Steroids

Effectiveness of IL-6 Receptor Inhibitors versus Methotrexate or any Conventional Immunomodulators in Patients with Steroid Refractory Polymyalgia Rheumatica Sponsored by Sanofi https://t.co/TR4E0JvcTn https://t.co/t48JlXeUjA

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Dr. John Cush @RheumNow( View Tweet )
Vamorolone: a New Steroid on the Horizon? Vamorolone is a potentially new alternative to traditional glucocorticoids for use in inflammatory diseases. It is a dissociated steroidal compound with reduced side effects, and in an animal model of inflammation has shown effective https://t.co/38WTOAuuJy
Dr. John Cush @RheumNow( View Tweet )
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Should Lupus Nephritis Receive PJP Prophylaxis?

Jack Cush, MD

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. 

There are no clear guidelines

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Matched cohort study of 83,811 #RA pts showed RA had a 12% increased risk of avoidable hospitalizations (CHF, pulmonary edema; (IRR 1.12). Predictors of ACSC hosp. were age, Steroids, ambulatory comorbid Dxs. ambulatory care access & ^ primary care may reduce this risk. https://t.co/Tx7LO59RbP
Dr. John Cush @RheumNow( View Tweet )
Vamorolone: a New Steroid on the Horizon? Vamorolone is a potentially new alternative to traditional glucocorticoids for use in inflammatory diseases. It is a dissociated steroidal compound with reduced side effects, and in an animal model of inflammation has shown effective https://t.co/zHDyJbU23q
Dr. John Cush @RheumNow( View Tweet )
Steroids, Prophylaxis and Pneumocystis Pneumonia A case-control study has shown that glucocorticoids and tapering glucocorticoids are risk factors for the development of Pneumocystis jirovecii pneumonia (PJP). The authors provide guidance on the optimal timing for prophylaxis https://t.co/0nKVEKOEex
Dr. John Cush @RheumNow( View Tweet )
Matched cohort study of 83,811 #RA pts showed RA had a 12% increased risk of avoidable hospitalizations (CHF, pulmonary edema; (IRR 1.12). Predictors of ACSC hosp. were age, Steroids, ambulatory comorbid Dxs. ambulatory care access & ^ primary care may reduce this risk. https://t.co/AxQVoXoxxx
Dr. John Cush @RheumNow( View Tweet )
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An Epidural Letdown (4.4.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.

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Vamorolone: a New Steroid on the Horizon?

Jack Cush, MD

Vamorolone is a potentially new alternative to traditional glucocorticoids for use in inflammatory diseases. It is a dissociated steroidal compound with reduced side effects, and in an animal model of inflammation has shown effective antiinflammatory properties and reduced systemic

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Steroids, Prophylaxis and Pneumocystis Pneumonia

Jack Cush, MD

A case-control study has shown that glucocorticoids and tapering glucocorticoids are risk factors for the development of Pneumocystis jirovecii pneumonia (PJP). The authors provide guidance on the optimal timing for prophylaxis use and withdrawal.

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An estimated 118,000 people throughout the world have EGPA. Steroids & immunosuppressants have been the mainstay; but for managing EGPA. Mepolizumab (2015) & Benralizumab (2024) are FDA approved for EGPA. The latter (Fasenra) approval based on the MANDARA trial https://t.co/84W4sOig9d
Dr. John Cush @RheumNow( View Tweet )
GCA,woman

Upadacitinib for Giant-Cell Arteritis - A Phase 3 Trial

Jack Cush, MD

The NEJM has published a randomized controlled trial in giant-cell arteritis (GCA) patients, demonstrating significant efficacy and safety of upadacitinib (UPA), given as 15 mg daily, as compared to placebo. 
 
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Vamorolone, a promising alternative to traditional glucocorticoids for inflammatory diseases. ◦ #Vamorolone is a dissociated steroid compound with reduced side effects. ◦ Unlike conventional #glucocorticoids, vamorolone lacks the hydroxyl or ketone groups and is resistant to https://t.co/yvDWqcbXbn

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Alberto Giraldo @alb_giraldo( View Tweet )
Stillsnow, Stills, podcast

1st Line Biologics vs csDMARDs in Adult Still's Disease

Jack Cush, MD

A German multicentre, retrospective study assessed the first-line efficacy of biologics and conventional synthetic DMARD therapy in patients with adult-onset Still's disease and found biologic agents were significantly better with sustained, event-free remissions and fewer complications.

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Diagnosing PMR is easy before Pred initiation; but after steroids NO SO. Before Pred, PMR Dx from non-PMR (median probabilities 7.8 vs 2.8) w/ 86% sensitivity/83% specificity. After Pred Dx probability of PMR dropped to 1.0 w/ sensitivity 3.5%; not much better w/ Pred D/C https://t.co/q4TceeFByc
Dr. John Cush @RheumNow( View Tweet )
Diagnosing PMR is easy before Pred initiation; but after steroids NO SO. Before Pred, PMR Dx from non-PMR (median probabilities 7.8 vs 2.8) w/ 86% sensitivity/83% specificity. After Pred Dx probability of PMR dropped to 1.0 w/ sensitivity 3.5%; not much better w/ Pred D/C https://t.co/RRIYY6xleN
Dr. John Cush @RheumNow( View Tweet )
Adrenal Dysfunction after Steroids in PMR and GCA Patients JAMA has published a study of PMR and GCA patients who stopped glucocorticoid (GC) therapy and noted a low (1.2%) risk of GC-induced adrenal insufficiency after planned cessation. https://t.co/zQSa8ex9na https://t.co/gkKxHFPuNe

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Dr. John Cush @RheumNow( View Tweet )
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Peripheral Nerve Blocks for Hip Fractures

Jack Cush, MD

JAMA reviews the use of peripheral nerve block with hip fractures as an effective pain management strategy that can be performed by credentialed clinicians outside of the operating room.

Hip fractures are common, especially in older adults (≥65 years), and may include a 1-year mortality

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Targeting Obesity in Rheumatic Disease Patients

Jack Cush, MD

Sattar et al. has published an informative overview of the effect of obesity on rheumatic and musculoskeletal diseases (RMDs). They estimate that nearly 70% of RMD patients are overweight or obese.

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Adrenal Dysfunction after Steroids in PMR and GCA Patients JAMA has published a study of PMR and GCA patients who stopped glucocorticoid (GC) therapy and noted a low (1.2%) risk of GC-induced adrenal insufficiency after planned cessation. https://t.co/ZTaIQxs0ex https://t.co/LA5qji8Zj5

Links:

Dr. John Cush @RheumNow( View Tweet )
Glucocorticoid Toxicity Index Dr. John Stone has led the effort to develop the GTI - glucocorticoid toxicity index. In this review article he acknowledges the need and benefit of steroids, but details a novel means to identify and limit the untoward effects of glucorticoids https://t.co/foTaoYrfDn
Dr. John Cush @RheumNow( View Tweet )
Prgnancy,outcome

Disease activity during Pregnancy in Rheumatoid arthritis and Spondyloarthritis

Jack Cush, MD

A prospective French study of rheumatoid arthritis (RA) or spondyloarthritis (SpA) patients showed that most maintained stable disease activity during pregnancy, but over one-third flared and required major changes in treatment.

The aim of this study was to analyze disease activity and

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Adrenal Dysfunction after Steroids in PMR and GCA Patients

Jack Cush, MD

JAMA has published a study of PMR and GCA patients who stopped glucocorticoid (GC) therapy and noted a low (1.2%) risk of GC-induced adrenal insufficiency after planned cessation.

GC are widespreadly and chronically used in rheumatology, often with the

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PAFLAR Guidelines for Polyarticular Juvenile Idiopathic Arthritis

Jack Cush, MD

The Pediatric African League against Rheumatism (PAFLAR) initiative has published its guidelines for the diagnosis and treatment of polyarticular juvenile idiopathic arthritis (pJIA

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Glucocorticoid Toxicity Index Dr. John Stone has led the effort to develop the GTI - glucocorticoid toxicity index. In this review article he acknowledges the need and benefit of steroids, but details a novel means to identify and limit the untoward effects of glucorticoids… https://t.co/xR8D4Jpjfv https://t.co/LyfHrbneTO
Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

Overlap Syndrome with ILD

Jack Cush, MD
Cush RheumThought ILD

How would you manage a patient with Overlap (anti-synthetase) syndrome, ILD, polyarthritis and myositis?

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Best of 2023: PMR: glad or bad tidings?

Sarah Mackie, MRCP, PhD
Smile feedback opinion yes no good back opinion
Please don’t tell your patient that PMR “typically” lasts two years. According to real-world data from the UK, one in four patients with PMR is prescribed steroids by their primary care physician for over four years. But nobody tells them this at the start, and that causes big problems later on. Read Post
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