A New RA Approval (8.1.2025)
Dr. Jack Cush reviews the news, journal reports and a new treatment for RA from the FDA.
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Rituximab is not Superior in EGPA
A cohort study of Eosinophilic Granulomatosis With Polyangiitis (EGPA) patients from the French Vasculitis Study Group failed to show superiority of rituximab compared to conventional strategy with glucocorticoids (GS) alone or in combination with cyclophosphamide.
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MTX or TNFi use in elderly #RA pts w/in a year of Dx of melanoma was not associated with increased mortality. This included melanoma in situ (48%), localized (47%) and regional (5%) melanoma. Steroid use however was assoc w/ reduced survival. https://t.co/QOXfEf51S1 https://t.co/6BPtEV6sOU
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Dr. John Cush @RheumNow( View Tweet )
CKD & Osteoporosis Rx Revisited (7.25.2025)
Dr. Jack Cush reviews the news, journal and FDA updates from this past week on RheumNow.com.
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Practical management of rheumatic immune-related adverse events with immune checkpoint inhibitors
Joint Bone Spine has published a full read review of the management of immune-related adverse events (irAEs) in patients receiving Immune checkpoint inhibitors (ICIs) for cancer.
Emapalumab Approved for MAS in Still’s
On June 27th, 2025, the FDA approved emapalumab for macrophage activation syndrome (MAS) in known or suspected Still’s disease (including both adult-onset Still’s disease (AOSD) and systemic juvenile idiopathic arthritis (sJIA)) with inadequate response or intolerance to glucocorticoids.
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Short full read review of the history, safety and use of Corticosteroids in Respiratory Medicine (including use in community-acquired pneumonia (CAP), ARDS, septic shock, ILD, COPD/asthma, COVID-19, Cancer, Sarcoid & IPF. https://t.co/aKMAT8IhLm https://t.co/RopoNnYJ6Z
Dr. John Cush @RheumNow( View Tweet )
Manifestations and Treatment in Relapsing Polychondritis
A large multicenter cohort study of Relapsing Polychondritis (RP) describes the clinical manifestations and treatment approaches to this rare, heterogeneous, multisystem disease
Variability of Guidelines on the Perioperative Use of DMARDs in Rheumatic Diseases Patients
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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ICYMI: Should Lupus Nephritis Receive PJP Prophylaxis?
A current review article suggests that the need for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in patients with systemic lupus erythematosus (SLE) and lupus nephritis will need to be individualized based on therapies and risk factors.
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ICYMI: AGA Guideline: Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals
The American Gastroenterology Association has published its revised clinical practice guidelines for the prevention and treatment of hepatitis B virus (HBV) reactivation in at-risk patients, particularly those with immune-mediated disease, receiving immunomodulatory therapy and steroids.
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Glucocorticoid Tapering in SLE
Dr. Yuz Yusof discusses abstract POS1224 presented at the 2025 EULAR meeting in Barcelona, Spain.
https://t.co/oI992YLvnB https://t.co/mPmMxcpMey
Dr. John Cush @RheumNow( View Tweet )
JAMA Clinical Challenge - 34-yoF with Forearm Pain and Stiffness. 1 yr of progressive skin tightening over forearms, tibia, LOM of fingers & elbows. Denied DM, Raynauds. Worse after tennis, better w/ steroids. Increased ANA, eosinophils, CRP, aldolase - your Dx? https://t.co/5VrE4OpZ4N
Dr. John Cush @RheumNow( View Tweet )
JAMA Clinical Challenge - 34-yoF with Forearm Pain and Stiffness. 1 yr of progressive skin tightening over forearms, tibia, LOM of fingers & elbows. Denied DM, Raynauds. Worse after tennis, better w/ steroids. Increased ANA, eosinophils, CRP, aldolase - your Dx? https://t.co/ppuzIB4iRf
Dr. John Cush @RheumNow( View Tweet )
A Review of Intracranial GCA
A comprehensive review in Rheumatology on intracranial giant cell arteritis (icGCA) stresses that GCA is both an intracranial and extracranial large vessel vasculitis, with the former having unique presentations, and outcomes.
A systematic review included 102
UK study of 17472 newly Dx #RA pts (10997 MTX, 4,540 csDMARDs; 13680 steroids-CS) w/ 1307 Serious Infx (SI) (3/100PY) & 311 SI deaths. MTX signif decr. SI (adj HR 0.72) & CS no effect HR 0.99. SI assoc w/ age, smoker, comorbidity, seropositive, high DAS28. 1 DAS unit incr SI https://t.co/Zmsuaf7Rw3
Dr. John Cush @RheumNow( View Tweet )
How to properly use steroids in early RA
Guidelines differ on the early treatment of RA – ACR suggests not to use glucocorticoids (GC) and EULAR updated recommendations for RA treatment presented at #EULAR2025 continued to suggest early treatment with MTX and glucocorticoids. https://t.co/FakKxRot0p
Dr. John Cush @RheumNow( View Tweet )
Steroids, Not JAKi, Are the Real Infection Risk
Dr. David Liew reporting at EULAR 2025 in Barcelona, Spain.
https://t.co/rLpyo1UNjd https://t.co/bDfdLTEM1N
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Dr. John Cush @RheumNow( View Tweet )
How to properly use steroids in early RA
Guidelines differ on the early treatment of RA – ACR suggests not to use glucocorticoids (GC) and EULAR updated recommendations for RA treatment presented at #EULAR2025 continued to suggest early treatment with MTX and glucocorticoids. We do know that it is not easy to get a significant minority
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2025 update of EULAR recommendations on lupus nephritis
At the 2025 EULAR congress in Barcelona, Prof Dimitrios Boumpas presented a summary of the updated EULAR recommendations on the management of lupus nephritis (LN). The most significant change in the treatment paradigm of LN is that the historic standard of care (SOC) (i.e.
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Sometimes you hear:
“PMR dose steroids don’t really matter”
Errrrr…
(You wouldn’t accept this steroid exposure in any other disease. Never)
#EULAR2025 POS0139 @RheumNow https://t.co/o6w2RpaGBj
David Liew @drdavidliew( View Tweet )
#EULAR vs #ACR #RA #recommendations
Do you agree that #ERA pts should receive #glucocorticoids
@RheumNow #EULAR2025
@eular_org
Janet Pope @Janetbirdope( View Tweet )
Management of AAV:
1.High dose GC f/b reduced dose taper ‼️caution in pts w/severe renal dz and RTX induction.
2. RTX effective for induction and maintenance, best for relapses.
3.PLEX: in RPGN pts if accesible ⚠️ risk for infection.
4.Avacopan: for faster GC weaning. No https://t.co/kfZ4gM38KG
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Adela Castro @AdelaCastro222( View Tweet )
Pearls on EGPA:
1. GC are mainstay for mild
dz
2. Organ threatening/relapsing➡️CYP (RTX alternative)
3. W/o organ threatening➡️ anti-IL-5/IL-5R.
4. IL5i are less effective for ENT
5. Consider sx for nasal polyps.
#EULAR2025 @RheumNow https://t.co/zoJEWxafsN
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Adela Castro @AdelaCastro222( View Tweet )
“That is why this task force continues to say: nothing is better than methotrexate and glucocorticoids to start”
- Josef Smolen, on RA treatment
#EULAR2025 @RheumNow https://t.co/AbkgWS8tvH
Links:
David Liew @drdavidliew( View Tweet )
