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pregnancy,doctor,consult

Are We Overcautious With TNF Inhibitors in Pregnancy?

MedPage Today
Sep 27, 2022

What may seem like a prudent approach to treatment of inflammatory bowel disease (IBD) in pregnant women actually represents an overabundance of caution, suggested researchers who found no increased risk from tumor necrosis factor (TNF) inhibitors.

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VTE Risk from Swedish Rheumatology Quality Register - VTE Prevalnce/1000PY TNFi 5.15; JAKi 11.33; Gen Pop 3.3. VTE adj HR JAKi vs TNFi =1.73 (1.24, 2.42); PE HR 3.21 (2.11, 4.88) and DVT HR 0.83 (0.47,1.45) https://t.co/WclcFpX3aI https://t.co/r1FXSZNcYJ
IL-6i in Behcets? Lit Review finds 25 articles papers, 74 pts (31 TNFi naive, 45 TNFi prior Rx). Pts Rx w/ tocilizumab IV. TCZ given for vascular, CNS , ocular & mucocutaneous. TCZ was effective in 87% TNF naive & 80% in TNFi Experienced pts. https://t.co/jdJ9H04lnE https://t.co/yoxrKiIVW2
Open label, noninferiority study TNFi withdrawal in 64 PsA & 58 axSpA pts. 2/3 tapered by dz activity T2T strategy (N=81) & 1/3 continued TNFi. At 12 mos. LDA seen in 69% w/ Tapering (~avg 53% dose) vs 73% no-tapering group (91% dose) https://t.co/K6WFaesyRt https://t.co/zqo6nVGtqW
The 2022 ACR abstracts are published and posted for you. Let the Learning begin! https://t.co/ZqMAc8jV3U https://t.co/3iCGnzsPI5
Rheums! Have a Rheumatology question or case for Jack 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/1aSrRsLkel https://t.co/gmh155ty6w
Risk of TNFi-related psoriasis in 5088 TNFi Rx children w/ IBD, JIA, or CNO. Compared to non-TNFi exposed, kids on TNFi had an increased PSO risk w/ ADA (IRR 2.70; 1.53-4.75), infliximab (2.34) or etanercept (2.21) & not incr w/ DMARD use https://t.co/Y1Vn9kjk5N https://t.co/5CCxa5kMcU
JAK-pot study of 19 registries, 31,846 RA pts Rx w/ new drugs shows equal CDAI efficacy for TNFi (54%), ABA (50%), IL-6i (55%), & JAKi (56%). Most D/C for LOE. Compared to TNFi, JAKi and IL-6i were d/c more for adverse events, less for ineffectiveness https://t.co/FlqPUVdWaC https://t.co/BZnpwtB8SY
Rheums! Do you have a rheumatology question or case for Jack 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/cvmbzknQqA https://t.co/6mX5eRUNuU
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Hit Parade Review (8.12.2022)

Aug 12, 2022

We've got a lot to discuss this week: psoriasis; fatigue; sleep; sural nerve biopsies; uveitis and SpA; diet and RA; tofacitinib and the ORAL surveillance study; what not to take with mycophenolate - and more. In what order should these items be discussed? This week the run down is based on

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Fatigue is Under-Appreciated in Psoriatic Arthritis

Aug 09, 2022

Patient-reported fatigue is high in patients with psoriatic arthritis (PsA) and often goes under-recognized by physicians. Fatigue importantly impacts physical functioning, work productivity, and health related quality of life (HRQoL).

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More Bad Safety News for Xeljanz

MedPage Today
Aug 08, 2022

Another analysis of the mandatory postmarketing safety study for tofacitinib (Xeljanz) has confirmed what most observers expected: that rates of infection with the drug in rheumatoid arthritis are higher than with tumor necrosis factor (TNF) inhibitors.

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The Great Unknowns (8.5.2022)

Aug 05, 2022

Dr. Jack Cush reviews the news, FDA approvals, journal articles from the past week on RheumNow; plus viewer questions. This week great hopes for vitamin D, the great unknows of CSA and the great big mess that is the gout.




  1. 521 clinically suspect arthralgia (CSA) pts were

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Oral surveillance - tofacitinib vs TNFi in high risk pts: more infections, serious infection (SIEs) & non-serious infx with Tofa vs TNFi. SIE risk 17%-48% higher; SIE higher w/ high dose Tofa, esp in pts aged≥65. Usual risk factors - age, pred, comorbid. https://t.co/gjD8xqtfgp https://t.co/doMd4E9ClL
ACR guidance

ACR Updated Guideline on Vaccinations for Rheumatic Patients

Aug 04, 2022

The ACR has posted a new ACR Clinical Practice Guideline Summary providing recommendations on the use of vaccinations for children and adults with rheumatic and musculoskeletal diseases (RMDs).



This guideline builds on past

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blood, level, numbers, data, calculation

Best Labs for Still’s Disease

Jul 27, 2022

There is no “test” (blood or other) that is solely diagnostic of Still’s disease, but labs can help make a diagnosis or manage disease, and affirm the safety of drugs in use. ​​​​​​​ 

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11.5% of Crohns pts have TNFi use contraindications (either MS, CHF, neoplasia, infx risk, TNFi AE, comorbidities, SLE. Alternatively GI survey respondents use ustekinumab (76%), vedolizumab (249%), or tofacitinib (0.5%) https://t.co/6ApUz93iS0 https://t.co/PTmnsTd2Wh
Rheums: Got a Rheumatology question or case for Jack Cush? Record it here and we'll feature it on an upcoming podcast. Tell us your name and where you practice rheumatology.https://t.co/QUTIbK3r89 https://t.co/FZcTLREida
Rheumatologist Survey: What do you rely on MOST in diagnosing Still’s disease? Sxs? Labs? Both? Criteria? Fever? Vote here:https://t.co/oANKpKqJA5 https://t.co/LIjRSBHNBi
2021,year

ICYMI: 2021 Rheumatology Year in Review

Jul 08, 2022

For 2022, let's look our top 10 list of advances, game-changers, worries and those better medical practices that evolved during 2021.

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ICYMI: Adalimumab Addition vs. Methotrexate Escalation in Psoriatic Arthritis

Jul 08, 2022

An interesting study in Lancet Rheumatology shows that psoriatic arthritis patients not responding to methotrexate alone can respond after adding or escalating adalimumab on top of methotrexate to reach minimal disease activity (MDA) response. 

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Axial Spondyloarthritis

ICYMI: Update on Axial SpA at EULAR 2022

Jul 05, 2022

This year at EULAR 2022, there were important and interesting topics in Axial Spondyloarthritis (AxSpA). These are my picks of abstracts from the conference.

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Novel Anti-TNF Shines in Rheumatoid Arthritis Trial A new way of inhibiting tumor necrosis factor (TNF) for treating rheumatoid arthritis showed strong results in a phase II/III clinical trial, researchers said.https://t.co/fTmWeIrVD5 https://t.co/LPk2Ok2gac
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What Worries You, Masters You (7.1.2022)

Jul 01, 2022

Dr. Jack Cush reviews recent news, regulatory and guideline updates from the past week on RheumNow.com.  Studies on methotrexate use, COVID vaccination, Supplements and vitamins, and arthrocentesis despite anticoagulation are discussed.




  1. FDA approved Abbvies risakizumab-rzaa

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