employ it commonly, either as monotherapy or in combination with biologic or targeted synthetic DMARD treatment. It is inexpensive and widely available, and only modestly toxic.
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With their publication in June 2022 (1), the 3rd iteration of the Group for Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Treatment recommendations for Psoriatic Arthritis (PsA) may have set a record or sorts.
