On this week's podcast, Dr. Jack Cush reviews the news: Steroids are easy to start and hard to stop; hold the MTX but not the biologic or JAK; weighing in on avacopan; and age-old messages for older patients.

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Don't Hold the Biologic or JAK with COVID-19 Vaccination

A randomized clinical trial in inflammatory arthritis arthritis shows that temporarily holding biologic or Janus kinase (JAK) inhibitor therapy at the time of COVID-19 vaccination is not warranted.

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Predicting and Preventing PsA

PsA is often underdiagnosed in those with PsO, leading to diagnostic delays and undertreatment. This cohort study suggests that PsO patients exhibit predictors that can better inform dermatologists and rheumatologists.

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Funny! Dr. Glaucomflecken explains the REPLENISH trial -secukinumab for the treatment of polymyalgia rheumatica buff.ly/ZjNfDyo

Retrospective Kuwait registry study of 2629 RA pts- 2326 (88.5%) w/ early (EORA) vs 303 (11.5%) late(LORA). LORA had more age related comorb. Dz (2 vs. 0.9), similar DAS28/CDA, but signif higher ESR (41 vs 33). T2T applies regardless of age!! buff.ly/RS4sd4h

Retrospective cohort study of 387 ANCA-assoc. vasculitis pts Rx w/ GC +/- avacopan (AVA 52 vs 335 not Rx AVA). AVA use assoc w/ signif less severe infx (adj HR 0.22), & less pred use - but no diff in relapse risk was observed. buff.ly/LOillNw

FDA has approved rembrutinib (Rhapsido - BTK inhibitor from Novartis)as 1st Rx for adults with dermographism not controlled by H1 antihistamines (expanding its use beyond chronic spontaneous urticaria) buff.ly/xNfuSlh

Giant Cell Arteritis market size was valued approximately $960 million USD in 2023 - read for interesting drug developments in GCA arena buff.ly/E7cSZ9d

Agenx announced it will discontinue its phase 3 UNITY study -efgartigimod SC in adults with mod-to-severe Sjögren's dz, based on not meeting clinESSDAIwk 48 & rec from DSMB. ""Sjögren's Disease is one of the most heterogeneous and complicated diseases in immunology.." buff.ly/ZsX3rsX

A pooled meta-analyses shows that exercise reduced pain versus control immediately after the intervention (SMD −0.59; 95% CI −0.65 to −0.53; P<0.001). The benefit held across musculoskeletal, inflammatory, neurologic and cancer pain, and for every modality tested.

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Study of 64 Stills related #MAS pts (55 sJIA; 9 AOSD). All Rx GCs; 75% anakinra, 52% ciclosporin. Complete remission in 7, partial Rem in 64%; GCs tapered in 78% in median 40d. MAS recurred in 31%; 11% died; 1-year survival probability 93.75% buff.ly/LRpqGRr

Retrospective real world avacopan (AVCP) safety data from UK vasculitis center looked at AAV pts (RTX or CTX) rx w/ AVCP (n 133) or not AVCP (n 458). @1 yr AVCP had nonsignif incr in ALT >2xULN (15.8% v 11.4%) or >3xULN (11.3% v 6.3%; P 0.064) No diff AP, Bili, Hy's law signals buff.ly/jJ3KFkU

43 Bx-provenGCA in Black Caribbeans - incidence rate 1.76/100K pY w/ 4 fold incr betw 1993 & 2014. Mean Age 76; F:M ratio 4.4. Initial Sxs HA (65%), jaw claud (33%), scalp tender (37%), anterior ischemic optic neuropathy (26%) & PMR (33%). Mean survival was 13 yrs buff.ly/G3h4AXB

QD Clinic: How Weight Loss Changes the Course of Knee OA

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UK study 46 adult PsA pts w/ BMI ≥25 showed use of digital wt. & Dz app (vs no app) improved weight loss (− 1.55 vs − 0.18 kg), dz activity by CPDAI (p < 0.001), esp w/ arthritis (p 0.017) & enthesitis (p  0.034) domains. Weight loss correlated w/ dz activity improvement. buff.ly/yNcUXTe

Remission – Believe it or Not (10.2.2026)

Dr, Jack Cush reviews the news and journal articles from the past week on RheumNow.
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T-cell engager blinatumomab (CD3xCD19 TCE) was used for Deep B-cell depletion in 15 resistant RA pts (MDR-RA). @wk 12 9/15 CDAI LDA, 3/15 CDAI remission. Synovial B cells were depleted (4 of 5 biopsies) but not in lymph nodes. Later, 14/15 flared. No ICANs, 3/15 w/ CRS (gr 1) buff.ly/OUB8fgN

Metanalysis of IVIG in scleroderma (11 studies, 363 pts) showed IVIG to be safe; signif improvement in skin by mRSS (SMD −0.59; p 0.0019) & GI Dz (SMD −0.73; p 0.0012; I2 = 0%). W/ inflam myopathy signif reduction in CK (SMD −0.53; p<0.001) buff.ly/aEfUIjg

Biogen announced the 52 week OL results of AMETHYST Phase 2/3 RCT of litifilimab in 93 #CLE pts. Betw wk 24 & 52, pts improved w/ clear skin (27.2%; CLA IGA 0-1) & 29% CLASI-70 (dz activity) buff.ly/Yr5dcLR

Using national survey data of adults (62-85 yrs) saw no change in Rx Med (84% vs 85%) or dietary supplement (66% vs 67%) use betw 2015-2016 & 2021-2013. But OTC declined (60% vs 55%; P = .04). Polypharmacy signif incr. Drug-drug interactions declined buff.ly/5YWVnML