Rheumatoid Arthritis

Telling You Where to Go (12.19.2025) Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow. Who would've thunk - a PsA FMF connection? Labs to diagnose SSc-ILD? IgA-RF may be important or RZV may not work in JAK inhibitor treated patients? https://t.co/bwF89L9Z7R
Dr. John Cush @RheumNow( View Tweet )
ILD damage fibrosis path

Best of 2025: Antifibrotics - A New Class of Therapies in Rheumatology?

Shervin Assassi, MD

Rheumatologists typically manage systemic autoimmune rheumatic diseases and associated interstitial lung disease with immunosuppressants. However, evidence increasingly supports also the use of antifibrotic agents in this setting.

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MTX.pills

Best of 2025: Methotrexate intolerance in rheumatoid arthritis

Jack Cush, MD

Methotrexate (MTX) is the most commonly used DMARD in rheumatoid arthritis (RA); however, there is significant intolerance to this drug among adult RA patients - especially at doses above 15 mg per week.

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Lancet review of skin cancer risk w/ inflammatory arthritis - both melanoma and Non-melanoma skin cancers are increased in RA & inflammation. Also Package inserts for TNFi say all TNFi Rx pts should have complete skin exams "periodically". Skin cancer screening advised. https://t.co/XddFDe0xh8
Dr. John Cush @RheumNow( View Tweet )
Japanese retrospective study-194 #RA pts Rx w/ JAK inhib (74 vaccinated w/ recombinant zoster (RZV) & 120 Not-Vax). H.zoster lower w/ RZV (4.8/100PY) vs UnVax (7.8/100PY) w/ overall efficacy of 59.1%. RSV Vax pts who got HZ had signif lower lymphocyte #s, higher SDAI & CDAI. https://t.co/vJJRflJ23x
Dr. John Cush @RheumNow( View Tweet )
Austrian 1K Paracelsus cohort study; from 9,665, 296 (3.1%) had RA. CKD prevalence was higher in RA vs controls (11.8% vs. 6.7%, p<0.001). Albuminuria was dominant renal dz in RA (6.8% vs 4.2%, p=0.027), but missed signif after adjustments (OR 1.43; 0.96–2.13) https://t.co/9DnErwT4rX
Dr. John Cush @RheumNow( View Tweet )
Cases & Guidelines: Tuesday Night Rheumatology Panelists discuss their approaches to a range of difficult cases in multiple areas, including RA, PsA and PMR. Panelists: Audrey Gibson, PA-C; Benjamin A. Smith, PA-C; Emma Bavage, ANP; Jack Cush, MD https://t.co/vl5J9NYUKZ https://t.co/nsTf370bu9

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Dr. John Cush @RheumNow( View Tweet )
RheumNow Podcast square

Telling You Where to Go (12.19.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com. Who would've thunk - a PsA FMF connection? Labs to diagnose SSc-ILD? IgA-RF may be important or RZV may not work in JAK inhibitor treated patients?

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🦴 Genant-Modified Sharp Scoring System 🧮 A radiographic scoring system used to quantify joint damage in Rheumatoid Arthritis (RA), especially in clinical trials and long-term follow-up. 🔍 What does it assess? X-rays of hands and feet for: •Erosions •Joint Space Narrowing https://t.co/r5bvzFliBP

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Ravi Kumar @RheumattDoc( View Tweet )

Lancet review of skin cancer risk w/ inflammatory arthritis - both melanoma and Non-melanoma skin cancers are increased in RA & inflammation. Also Package inserts for TNFi say all TNFi Rx pts should have complete skin exams "periodically". Skin cancer screening advised. https://t.co/MNuQO6Dw5b
Dr. John Cush @RheumNow( View Tweet )
IN RA: IgA-RF seen in 50%, IgA-ACPA in 20-40% (& are very specific). IgA-RF or -ACPA found in serum, saliva & syn.fluid.& may underlie "mucosal hypothesis" of RA. IgA-RF assoc w/ more severe RA, worse outcomes, Xtra-articular manifestations, & blunted TNF inhibitor responses https://t.co/SVUJmrIy2F
Dr. John Cush @RheumNow( View Tweet )
Japanese retrospective study-194 #RA pts Rx w/ JAK inhib (74 vaccinated w/ recombinant zoster (RZV) & 120 Not-Vax). H.zoster lower w/ RZV (4.8/100PY) vs UnVax (7.8/100PY) w/ overall efficacy of 59.1%. RSV Vax pts who got HZ had signif lower lymphocyte #s, higher SDAI & CDAI. https://t.co/4VMWPhzXeL
Dr. John Cush @RheumNow( View Tweet )
Austrian 1K Paracelsus cohort study; from 9,665, 296 (3.1%) had RA. CKD prevalence was higher in RA vs controls (11.8% vs. 6.7%, p<0.001). Albuminuria was dominant renal dz in RA (6.8% vs 4.2%, p=0.027), but missed signif after adjustments (OR 1.43; 0.96–2.13) https://t.co/qf0IpZC50Q
Dr. John Cush @RheumNow( View Tweet )
EULAR.Docs.APP

Role of the Nurse in the Care and Management of Rheumatic Diseases - EULAR Review

Jack Cush, MD

In 2023, a EULAR subcommittee set out to assess the roles of nurses and Advanced Practice Nurses (APN) in the care of arthritis as outlined in published EULAR guidelines. The scope of APN practices was first proposed in 2012 and revised in 2018. EULAR updated its recommendations for the role

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AANP survey of US 2338 Nurse Practitioners (mostly primary care) re: shared pts w/ rheumatologists. NPs managing RA want improved communication w/ rheums, & education on RA management. PC NP confidence w/ RA was 47% Somewhat confident, 6% very confident, 19% not confident. https://t.co/YVEpJua9hj
Dr. John Cush @RheumNow( View Tweet )
Tarsal Tunnel Syndrome - review and quiz. A compressive neuropathy of the posterior tibial nerve within the tarsal tunnel. 80% caused by lipoma, ganglion, varicosity, trauma, tenosynovitis, rheumatoid arthritis, diabetes, etc https://t.co/zCyeVIJEuy https://t.co/f4jA13FDvN

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Dr. John Cush @RheumNow( View Tweet )
In US, Tofacitinib loses patent exclusivity & goes generic in 2026. Worldwide Tofa sales in 2024 were $3.08 billion (55% use in RA; N. America 1st w/ ~38% of market). Tofa sales projected to rise to $5.7 bill in 2029 https://t.co/nKPaQdglYw https://t.co/DdMymmk8go

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Dr. John Cush @RheumNow( View Tweet )
Israeli retrospective study of 9736 colchicine Rx FMF pts matched w/ 97 360 controls. On F/U Psoriatic arthritis developed in more FMF pts (43 vs 119) - HR 3.52 (CI: 2.48, 5.0). ^Risk w/ older age, smoking, SES https://t.co/blDIsmHWPC

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Dr. John Cush @RheumNow( View Tweet )

I Can't Believe it's Not Seronegative Rheumatoid Arthritis?! In rheumatology, we're no stranger to uncertainty. In any diagnosis of seronegative rheumatoid arthritis, it's always our invitation to reconsider the diagnosis. https://t.co/JaLfRha6dq https://t.co/WwT5Q8B5Ad

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Dr. John Cush @RheumNow( View Tweet )
Retrospective EHR study of 38,327 COVID-19 infx pts & 1,143 whodeveloped post Covid Syndrome (PCC). PCC risk was signif higher in women & obese. Pre-COVID, psoriasis (OR 1.41) & RA (OR 1.64) had incr risk of PCC. Post COVID, more Sjögren’s (OR 4.05) among PCC. https://t.co/0Z48Hy43XY
Dr. John Cush @RheumNow( View Tweet )
Cases & Guidelines: Tuesday Night Rheumatology Panelists discuss their approaches to a range of difficult cases in multiple areas, including RA, PsA and PMR. Panelists: Audrey Gibson, PA-C; Benjamin A. Smith, PA-C; Emma Bavage, ANP; Jack Cush, MD https://t.co/1HPBdPdIVx https://t.co/30Q6azQU3r

Links:

Dr. John Cush @RheumNow( View Tweet )
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Reefer Madness (12.12.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal and regulatory reports from this past week on RheumNow.com.  B cell drugs in SLE and ITP, biomarkers in GCA & PSS and great videos by APPs.

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RHEUM Survey> In RA, seropositivity correlates best with what?

Dr. John Cush @RheumNow( View Tweet )

Betsy Kirchner

Metabolic Bone Pearls

Elizabeth Kirchner, DNP

Betsy Kirchner, DNP, shares practical tips for managing metabolic bone disease, including the importance of VFA imaging to catch asymptomatic vertebral fractures and utilizing fracture liaison services to close care gaps. She highlights key pearls like the doubled fracture risk in RA patients,

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I Can't Believe it's Not Seronegative Rheumatoid Arthritis?! In rheumatology, we're no stranger to uncertainty. In any diagnosis of seronegative rheumatoid arthritis, it's always our invitation to reconsider the diagnosis. https://t.co/JGPTXkvF3E https://t.co/ds1aRzAPF7

Links:

Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

Advanced Practice Rheum

Evaluation of Rheumatic Complaints

Jack Cush, MD
Evaluation of MSK cover
Dr. Cush provides a systematic approach to evaluating musculoskeletal and rheumatic complaints in clinical practice. Read Post

Hydroxychloroquine for Everyone

Jack Cush, MD
ra.hands2_.JPG
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. Read Post
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