Withdraw DMARDS after remission?

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The possibility of withdrawing DMARDs after patients achieve remission has been in our minds for a while. Yet when our patients ask whether it is a good idea to taper or stop their DMARD when they are doing well, most of us don’t have a black or white answer for them.

Race to the top: how high will treatment response rates in RA reach?

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We have become accustomed to the 60/40/20% rule for the outcome of ACR 20/50/70 respectively for biologics and targeted synthetic DMARDs.

Plotting Future ACR Convergence Meetings (11.24.2023)

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In this week's podcast, Dr. Jack Cush reviews the ACR Convergence 2023 meeting and proposes how to best learn at your next large medical meeting.

Reconsidering Steroids

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There is not a single one of us in rheumatology who hasn’t prescribed steroids, but we really need to reconsider how much and how often we use them.

TNFi and RA-ILD – The Pendulum Swings Again

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TNF inhibitors revolutionised the treatment of rheumatoid arthritis. While highly effective for the joint manifestations of the disease, a note of caution was sounded regarding the potential for worsening of ILD with these agents. Within this framework, a study by England et al presented at ACR23 was highly relevant.

IgG4 disease- the WInS withdrawal study results

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IgG4-related disease describes a group of fibroinflammatory diseases whose features may include autoimmune pancreatitis, swelling of or within an organ system, salivary gland disease, swollen lymph nodes, skin manifestations, and symptoms consistent with allergies or asthma. While remission induction treatment with glucocorticoids has proven effective, the high relapse tendency is an ongoing challenge for clinicians.

Why are older RA patients getting mistreated?

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Most rheumatologists, if asked, would say that every rheumatoid arthritis patient should be started on a DMARD of some sort - if not at diagnosis, then pretty soon after. So I am genuinely shocked that, in a large United States Medicare 20% sample dataset between 2008-17, less than 30% of new RA patients aged 66 years or older have a DMARD initiated.

Early aggressive treatment in SLE: are we there yet?

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Early treatment with DMARDs has revolutionised the outcomes of patients with rheumatic arthritis. However, this concept has not been fully extrapolated to other autoimmune rheumatic diseases such as systemic lupus erythematosus.

Do We Stop or Continue Treatment?

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Remission had been a dream, an elusive concept. But then, with the introduction of biologics, conventional synthetic and targeted synthetic DMARDS, patients are able to live longer and with a better quality of life. While these therapeutics have been helpful, they are expensive and carry potential side effects. The big question looms: Do we stop or continue treatment?

JAKi and TYK2i: What to use and when?

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You can see that the JAKi/TYK2i have both approved or potential seropositive and seronegative indications. There are also improvements in PsO for the class and studies in CTDs. So, it is difficult to know which to choose.

Can Rheumatologists Accurately Diagnose axSpA in Patients with Chronic Back Pain?

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Chronic low back pain is a common complaint that brings patients to the doctor’s attention. Although the majority of low back pain is mechanical in nature, an important minority is inflammatory in nature.

Rheumatology Roundup - ACR 2023

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Drs. Jack Cush and Arthur Kavanaugh discuss highlights and key takeaways from ACR 23.