Rheumatoid Arthritis

UK study of 1846 RA pts starting a b/tsDMARDs, ~30% on steroids & majority (2/3) continued use over the first year of new novel treatment. This suggests these aer either severe RA pts or that we are not vigilant in limiting/weaning/stopping steroids in RA patients - which is it? https://t.co/TrAktincKT
Dr. John Cush @RheumNow( View Tweet )
Japan retrospective study of 38 RA pts who developed MTX assoc lymphoproliferative disorder (LPD) - 22 w/ spontaneous regression (SR) vs 16 non-SR (w/ 5 deaths). non-SR Pt had higher LDH levels at Dx & lower lymphocyte recovery 1 mo. post MTX withdrawal & higher mortality risk https://t.co/TRizVwP2BQ
Dr. John Cush @RheumNow( View Tweet )
Plenty of evidence that toxic environmental exposures increase #RA risk. Full read, intelligent report from Stanhope et al showing how (healthy environmental) green space exposures are protective & capable of preventing RA!! Lifestyle is gigantically important in your https://t.co/LUWmHhUT7F
Dr. John Cush @RheumNow( View Tweet )
VA registry study; among 2771 RA pts (~65y), 64 (2.3%) had CPPD by ICD9/10 codes. RA+CPPD pts signif older [68 v. 64y], w/ more comorbidity/OA (94 v 80%), spine Dz, DM, but less ACPA (63 v 78%). SNRA+CPPD achieved less LDA, more use of pred & b/tsDMARDs (OR >2), death, TJR. Is https://t.co/hUPJzDseVc
Dr. John Cush @RheumNow( View Tweet )
Systematic review of Difficult-to-treat RA (D2T-RA): 23 articles, 27,987 RA pts from 13 countries - pooled prevalence of D2T-RA was 11.7% (10.9% overall; 13.2% in b/tsDMARDs-treated RA). 47% D2T-RA had persistent inflammatory refractory RA (PIRRA). Prevalence decreased w/ https://t.co/0Gatzbfxid
Dr. John Cush @RheumNow( View Tweet )
UK study of 1846 RA pts starting a b/tsDMARDs, ~30% on steroids & majority (2/3) continued use over the first year of new novel treatment. This suggests these aer either severe RA pts or that we are not vigilant in limiting/weaning/stopping steroids in RA patients - which is it? https://t.co/7NWeAWTjSy
Dr. John Cush @RheumNow( View Tweet )
Japan retrospective study of 38 RA pts who developed MTX assoc lymphoproliferative disorder (LPD) - 22 w/ spontaneous regression (SR) vs 16 non-SR (w/ 5 deaths). non-SR Pt had higher LDH levels at Dx & lower lymphocyte recovery 1 mo. post MTX withdrawal & higher mortality risk https://t.co/SsBQRxFvD1
Dr. John Cush @RheumNow( View Tweet )
JAMA teaching case: 57 yoF w/ RA Rx w/ HCQ, NSAID, TNFi (ETN -->ADA) develops a new rash - pruritic vesicles/papular on neck, mouth, ears, chest, hands w/ some becoming ulcerated plaques, ESR >100. WHAT TO DO? A) steroids; B) stop ADA; C) Benadryl or D) Read more? Pt had https://t.co/DQpeUOC5I3
Dr. John Cush @RheumNow( View Tweet )
Best of 2025: Variability of Guidelines on the Perioperative Use of DMARDs in Rheumatic Diseases Patients Despite advances in treatments reducing the need for major surgery, many rheumatic disease patients still require surgery while on DMARDs. A review of perioperative https://t.co/LHClCUvHrb
Dr. John Cush @RheumNow( View Tweet )
SMART study - Single vs. Split Dose Methotrexate in RA Split dose weekly, oral methotrexate (MTX) was shown to be superior to single dose MTX in treating active rheumatoid arthritis (RA) patients. https://t.co/JN5wPGNjao https://t.co/hI8dxWmZe8

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Dr. John Cush @RheumNow( View Tweet )
hospital,surgery

Best of 2025: Variability of Guidelines on the Perioperative Use of DMARDs in Rheumatic Diseases Patients

Jack Cush, MD

More effective treatments in patients with rheumatic diseases have resulted in less need for major surgery, yet a substantial number of RMD patients will undergo surgery often in the setting of DMARDs use. A scoping review looked at numerous clinical practice guidelines/recommendations for the

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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/rlnogTqk49
Dr. John Cush @RheumNow( View Tweet )
ra.hands2_.JPG

Best of 2025: 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

Read Article
Best of 2025: Methotrexate intolerance in rheumatoid arthritis 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. https://t.co/hzfF7UVKVI
Dr. John Cush @RheumNow( View Tweet )
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.

Read Article
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 )

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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