Rheumatoid Arthritis

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Long-term Lab Monitoring in RA is Inefficient

Jack Cush, MD

Annals of Internal Medicine has published a retrospective study of long-term routine laboratory toxicity monitoring (lt-RLTM) in patients receiving disease-modifying antirheumatic drug (DMARD) therapy showing that most very abnormal laboratory
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RHEUM Survey: How important is "Seropositivity" in RA?

Dr. John Cush @RheumNow( View Tweet )

MTX.pills

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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Celltrions tocilizumab biosimilar, tocilizumab-anoh (Avtozma, CT-P47), had similar efficacy when switching from reference tocilizumab (Actemra; Genentech) in a study of 444 RA patients x 52 wks. https://t.co/7aAyuUkZJ9 https://t.co/kJUrRkhstb

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Dr. John Cush @RheumNow( View Tweet )
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Physical Therapy Underprescribed

MedPage Today

Just one patient in six was referred for physical therapy (PT) within 15 days of being treated for knee pain at one major U.S. health system, researchers found, despite nearly universal consensus that PT should be recommended in most cases.

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Single-center Retrospective study of 4,736 RA, propensity matched 509 w/ RA-ILD vs 509 without ILD. In multivariate analysis RF positivity was an independent risk factor for RA-ILD (adj OR = 1.5) w/ signif nonlinear relationship observed, risk threshold @60 IU/mL Paradoxical https://t.co/0XtWnIsbmK
Dr. John Cush @RheumNow( View Tweet )
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It's now called Sjögren Disease!

Jack Cush, MD

Sjögren syndrome is now Sjögren disease, according to recommendations stemming from the 2023 International Rome consensus for the nomenclature of Sjögren disease.

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Clinical Rheumatology Thread for Busy GPs: Post 1 Early inflammatory arthritis(IA): the 3–3–3 rule •Onset ≤3 months •Morning stiffness ≥30–60 minutes •≥3 swollen joints (MCP/MTP common) If present, manage as IA: urgent rheum referral; NSAIDs if no contraindications. https://t.co/hcoumX1ZVY

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Aravind Palraj @Rheumat_Aravind( View Tweet )
Future,space,time

Rheums Speak: Future of Rheumatoid Arthritis

Jack Cush, MD

The third survey in this series addressed clinician views on future trends (AI), future therapies and lessons learned.

This survey captured 233 responses from rheumatologists (91), most (61%) from the USA. US respondents were from the Southeast (17.5%), Southwest (11.4%), Mid-Atlantic (

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Rheumatic Dz & HIV - Arthralgia: self limiting - HIV-assoc arthritis: mimics RA - Occurs w/ HIV: SpA, ReA, PsA - Less : IIM, vasculitis, opportunistic infxn https://t.co/Yf7jZ0icZw https://t.co/6FuJgvDYRF

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Dr. John Cush @RheumNow( View Tweet )
Cohort study of 1,553 Biologic or JAKi Rx IBD (Crohns; UC) pts (SpA excluded) found 106 (6.8%) w/ MSK Sxs & 30 (1.9%) later Dx w/ SpA (20: axial, 10: peripheral) after median F/U 5.2 yrs. SpA risk factors: partial Mayo UC (HR 1.57) & HLA-B27 positivity (HR 3.70) https://t.co/WgLLUjlLMk
Dr. John Cush @RheumNow( View Tweet )
The world of rheumatoid arthritis treatment has changed dramatically. What do the experts say about the evolution of biologics and DMARDs over the last 20 years? Join us for a live webinar, moderated by Dr. Jack Cush, where we'll unpack the results of a nationwide survey. Tues, https://t.co/pKhuHPwcs0
Dr. John Cush @RheumNow( View Tweet )
The Patient Journey with Rheumatic Disease Oton and colleagues have reviewed the "patient journey" - from symptoms to specialty referral in those diagnosed with rheumatic and musculoskeletal diseases (RMDs). They identify the eight stages along the way and where improvements https://t.co/VY3kB3Ohmp
Dr. John Cush @RheumNow( View Tweet )
Pain Flares in RA are just pain, not inflammation. Study of 195 RA pts (11+ yrs dz dur), 49-89% experienced at least 1 flare (median 2-4 flares/mo), IQR 2.1-5), lasting median of 2 days. Flares preceded by worsening mood, anxiety, sleepiness - but no change in Accelerometer https://t.co/csbHtiEglp
Dr. John Cush @RheumNow( View Tweet )
Wondering what rheumatoid arthritis experts think about the future of treatment? Dr. Jack Cush moderates a special Tuesday Nite Rheumatology session, live at 7 PM ET on August 26th, where experts will dive into a nationwide survey on the evolution of biologics and DMARDs. Hear https://t.co/afYRarqjvj
Dr. John Cush @RheumNow( View Tweet )
Pain Flares in RA are just pain, not inflammation. Study of 195 RA pts (11+ yrs dz dur), 49-89% experienced at least 1 flare (median 2-4 flares/mo), IQR 2.1-5), lasting median of 2 days. Flares preceded by worsening mood, anxiety, sleepiness - but no change in Accelerometer https://t.co/twI6wcxKf7
Dr. John Cush @RheumNow( View Tweet )
RheumNow Podcast square

Teaching You How to Think… (8.15.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal reports and press clippings from the past week on RheumNow. Positive results in a Sjogren's trial, to PT or not to PT, and  aphorisms to live by.

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Patient,instruction

The Patient Journey with Rheumatic Disease

Jack Cush, MD

Oton and colleagues have reviewed the "patient journey" - from symptoms to specialty referral in those diagnosed with rheumatic and musculoskeletal diseases (RMDs).
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The world of rheumatoid arthritis treatment has changed dramatically. What do the experts say about the evolution of biologics and DMARDs over the last 20 years? Join us for a live webinar, moderated by Dr. Jack Cush, where we'll unpack the results of a nationwide survey. Tues, https://t.co/o2WqAaQ2mN
Dr. John Cush @RheumNow( View Tweet )
PT in RA - Metanalysis of 17 RCTs, 1362 pts Rx w/ aerobic/resistance exercise, hydrotherapy, manual Rx, electrotherapy, multimodal Rx. 5 RCTs (n 307) signif reduced pain (SMD −0.347; interpreted as a small to medium effect favoring PT. https://t.co/UJGSGrgMV0 https://t.co/n4DzMSm9iJ

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Dr. John Cush @RheumNow( View Tweet )
Venous thromboembolism (VTE) risk goes up w/ age, obesity, estrogens; BUT a UK primary care database shows VTE risk signif higher in RA (n 23K) vs matched controls (n 94K): adj HR 1.46. Absolute VTE risk higher w/ age & BMI, but VTE higher in younger v older; normal vs. Hi BMI: https://t.co/htI2YqiF0c
Dr. John Cush @RheumNow( View Tweet )
French OL trial of PCV13 vaccination in 248 early, DMARD Naive RA pts starting MTX @ same time or after 1 month delay. 1 mo delay in MTX resulted in significantly higher responses (46%, 65%) vs. pts vax while taking MTX. Signif responses seen 1 yr later. RA activity equal betw. https://t.co/AnqK89ZJtE
Dr. John Cush @RheumNow( View Tweet )
Mayo study of 659 incident RA pts finds Multimorbidity predicted 29% (OR:1.29) higher odds of RA flare, & 34% lower (OR:0.66) odds of remission. RA Flares assoc w/ female, smoking, younger age shorter Dz duration, but not seropositivity. Remission assoc w/ male, not smoking, https://t.co/yEwkQ63zIh
Dr. John Cush @RheumNow( View Tweet )
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Rheums Speak: Changing Rheumatology Practices & Choices

Jack Cush, MD

RheumNow surveyed clinicians worldwide on how their rheumatology practice, treatment decisions, and career outlooks have changed over the past 20 years. 242 respondents (68% from the USA) shared their perspectives on the changing landscape of rheumatoid arthritis care, practice patterns, and

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Rheums Speak - RA Treatment Survey RheumNow's August 2025 “Live Vote” surveys will examine Rheumatologist impressions, knowledge and practices over the last 20 years when treating rheumatoid arthritis. https://t.co/hJSQ5mMJ6b https://t.co/7sBXpzkVLg

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Dr. John Cush @RheumNow( View Tweet )

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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