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Simon Says “Don’t Do This” (1.27.2022)

Jan 27, 2023

Dr. Jack Cush reviews this week’s journal articles, focuses on studies that should not have been done and responds to viewer questions in Ask Cush Anything.

  1. "Dry Synovitis" exist in juvenile arthritis pts? Study of 12 DS pts, says its different from Poly #JIA; onset 6.1 yrs

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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.
Korean study of 439 RA pts starting JAKi, TNFi or non-TNFi. Physician choice of JAKi was more likely with age (OR 1.03), no pulmonary Dz (OR 0.07), Higher Dz activity (OR 1.80) & prior tacrolimus (OR 2.05)
JAK Janus

JAK-pot Study: To Cycle or Switch after JAK inhibitor Failure?

Jan 23, 2023

Data from 17 international registries (JAK-pot collaboration) suggest that for Rheumatoid arthritis (RA) patients failing their first janus kinase inhibitor (JAKi), it did not matter if they were cycled to another JAKi or switched to a biologic disease-modifying antirheumatic drug (bDMARD).

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2022 Memorium Sadly, too many of our rheumatology colleagues passed on in 2022. Here is an (incomplete) list of notable brethren, mentors, do-gooders and great rheumatologists.
PsABiostudy followed PsA pts starting TNFi vs ustekinumab x12 mos showing equivalent durability at 1 yr (72% vs 71%). cDAPSA LDA was seen in 56% UST vs 67% TNFi (similar for MDA (34% vs 43%)
For 2023 - what you going to focus on with your patients? Same ole, same ole means youre not getting better. How about focusing on 2 main messages, mine would be patient "STRENGTH" and "COMPLIANCE" (meaning more Rx education)
Join us for RheumNow Live this March 18-19 in Dallas, TX! We're not like other meetings--we're answering the questions you want answered. RNL is a meeting to engage your mind and change your practice. Join us in-person or virtually!
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2022 Rheumatology Year in Review (1-6-2023)

Jan 06, 2023

Dr. Jack Cush reviews the best of 2022 in Rheumatology - highlights on new drug indications, breakthrough lupus therapies, new biosimilars and the multivitamin letdown.

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TNF inhibitors Dont Increase Cancer Risk! 4592 RA pts:TNFi Rx (2296) vs matched DMARD Rx (2296) pts. TNFi had a lower cancer risk than DMARD Rx (IR 6.5 vs. 15.6 /1000PYs]). TNFi had Lower HR GI CA (0.432), breast CA (0.146), GU CA (0.220)
MTX side effects more prominent in PsA than RA pts. Study of 240 PsA & 86108 RA pts starting either MTX or TNFi. TNFi AE same betw PsA & RA, but MTX adverse greater in PsA (44.8% vs. 29.4%), especially N/V, abdominal pain, depression, tinnitus

Inflammatory Arthritis and Hidradenitis Suppurativa

Dec 09, 2022

Hidradenitis suppurativa (HS) (also called acne inversa), is a chronic inflammatory skin disorder affecting apocrine gland-bearing skin in the axillae, groin, and under the breasts and is characterised by persistent or 

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Lifestyle Modifications may enhance TNF Inhibitors in axSpA

Bimekizumab Efficacy in TNF-Refractory Psoriatic Arthritis

Dec 07, 2022

Bimekizumab, a selective inhibitor of interleukin (IL)-17F and IL-17, has shown superior efficacy and safety in a 16 week trial in patients with active psoriatic arthritis who previously failed therapy with tumour necrosis factor-α (TNFi) inhibitors.

The BE COMPLETE study was a phase

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TARGET Trial - Cardiovascular Risk Reduction in Rheumatoid Arthritis

Dec 05, 2022

A recent randomised clinical trial suggests immunomodulators reduce arterial inflammation, and thereby cardiovascular (CV) risk, but shows no significant benefit to TNF inhibitors over triple therapy in patients with rheumatoid arthritis (RA).

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Comparing Biosimilar Growth in the US, Germany, and Switzerland

Dec 05, 2022

The biosimilar landscape will change dramatically in 2023, following the successful rollouts in other countries in Europe. This analysis of the uptake and price of biologic therapy in Germany, Switzerland and the United States suggest that anticompetitive practices in the US could allow

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MTX side effects more prominent in PsA than RA pts. Study of 240 PsA & 86108 RA pts starting either MTX or TNFi. TNFi AE same betw PsA & RA, but MTX adverse greater in PsA (44.8% vs. 29.4%), especially N/V, abdominal pain, depression, tinnitus
ACR meeting education

ACR22 Takeaways: Pre-RA, Lupus, PsA and AS

Nov 29, 2022

ACR22 Convergence left us bountiful with information from all over the world. Here are a few of my personal highlights and key takeaways. 

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TNFi cycling in axSpA: Results from CorEVITAS Registy study Dr. Rachel Tate ( @uptotate) reviews abstract #1499 presented at #ACR22.
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A Multidimensional Approach in the Management of Axial Spondylarthritis

Nov 21, 2022

There has been much focus on the pharmacologic management of axSpA. Despite optimal control of inflammation, symptoms of fatigue and pain can persist. Long term use of analgesics including opioids carries significant risks. Strategies to improve response to treatment in this population is

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ACR 2022 Appraisal, Praise & Critique (11.18.2022)

Nov 18, 2022

It was great to be back at an ACR annual meeting, this one in Philadelphia - Philly was great. A walking town, rich in culture, history and good places to meet and mingle. 

I loved the city, but not the convention center (not easy to navigate). 

The meeting itself was very

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Gender Differences in Axial Spondyloarthritis

Nov 17, 2022

Rheumatic conditions such as SLE and RA exhibit female predominance. In contrast, increasing evidence suggests that gender differences occur in axial spondyloarthritis in terms of time to diagnosis, clinical manifestations, treatment outcomes and quality of life. The exact mechanisms are

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Abstr #2192 risk of serious infxn in newborns of mothers on TNFi by placental transfer - % serious infection in TNFi in high vs low placental transfer (2.1% vs 1.6%) - HR (high vs low) 0.98 (95% CI 0.36-2.61) - No significant difference in risk of serious infxn @RheumNow #ACR22
Which is better for CV risk in RA: triple therapy DMARDs or TNFi? TARGET study n=159 using PET/CT surrogate (endpoint responsiveness👀) - either led to benefit - both equally good - benefit *not* linked to change in DAS28 A direct CV effect of RA Rx? ABST2215 #ACR22 @RheumNow