TNF inhibitor

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“ABCDE” Approach to Difficult-to-Treat Rheumatoid Arthritis

Jack Cush, MD

The proposed approach to difficult-to-treat rheumatoid arthritis is based on the EULAR definition (having failed 2 or more b/tsDMARDs). The authors provide guidance in the form of an easy acronym, A B C D E, which covers both diagnostic and therapeutic considerations.

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Rheums! Do you have a Rheumatology question or case for Dr. Cush? Record it here, and we may feature it on an upcoming podcast. Tell us your name and where you practice rheumatology. https://t.co/LZ59KW8HdA https://t.co/DwHdvpTYax

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Dr. John Cush @RheumNow( View Tweet )
SELECT-PsA 2 subanalysis of 195 active PsA not responding to TNFi shows switching to upadacitinib 15 (vs PB) was superior @wk 24 - ACR20 (58% vs 22%), ACR50 (38% vs 9.5%), ACR70 (22% vs 0%), MDA (24% vs 3%) & maintained thru wk 152. Switching MOAs makes sense! https://t.co/YEkZuQ95Mu
Dr. John Cush @RheumNow( View Tweet )
Resolved HBV infx (HBsAg-neg/anti-HBc+) retrospective study of HBc seroclearance in 230 pts Rx w/ anti-CD20 mAb. anti-HBc seroclearance seen in 16.5% (assoc w/ Younger age, less CD20 Rx, MMF Rx). HBV reactivation seen 5/230 (2.2%), including two w/ HBc seroclearance. HBc https://t.co/T0gfxftOgu
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True or False: A meta-analysis of 61 studies found that exercise showed anti-inflammatory trends, including reductions in CRP, IL-6, and TNF-α, in most chronic diseases. Test your knowledge in this week's RheumIQ at https://t.co/TBlB4pmnKa. https://t.co/7MxkveOuZE

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Dr. John Cush @RheumNow( View Tweet )
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NME: New Molecular Entities (8.28.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com. Take this week's RheumIQ and test your knowledge!

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Does exercise affect inflammatory biomarkers? Metanalysis of 61 studies shows mostly low certainty evidence of inflammation-modulating effects of exercise. In most chronic diseases, exercise showed anti-inflammatory trends w/ reductions in CRP, IL-6, TNF-α https://t.co/EP74b3mVAT https://t.co/WBTHjsCzKL

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Dr. John Cush @RheumNow( View Tweet )
VA study of 4108 RA-ILD (2006-21). PRED use was 65-77%, A& 1st line Rx (MMF, AZA, RTX, CTX) incr after ILD, use was low (1.2-12%). MTX decr (47 to 30%), but LEF, TNFi, ABA incr. Predictors of ILD Rx: FVC, CCP+, ILD Dx after 2012. https://t.co/GT3Vwo11w1 https://t.co/KFDKsjkN0k

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Prolonged exposure to targeted Rx in #SpA not assoc w/ increased cancer risk. French claims study 56,591 SpA pts- 1,224 CA (1,029 solid, 116 Heme). TNFi, IL17i, IL12/23i, IL23i, JAKi Exposure >6 vs ≤6 mos assoc w/ lower CA (HR 0.86; 0.75-0.99); signif for Heme (HR 0.65), not https://t.co/rHAa0CkAjT
Dr. John Cush @RheumNow( View Tweet )
French study of 90 RA F pts w/ 100 pregnancies (steroids 46% & biologics 39% were used). Vs 359 controls, RA had signif. more preterm birth (PTB;OR 2.08) & small for gestational age. SGA assoc w/ nulliparity (adj OR 4.38), PTB assoc w/ maternal age (aOR 1.14) & GC ≥10 mg/d (aOR https://t.co/StCJW2rsZI
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ZEUS Trial: IL-6 Inhibition Fails to Cut Cardiovascular Events The phase 3 ZEUS trial tested the IL-6 ligand inhibitor ZVK in over 6,000 patients with ASCVD, CKD, and elevated hsCRP. Although ZVK significantly lowered IL-6 and CRP levels, it did not improved outcomes (HR 0.99 https://t.co/jf2gAtvmpZ
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FDA & Fresenius Kabi Issues Nationwide Recall of Tyenne® (tocilizumab biosimilar) Injection 400 mg/20 mL Vials Due to Presence of Glass Particles. Applies to NDC Number 65219-594-20, Lot Number 16UI07 , Expiration date: 08/2028 . FDA warns possible ISR or VTE. https://t.co/YMRC9FO7Mu
Dr. John Cush @RheumNow( View Tweet )
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Mentshlichkeit* (8.7.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and recent journal reports on RheumNow.com.

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A Tribute to Daniel L. Kastner, MD, PhD (1951–2026)

Jack Cush, MD

The rheumatology, genetics and NIH communities mourn for Dr. Daniel L. Kastner, who died on July 28, 2026, in Bethesda, Maryland, at age 74. The following are declarations, tributes, and memories dedicated to this mensch of a man, titan of science, memorable mentor and humble physician.

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JAMA Case Quiz - A 57 yoF w/ #RA has a new vesicular rash. 9mos prior ETN change to ADA. Rash (painful, pruritic) started 2 wks ago. Exam: PIP swelling, & ulcerated plaques on neck, chest, & erythroderma on hands, CRP 15.0 mg/L , ESR 111 mm/h. What would you do? order?

Dr. John Cush @RheumNow( View Tweet )

3 Rx are FDA approved for hidradenitis supprativa (secukinumab, adalimumab, bimekizumab). New JAK1i Povorcitinib in STOP-HS1 and STOP-HS2 ph 3 PCTs (608/619 pts). Povo showed HiSCR50 ~42% vs PBO 29% @wk12. AE: acne, pharyngitis https://t.co/n3FJUOjNuo https://t.co/9YAmPqW44z

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Dr. John Cush @RheumNow( View Tweet )
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Chikungunya Club Meeting (7.24.2026)

Jack Cush, MD

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

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Seronegative RA Disease Activity (7.17.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal articles and Gout features from this past week on RheumNow.com.

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RHEUM SURVEY>> Which Gout drugs lower the risk of cardiovascular death? Answer here: https://t.co/1OY1B3ET7B https://t.co/MRJP5OOtXb

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Dr. John Cush @RheumNow( View Tweet )
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ICYMI: Updated CRA/SPARCC Recommendations for Axial Spondyloarthritis

Jack Cush, MD

In 2024, the Canadian Rheumatology Association (CMA) and the Spondyloarthritis Research Consortium of Canada (SPARCC) published a comprehensive set of 56 treatment recommendations for the management of axial spondyloarthritis. This first update is focused on the reassessment of IL-17i

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ICYMI: 2025 Update: EULAR Recommendations on Rheumatoid Arthritis Management

Jack Cush, MD

The European Alliance of Associations for Rheumatology (EULAR) has updated their rheumatoid arthritis (RA) management recommendations, notably with fewer recommendations (total of 9, down from 11 in 2022 version), by merging and removing previous recommendations.

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2026 Guidelines for the Treatment of Axial Spondyloarthritis

ACR

New and updated clinical guidelines released today provide comprehensive, evidence-based recommendations for the management of axial spondyloarthritis (axSpA) for both adults and children. The effort includes an update to the 2019 ACR/SAA/SPARTAN treatment guidelines focusing on adults,

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Do You Zoster Vaccinate? (6.19.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal reports and best ways to review EULAR 2026.

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A Disease Seeking Its Identity: Peripheral SpA, PsA, and the SPARTACUS Evidence

Nelly Ziade

For years, peripheral spondyloarthritis has been managed with a cautious, stepwise approach: start with NSAIDs, escalate to conventional synthetic DMARDs, and only reach for biologics when everything else fails. The SPARTACUS trial, presented at EULAR 2026 in London, challenges that paradigm

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20% sample of elder RA Medicare pts (2009-2022) on TNFi who either stopped or tapered TNFi found 38% sustained de-escalation, while 62% re-escalated within a medianof 164. Re-escalation was more likely in Blacks, Hispanic/other, with a lower comorbidity burden. https://t.co/rEB3VdOii2
Dr. John Cush @RheumNow( View Tweet )

Therapeutic Updates

A JAKi After TNFi Failure in RA: SELECT-SWITCH at Week 12

Sponsored by AbbVie Medical Affairs + Health Impact
AbbVie August RX Update
Dr. Christina Charles-Schoeman and Dr. Manish Jain are back to discuss treatment considerations after TNFi failure in RA. Join them as they review the latest data from SELECT-SWITCH, including post hoc results in primary and secondary nonresponders presented at EULAR 2026.
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Recent Blogs

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Safety of Biologics and Novel Agents

Jack Cush, MD
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Dr. Jack Cush reviews safety of biologics and novel agents.
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Systemic Lupus Erythematosus

Jack Cush, MD
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Dr. Cush reviews systemic lupus erythematosus.
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Difficult to Treat Rheumatoid Arthritis

Jack Cush, MD
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Dr. Cush addresses the management of difficult-to-treat rheumatoid arthritis (D2TRA).
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Podcasts

  • ACR 2025 SpA Topic Podcasts Compilation 1
  • ACR 2025 Daily Podcasts Day2d
  • EULAR 2021 - Day2a 00:38:00
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