Rheumatoid Arthritis

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Hydroxychloroquine for Everyone

Jack Cush, MD

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

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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 )
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/qzlj0MIClY
Dr. John Cush @RheumNow( View Tweet )
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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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Study of 42 pts w/ long standing RA-LD undergoing Lung Transplant (LTx) betw 2004 -2020. Median survival was 5.3 yrs (1-yr survival 88%) - same survival as LTx in other CTD & non-CTD ILD LTx. Mortality was 43%, higher w/ UIP. RA/CTD is not a contraindication to LTx. https://t.co/C0dpThYcMT
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More Women with Autoimmune Diseases Die from Cardiovascular Disease Women with the autoimmune diseases rheumatoid arthritis, lupus or systemic sclerosis may have a higher rate of death related to cardiovascular disease than men with the autoimmune diseases, according to new https://t.co/Px9ayANsFL
Dr. John Cush @RheumNow( View Tweet )
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Vitamin D Headlines (5.9.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal reports and lupus highlights from the past week on RheumNow.com. Triple positivity, the gut and CRPS, and hope for better outcomes with Vitamin D therapy. 

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RA nodules respond to JAKi. Small case series of 7 established/refractory moderate-to-severe#RA pts w/ rheumatoid nodules who were treated w/ JAKi (tofacitinib, upadacitinib)-- 5/7 had complete resolution & 1 reduced nodules size (w/in 3-12 mos) on JAKi therapy. https://t.co/oQWHMBVQEi
Dr. John Cush @RheumNow( View Tweet )
single-centre study of 469 consecutive RA pts - 15 had VTE (3%). Strongest risk factor of VTE was the history of previous VTE (OR 44.7), recent hospitalisation (OR 6.82), diabetes (OR 11.23), and JAKi (OR 5.54) (Other studies show inflammation incr VTE risk) https://t.co/JfaBtfvujU
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Carpal Tunnel Syndrome as a Harbinger of Rheumatoid Arthritis Rates of carpal tunnel syndrome (CTS) were significantly greater in patients later diagnosed with rheumatoid arthritis (RA), according to a large, long-running observational study. https://t.co/JiYvjhsKEp https://t.co/szmG5vrvcd

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Dr. John Cush @RheumNow( View Tweet )
Study of 42 pts w/ long standing RA-LD undergoing Lung Transplant (LTx) betw 2004 -2020. Median survival was 5.3 yrs (1-yr survival 88%) - same survival as LTx in other CTD & non-CTD ILD LTx. Mortality was 43%, higher w/ UIP. RA/CTD is not a contraindication to LTx. https://t.co/JcTug1wsTZ
Dr. John Cush @RheumNow( View Tweet )
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Emulation trials in SLE: Real or Fake?

Janet Pope, MD, MPH, FRCPC

Recently a landmark paper was published in A&R studying the results of an emulation trial on SGLT2i (sodium-glucose co-transporter 2 inhibitors) showing benefit in SLE patients with diabetes mellitus (DM), for both renal protection and reducing cardiovascular events, using data from an

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RA nodules respond to JAKi. Small case series of 7 established/refractory moderate-to-severe#RA pts w/ rheumatoid nodules who were treated w/ JAKi (tofacitinib, upadacitinib)-- 5/7 had complete resolution & 1 reduced nodules size (w/in 3-12 mos) on JAKi therapy. https://t.co/YGK1EGiJiJ
Dr. John Cush @RheumNow( View Tweet )
single-centre study of 469 consecutive RA pts - 15 had VTE (3%). Strongest risk factor of VTE was the history of previous VTE (OR 44.7), recent hospitalisation (OR 6.82), diabetes (OR 11.23), and JAKi (OR 5.54) (Other studies show inflammation incr VTE risk) https://t.co/pBJDhXOgut
Dr. John Cush @RheumNow( View Tweet )
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Carpal Tunnel Syndrome as a Harbinger of Rheumatoid Arthritis

MedPage Today

Rates of carpal tunnel syndrome were significantly greater in patients later diagnosed with rheumatoid arthritis, according to a large, long-running observational study.

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Retrospective Medicare Claims data study of RA pts w/ metastatic non-small cell lung cancer who recv Rx w/ immune checkpoint inhibitor; found that ICI- Rx RA had the same survival as non-RA pts, and sterid use was not associated with worse survival https://t.co/JLlCfrRwvN https://t.co/DNEM32yocL

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Dr. John Cush @RheumNow( View Tweet )
Triple positivity (anti-CarP Abs, RF, ACPA) assoc w/ increased Dz activity in RA. Single center, 138 RA pts. Triple pos. pts had signif more TJC (10 v 7.7), Pain (6.3 v 5.1), DAS28-CRP (4.7 vs. 4.0), ESR (33 v 23), ACPA (395 v 369), but lower RF (164 v 453). NO diff in Bone https://t.co/DexENW4W2T
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DANBIO registry study of 720 RA pts w/ a prior solid cancer (breast, colon. lung, endometrial, melanoma, bladder) in remission who received any biologic DMARD, TNFi or RTX found no incr risk of CA recurrence w/ any bDMARD, TNFi, RTX. Specifically, no incr in breast CA recurrence https://t.co/YJw8qXz1yM
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Complex Evolution of RA Management and Outcomes FIRST is a Japanese longitudinal, real-world registry of rheumatoid arthritis (RA) management, and over the last 20 years has shown significantly improved outcomes, yet significant challenges and unmet needs remain. https://t.co/Vqe70WAijN
Dr. John Cush @RheumNow( View Tweet )
Japan IORRA RA registry shows from 2011 to 2023, despite better Rx & control & less pred, Fractures went up in RA. From 2011 to 2023- DAS resmission 38 to 65%, bDMARD use 14 to 42%, GC use 38 to 22%, OP Rx 32 to 38%; But all FX incr 47 to 53/1000 Pys. https://t.co/cgz0Gkasai https://t.co/D2Uro7mEAT

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US guided lymph node Bx compared 25 controls, 14 ACPA (+) & 45 ACPA (-) RA pts. ACPA+ LN Bx showed upregulated adaptive imm. genes, but ACPA neg LN Bx showed higher innate imm genes - especially w/ higher neutrophil presence & incr CD15 + PMNs irrespective of ACPA status https://t.co/C42QMd2zap
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No Extra Cancer Recurrence Risk with Biologics in RA Rheumatoid arthritis (RA) patients in Denmark with a history of solid tumor cancers, now in remission, faced no greater likelihood of cancer relapse when they were treated with biologic agents, compared with conventional https://t.co/dCspjN2oys
Dr. John Cush @RheumNow( View Tweet )
Retrospective Medicare Claims data study of RA pts w/ metastatic non-small cell lung cancer who recv Rx w/ immune checkpoint inhibitor; found that ICI- Rx RA had the same survival as non-RA pts, and sterid use was not associated with worse survival https://t.co/JLlCfrRwvN https://t.co/zeqeYt5ZHq

Links:

Dr. John Cush @RheumNow( View Tweet )
Complex Evolution of RA Management and Outcomes FIRST is a Japanese longitudinal, real-world registry of rheumatoid arthritis (RA) management, and over the last 20 years has shown significantly improved outcomes, yet significant challenges and unmet needs remain. https://t.co/TwDIf5MJqF
Dr. John Cush @RheumNow( View Tweet )
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Keys to Mastery (5.2.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, articles and drug approvals from the past week on RheumNow.com. This podcast marks the beginning of our Lupus Campaign called "Lupus Unlocked: Keys to Mastery". This month's campaign on Lupus is sponsored by Aurinia.

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Recent Blogs

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

Screening and Overdiagnosis of ILD in RA

Michael Putman, MD, MSCI
Putman RheumThoughts
Dr. Michael Putman (Milwaukee, WI) reviews his approach to screening for ILD and RA, the potential for overdiagnosis and how this impacts treatment choices. Does this differ from your approach? Read Post
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