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Methotrexate and hepatic fibrosis: we must be doing something right

Dec 02, 2021

Methotrexate may be a rheumatologist’s best friend, but a key part of counselling any patient about its use has always been the risk of hepatotoxicity. Despite methotrexate’s near-ubiquitous use in rheumatology, and the consequent frequency of patient counselling about it, relatively little

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ICYMI: Filgotinib (Jyseleca) was approved by European Commission approved for EU use in adults with moderately to severely active Ulcerative colitis (not responding to conventional therapy or a biologic). Rec based on Phase 2b/3 SELECTION trial. https://t.co/9VbCJse6Tr

Dr. John Cush @RheumNow( View Tweet )

Nov 21, 2021
#ACR21 Thieves! TM11. Belly pain in patient with RA nodules: ⭐️ A: rheumatoid nodulosis of pancreas and duodenum. Great case! @Rheumnow https://t.co/PuO4tka3FJ
Nov 09, 2021
#ACR21 #Abstr1492 Could gut microbiome contribute to Anti-Ro+/autoimmunity in #lupus? Analyses of 125 stool samples from mother of children with neonatal lupus and/or heart block revealed its potential role in genetic-environment interaction @RheumNow https://t.co/FnJtZJSCRj https://t.co/ttRdP9NIrG
Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
Nov 09, 2021
Cush ACR learning computer online

Day 2 Report from ACR21

Nov 08, 2021

This report highlights the VITAL trial; the ORAL Surveillance Study; and the Microbiome study of monozygotic psoriasis patients.

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Loved this session on: Preclinical Rheumatoid Arthritis- Can we stop RA? As a patient advocate living with RA, my providers have always ran tests on my microbiome. The findings have correlated with my disease flares, and was a big trigger overall. #ACR21 @ACRheum Thank you! https://t.co/6hm6hr85JS
Effie Koliopoulos @RisingAboveRa( View Tweet )
Nov 08, 2021
Love-hate relationship with #methotrexate. Side effects are common ex nausea/GI in 1/3 and alopecia in women. ?if you ask do you get more AES. Tough to treat especially SEs are early. ?Coach pt to help w persistence abst1444# @RheumNow #ACR21 https://t.co/NDQDVz8lk2
Nov 08, 2021
Low incidence of GI-related serious AE in pooled 1 year data from VOY1&2 and DISC1&2 trials of Guselkumab for PsA/PsO treatment ⭐️no new onset IBD or exacerbation of IBD ⭐️no uveitis, infections, TB Abs#1342 #ACR21 @RheumNow https://t.co/x3OmLgInV0

Robert B Chao, MD @doctorRBC( View Tweet )

Nov 08, 2021
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Methotrexate and hepatic fibrosis: we must be doing something right

Nov 08, 2021

Methotrexate may be a rheumatologist’s best friend, but a key part of counselling any patient about its use has always been the risk of hepatotoxicity. Despite methotrexate’s near-ubiquitous use in rheumatology, and the consequent frequency of patient counselling about it, relatively little

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In one institution, 25% of Crohn's patients had abnormal SI findings on MRE/MRI. Majority without back pain, were female with intestinal complications. Abs#1306 #ACR21 @RheumNow https://t.co/z8Yvc98s67

Robert B Chao, MD @doctorRBC( View Tweet )

Nov 08, 2021
⭐️Imaging of the SIJ in psoriatic axSpA is similar to axSpA associated with iritis or colitis! Abst#0902 (https://t.co/f55Vfi1LSS) #ACR21 @RheumNow https://t.co/UCXrwPiyhh
Meral K. El Ramahi, MD @MeralElRamahiMD( View Tweet )
Nov 07, 2021
In pts w/o RF, liver bx prev suggestd if lifetime cumulative MTX dose was 1-1.5g, then 3.5-4g. All pts in centre offered Fibroscan liver stifness associations: - age, BMI - not cumulative MTX dose maybe survival bias, but what we're doing now is fine! #ACR21 ABST0786 @RheumNow https://t.co/I6IhS3jhmC
Nov 07, 2021
Interesting study with Dr. Julia Manasson on gut and skin microbiome in monozygotic twins discordant for psoriatic disease. (red = Psoriatic). Gut ruminococcus bromii virtually absent in psoriatic pts. Eager to see further studies! #ACR21 Abst#0944 @RheumNow https://t.co/zrZPBAjh5p
Pedro Castillo @_Castillo_Pedro( View Tweet )
Nov 07, 2021
Monozygotic twin study in PsO patients showed a gut and skin microbiome difference compared to their "normal" twin ⭐️Ruminococcus decreased/absent in gut flora of PsO ⭐️microbiome differences even in healthy PsO skin Abs#944 #ACR21 @RheumNow #ACRBesthttps://t.co/VlfVh5Kt3Y https://t.co/W0eSqi77lx
Robert B Chao, MD @doctorRBC( View Tweet )
Nov 07, 2021
MTX and liver: FibroScan scores compatible with liver fibrosis are significantly correlated w/ several parameters -BMI -waist circumference -male gender -age but NOT MTX cumulative dose in a cohort of 500+ patients. #Abst0786 @RheumNow #ACR21 https://t.co/RkSpVqN4qF https://t.co/9TENaR0WZ3
Aurelie Najm @AurelieRheumo( View Tweet )
Nov 07, 2021
AxSpA pts share a gut microbiome signature with Crohn's disease and anterior uveitis pts ⬇️Blautia ⬆️Veillonella and Lactobacillus ⭐️SpA pts uniquely enriched in Collinsella Abs#0062 #ACR21 @RheumNow #ACRBesthttps://t.co/sdlHxNbhr8 https://t.co/r8eG9c9vwa
Robert B Chao, MD @doctorRBC( View Tweet )
Nov 06, 2021
Is it time to consider targeting gut microbiome for treatment of AS? Large study identified: ⭐️Ruminococcus torques associated with FUT2 gene influences risk of developing AS Abs#0068https://t.co/E1hL18KZbQ#ACR21 #ACRBest @RheumNow

Robert B Chao, MD @doctorRBC( View Tweet )

Nov 06, 2021
"I don't want rheumatologist only use BLMB and nephrologist using only VCS." - Dr. M Petri on how we should work together with nephrologists on managing lupus nephritis. (She did give a final dig & added "BLMB can be used with any GFR") #ACR21 #GreatDebate @rheumnow

TheDaoIndex @KDAO2011( View Tweet )

Nov 06, 2021
Nature has published a full read over of "Homing in on an oral link to inflammatory disease" how the microbiome may be a pathogenic link to diseases like RA. https://t.co/wwB9Eg9nsH

Dr. John Cush @RheumNow( View Tweet )

Oct 29, 2021
liver,hepaitis,pink,gb

New Hope for NonAlcoholic Fatty Liver Disease

Oct 25, 2021

The current issue of the NEJM has two articles on nonalcoholic fatty liver disease (NAFLD also called NASH - nonalcoholic steatohepatitis), one dealing with the prognoses, outcomes and mortality of NAFLD and another prospective and promising interventional trial in NASH patients. 

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RheumNow Podcast – Quackademia (10.15.2021)

Oct 14, 2021

Dr. Jack Cush reviews the FDA approvals, news and the latest journal articles from the past week on RheumNow.com.

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Catastrophic Still's dz occurs early; compares 20 AOSD w/ organ failure vs 40 AOSD without. CAT-AOSD had shorter Dz duration, earlier Rx need; risks: younger; splenomegaly, liver, cardiac,lung involvement; ferritin level, no arthralgia https://t.co/8WIMd0JxZr

Dr. John Cush @RheumNow( View Tweet )

Oct 14, 2021
US Preventive ServTask Force has advised that adults >60 yrs should NOT take daily preventative aspirin without a no hx of MI/CVD risk (the GI risks outweigh CV benefit). If 40-59 yrs, discuss w/ their MD if ASA would be beneficial https://t.co/jfqnBjwLLn

Dr. John Cush @RheumNow( View Tweet )

Oct 13, 2021
liver,hepaitis,pink,gb

Hepatitis B Reactivation with Rituximab and Abatacept

Oct 12, 2021

Hepatitis B reactivation is an uncommon complication of biologic therapy use. Now, a serologic study of  rheumatoid arthritis patients shows that HBV reactivation is seen with rituximab, and less so with abatacept, especially in patients without hepatitis B antibody (HBsAb) positivity.

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RheumNow Podcast – Jack of All Subspecialties (10.1.2021)

Oct 01, 2021

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com




  1. A population based Swedish study of birth records shows that antibiotic exposure in first three years of life to be associated with a future risk of JIA, although infections during fetal

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