Rheumatoid Arthritis

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Methotrexate Fails in Knee Osteoarthritis

MedPage Today

We'll be blunt: methotrexate flopped in a randomized placebo-controlled trial among patients with osteoarthritis (OA) of the knee.

Contrary to results from a previous trial in hand OA, the old-line disease-modifying anti-rheumatic drug (DMARD) failed to bring any improvement relative to placebo

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Early RA or undiff. arthritis (UA) shows initial hi-dose steroids have significantly better earlier outcomes, but lower doses have fewer early side effects. IMPROVED used high dose GC (60 mg/d tapered to 7.5 mg in 7wks). tREACH used lower dose GC (15 mg/d tapered in 10 wks to https://t.co/TkrGPb6EBZ
Dr. John Cush @RheumNow( View Tweet )
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Moneyball Rheumatology (5.30.2025)

Jack Cush, MD

Dr. Jack Cush reviews the book/movie, "Moneyball" and a suggests moneyball strategy is needed to find next level responses for our patients.

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Turkish study of 1263 primary care referrals to rheumatology found 35.7% with inflammatory rheumatic Dz (IRD), 17.7% osteoarthritis, and 11.2% regional pain syndromes. Another German study showed low risk of IRD if CRP <5 https://t.co/v5qYb7c7jP https://t.co/iq4NfcC3cH https://t.co/6lkTMSBUqc

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Dr. John Cush @RheumNow( View Tweet )
Hydroxychloroquine for Everyone 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, https://t.co/qKnObzr5ib
Dr. John Cush @RheumNow( View Tweet )
Why DORIS or LLDAS #remission 🤔 ⬇️mortality ⬇️damage ⬆️QoL Dr Nikpour at On Rheum Assoc Shows Remission > LLDAS no pred ✅ best @RheumNow https://t.co/tFcPrkd5Vd

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Janet Pope @Janetbirdope( View Tweet )
Lupus QD Clinic - Rhupus dsDNA+ SLE Plus CCP+ RA = Rhupus https://t.co/lyV7fgd1vp https://t.co/Ptw0dmyqCj

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Dr. John Cush @RheumNow( View Tweet )
T2T in #SLE Lots of #rheumatologists do NOT do a validated measure so #DORIS remission may be over estimated But great algorithm for #lupus #Rx ⁦@RheumNow⁩ #LUPUS2025 https://t.co/mGoopRtK2F

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Janet Pope @Janetbirdope( View Tweet )
T2T in SLE https://t.co/efTxDZz8Qd https://t.co/TvhOzCX34Q

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Janet Pope @Janetbirdope( View Tweet )
No Cancer Recurrence with Biologic DMARDs in RA A prospective Danish rheumatoid arthritis (RA) registry study look at the risk of recurrence when a biological disease-modifying antirheumatic drugs (bDMARDs) was ued in patients with a a prior solid cancer (in remission) and https://t.co/T7G96cAlE6
Dr. John Cush @RheumNow( View Tweet )
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Diagnosing Neuropsychiatric SLE (5.23.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from RheumNow.com - including views on the vagus nerve, NPSLE and CAR-T mania.

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Tocilizumab vs. Methotrexate in Rheumatoid Arthritis A large randomized rheumatoid arthritis (RA) clinical trial compared subcutaneous tocilizumab (TCZ) vs oral methotrexate (MTX) vs. the combination of subcutaneous TCZ and MTX, and showed that TCZ was superior to MTX, either https://t.co/AS8MJaujIE
Dr. John Cush @RheumNow( View Tweet )
If vagus nerve stimulation improves RA; then what if vagotomy? Danish study of vagotomy (1977-1995). 6070 vagotomy matched w/ 60,699 comparators. Truncal vagotomy was assoc w/ signif incr RA incidence (OR 2.62), but not superselective vagotomy (OR 1.05). NO diff in incident OA https://t.co/Rs1EyrQd57
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Infusion/injxn-reactions (IRRs) w/ biologics studied in 1,832 RA pts - IRRs seen in 9.7% & were signif more common w/ being younger (OR1.79), secondary Sjögren's (OR 2.17), prior leflunomide (OR 1.5); but less common w/ Abatacept (OR 0.26) & tocilizumab (OR 0.42), golimumab (OR https://t.co/IaHajITWri
Dr. John Cush @RheumNow( View Tweet )
Panacea of Prednisone & Cannabis (5.16.2025) Dr. Jack Cush reviews the news, journal and regulatory reports from this week on RheumNow. Interesting trends and results with prednisone in lupus, cannabis in RA and opioid deaths too! https://t.co/QDtxItYSco https://t.co/s4nYmMe3vs

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Dr. John Cush @RheumNow( View Tweet )
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No Cancer Recurrence with Biologic DMARDs in RA

Jack Cush, MD

A prospective Danish rheumatoid arthritis (RA) registry study look at the risk of recurrence when a biological disease-modifying antirheumatic drugs (bDMARDs) was ued in patients with a a prior solid cancer (in remission) and found no increased

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syringe, pill, DMARD, Treatment, therapy

Tocilizumab vs. Methotrexate in Rheumatoid Arthritis

Jack Cush, MD

A large randomized rheumatoid arthritis (RA) clinical trial compared subcutaneous tocilizumab (TCZ) vs oral methotrexate (MTX) vs. the combination of subcutaneous TCZ and MTX, and showed that TCZ was superior to MTX, either given as TCZ monotherapy or in combination with MTX. 

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Periprosthetic femoral Fx (PPFF): metanalysis of 36 studies found PPFF risk factors: Uncemented stems (OR 3.36), major teaching hosp (2.0), female (1.6), obesity (1.4), Hi comorbidity(1.4), RA (1.89), (1.67), revised THR (2.6). OA = protective (0.51) https://t.co/y2BpH8LUb6 https://t.co/EjX6R9QTK3

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Dr. John Cush @RheumNow( View Tweet )
Lupus QD Clinic - Rhupus dsDNA+ SLE Plus CCP+ RA = Rhupus https://t.co/lyV7fgd1vp https://t.co/IKkS0enQH9

Links:

Dr. John Cush @RheumNow( View Tweet )
Periprosthetic femoral Fx (PPFF): metanalysis of 36 studies found PPFF risk factors: Uncemented stems (OR 3.36), major teaching hosp (2.0), female (1.6), obesity (1.4), Hi comorbidity(1.4), RA (1.89), (1.67), revised THR (2.6). OA = protective (0.51) https://t.co/y2BpH8LUb6 https://t.co/hX2lcjI4Kg

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Dr. John Cush @RheumNow( View Tweet )
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Biologics in Pregnancy Patients With Autoimmune Disease

Jack Cush, MD

A large cohort, claims data study shows that among pregnant women receiving biologic therapies for autoimmune conditions, 72% continued their biologics pregnancy, more so among inflammatory bowel disease (IBD) patients than those with rheumatoid arthritis (RA), psoriasis (PsO) or psoriatic

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Smoking & Autoantibodies in Rheumatoid Arthritis Investigators from the Netherlands have published their findings that smoking is a risk factor in rheumatoid arthritis (RA), led by the induction of local autoimmune responses at mucosal sites (in the lungs) and exemplified by https://t.co/SQa3PrRnOI
Dr. John Cush @RheumNow( View Tweet )
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Panacea of Prednisone & Cannabis (5.16.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal and regulatory reports from this week on RheumNow.com.  Interesting trends and results with prednisone in lupus, cannabis in RA and opioid deaths too!

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National Inpatient Sample retrospective study of #RA pts using cannabis (n 42,415). Cannabis assoc w/ lower mortality (0.98% vs 2.71%; OR 0.50), depression (OR 0.47), chronic pain (OR 0.45), anxiety (OR 0.55); but more use of opioids (OR: 1.10), nicotine (OR: 1.35), & alcohol https://t.co/87SnCHVxkN
Dr. John Cush @RheumNow( View Tweet )
cigarette,tobacco,smoking,fumes

Smoking & Autoantibodies in Rheumatoid Arthritis

Jack Cush, MD

Investigators from the Netherlands have published their findings that smoking is a risk factor in rheumatoid arthritis (RA), led by the induction of local autoimmune responses at mucosal sites (in the lungs) and exemplified by RA-specific autoantibodies. 

RA is characterized by the

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Recent Blogs

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. Read Post

Best of 2023: New ACR RA-ILD Treatment Guidelines – What Were They Smoking!?

Richard Conway, MBBChBAO, PhD
Lungs ILD
Rheumatoid arthritis related interstitial lung disease (RA-ILD) is common, with symptomatic RA-ILD affecting approximately 8% of RA patients. There is a very limited evidence base supporting treatment and therefore the recent release of ACR guidelines is to be welcomed. However, the published guidelines appear discordant with the best available evidence base.  Read Post
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