DERM on RheumNow (July 2026) Save

Welcome to the Derm on RheumNow podcast for July 2026. I'm Jack Cush with RheumNow. This podcast is for dermatologists and those interested in the overlap between dermatology and rheumatology. As an FYI to my dermatology colleagues, RheumNow started about 12 years ago when I wanted to have a website and an email sort of news publication service for rheumatologists written by rheumatologists, and we publish about 25 pieces of news every week either as long form articles or as tweets, and then we have podcasts and videos and other things as well for our very large rheumatology audience. But in doing that we cover a lot of subjects that we co-manage — you know, lupus patients, dermatomyositis, scleroderma, vasculitis, hidradenitis, etc. And hence why I've been doing this podcast.

This podcast this month we've had a major educational campaign on gout, which I'll spare you reports about. And so we have a few things that are probably worth mentioning as a review.

One report looked at the 20-year trends on 6,500 patients with scleroderma, looking at the era from 2005 to 2025, and they showed that endothelin receptor antagonist use and the use of prostoids and prostacyclin therapies went from being scant in 2005 to being used in 28% of people in 2025. While calcium channel blocker use and phosphodiesterase 5 inhibitors has remained stable, our former reliance on cyclophosphamide has shifted to mycophenolate — a predominant use of mycophenolate — rituximab and nintedanib, the latter being for the lung disease associated with this, and thankfully steroids have dropped from, I think it's 50%, down to 18%. We shouldn't be using steroids in systemic sclerosis patients.

I have another systemic sclerosis report, a meta-analysis of 31 studies, 32,000 patients, that looks at the risk of malignancy. With our disorders in rheumatology we know that chronic inflammation imparts a malignancy risk, and in rheumatology it's almost — it's funny how uniform it is. It's a higher risk of lymphoma, maybe a higher risk of leukemia, a higher risk of skin cancer and lung cancer. And we have lower risks of some things, especially colon cancer and oral cancers. And that may be because of our use of non-steroids and COX-2 inhibitors that lower those risks.

Anyway, in this study of 32,000 patients, again a 66% higher risk of cancer in systemic sclerosis patients. The cancers that were most commonly seen were esophageal, liver, cervical, lung, and hematologic. The standardized incidence ratios — where you compare the risk of cancer in systemic sclerosis to the population risk — it's either a three-fold higher SIR, 3.3, to 14-fold higher SIR, 13.95. The time from the onset of systemic sclerosis to cancer, the mean was 7.4 years. So it doesn't take forever, but there was a fairly wide confidence interval there. So I think you should be looking for this, as we should be in rheumatology.

Can you vaccinate patients with autoimmune diseases against herpes zoster? As you know, the Zostavax live virus vaccine is gone — outlawed, no longer available in the United States — and has been replaced by the recombinant zoster vaccine called Shingrix. Here's a study in 76 systemic sclerosis patients who were immunosuppressed, taking a DMARD of some sort, compared to 304 controls, and they all received two doses of the recombinant vaccine. The point of the paper was to say that the scleroderma patients have a lower rate of seroconversion, but it ain't that much lower. I mean, it's 93% versus 99% in the controls. So there are high rates of seroconversion. It's a little bit lower, but it wouldn't stop me from doing it. I would be more certain to do it knowing that we have really high seroconversion rates, and there's no need for additional dosing, I think, to boost that up.

But again, those are looking at the humoral responses. If you look at cell-mediated responses, they were the same, and actually the patients with systemic sclerosis had actually fewer overall adverse events — and we're talking about the minor stuff, the constitutional achy arm, feeling nauseous, not doing well for a few days.

A large UK database from primary care looked at the frequency of Raynaud's over a 25-year period, 1998 to 2023. The prevalence was almost 900 cases per 100,000 — that's about one per thousand in the population overall in 2023 — and this is in the UK — they had 158,000 patients with Raynaud's. This was more frequent in the elderly, more frequent in females, less in African-Americans, and less in those who lived in London. Not sure why that was, because there's certainly a lot of young people and people of African descent living in London, per se. Anyway, the incidence rate was 46 per 100,000. And again, it's something we all take care of and need to have a plan for.

Two last reports were, I think, good guidelines kind of ideas. One is a report in Annals of Internal
medicine looked at an application for screening dermatomyositis patients for cancer. And there's this international myositis assessment and clinical studies group, IMACS, that developed guidelines that are based on likelihood and risk. So there are some people with dermatomyositis that are at low risk and some that are at higher risk based on manifestations — being older, for instance, or based on the autoantibody associated with that, such as NXP2 or MDA5 for instance — and they basically impart a screening procedure that not everybody needs to have PET scans, colonoscopies, mammographies, and whatnot. My advice always has been treat them as you would — they're going to be older — do age-appropriate health maintenance screening. But these guidelines in this paper say that in their 413 patients with a known diagnosis of dermatomyositis, the overall risk of a paraneoplastic malignancy was 6.5%. But when they used the guidelines in high-risk people, that went up to 8.8%. Now, that's a meaningful number if you can make an earlier diagnosis of malignancy. And so being familiar with these guidelines and screening people based on their a priori risk — when you followed the guidelines for high-risk people it was 8.8%, when you followed the guidelines for low-risk people it was only 2.5% — sort of justifying the use of these guidelines in screening patients with dermatomyositis.

As I mentioned last month, we were at the EULAR meeting in London looking at all the new research and we had a nice review article put up. It was called "Psoriatic Arthritis: EULAR 2025 Recap." You may want to click on the link in the show notes and read that. It's a pretty short read. We go over a synopsis where we kind of grouped up what we saw were trends at that meeting, including head-to-head trials. There were a number of head-to-head trials including BOLD and the TOGETHER PsA and TOGETHER PSO and the APEX study with guselkumab. There was a lot about obesity, GLP-1s, and diet in psoriatic arthritis that you may be interested in and that you probably are already aware of. In fact, that anti-inflammatory diet does work in psoriatic disease, and the MediCispa study for instance showed that it works in psoriatic arthritis. There were a number of reports reviewing the diagnosis of subclinical psoriatic arthritis, where you find imaging evidence of inflammation before they have much in the way of swollen joints or clinical manifestations. And then there were the same reports that you've seen in the past that we see occasionally, where if you take a psoriasis cohort and you treat them aggressively, can you prevent the onset of psoriatic arthritis? And that's been shown probably better with the IL-17 inhibitors than with the TNF inhibitors. I think that's very interesting data and speaks well for what you do in managing psoriasis aggressively, by yourself or sometimes even with a rheumatologist. And then there was a fair amount on pain management in PsA patients that you might find of some utility.

Anyway, check out this report. You can go to the website or the YouTube channel to click on these links and learn more about these particular citations. We'll talk next month. Take care.