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Legislative Issues Affecting APPs

Jack Cush, MD

Here's a summary of legislative issues in three key areas: APRN compact and interstate licensing hold up; scope of practice; and, reimbursement hassles.

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Long-Term APP Retention: Building Success for Practices and Providers

Lindsay Tom PA-C

Advanced Practice Providers (APPs) play an increasingly vital role in rheumatology practices across the country. With rising patient volumes and a growing demand for timely, high-quality care, incorporating an APP into a rheumatology team can be transformative.

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Turkey Tryptophan (11.28.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and reports from this past week on RheumNow.com, including reports on FDA resurrections, FM seasonal worsening, and do you fight switch or swap biologics in PsA TNFi nonresponders?

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Partial vs Total Knee Replacement: Is One Superior?

Patients with osteoarthritis (OA) primarily affecting only one knee joint compartment did just as well with partial knee replacement (PKR) as with total arthroplasty after 10 years in a randomized trial -- and maybe a little bit better. Final results of the landmark TOPKAT study indicated that rates of the most clinically important outcomes were nearly equal between the two procedures, according to David Beard, DPhil, GDPhys, MCSP, MSc, of the University of Oxford in England, and colleagues. These similarities included Oxford Knee Score (OKS) values both at year 10 and cumulatively during the entire follow-up period, as well as reoperations and revisions.

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PROSPERO metanalysis of 22 studies & 2208 JIA associated uveitis (JIAU) showed severe visual impairment in 16.6% at ~18 yrs. Most frequent: Cataract (44.3%), followed by glaucoma, synechiae, band keratopathy and hypotony. Biologics were protective https://t.co/6OoupX64NE https://t.co/4GFnugdvod

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A&R USA adult rheum workforce study showed in 2019, there were 5,667 rheumatologists & 379 APPs. Betw 2009 - 2020, rheumatologist #s increased 23%, while #APP #s increased 141%. There was a signif increase in female rheumatologists & APPs over time https://t.co/Y5ZSwPLsNe https://t.co/RzDxbN7irL

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Congratulations to Professor Stuart Ralston (Versus Arthritis Professor of Rheumatology) from the University of Edinburgh. He has been honored with the RSE Sir James Black Medal by The Royal Society of Edinburgh for his research research & dedication to medical education https://t.co/vCm4Mkp6u7
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Treating Refractory Still's Disease A full read systematic review article examined treatment options for difficult to manage systemic juvenile idiopathic arthritis, or Still’s disease. It classified these refractory disease patients as those with either (1) persistent https://t.co/uDeIkIek1d
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"When you learn, teach. When you get, give." – Maya Angelou

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BASDAI scores elevated in Fibromyalgia - 58 FM pts were surveyed wtih FIQ, SSS, BASDAI. BASDAI was ≥ 4 points in 91.4% of FM (vs 13% controls (p < 0.001). BASDAI correlated w/ the FIQ (pain, fatigue, stiffness) & SSS scores (r = 0.88, p < 0.00). Could BASDAI be used in FM? https://t.co/M0tI8wjzh4
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A New Disease Activity Score for Antiphospholipid Syndrome? APS is a systemic autoimmune disorder. It is characterised by the presence of antiphospholipid antibodies and a broad spectrum of clinical features, causing obstetric as well as thrombotic, microvascular and https://t.co/G2xGtOPmwb
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BASDAI scores elevated in Fibromyalgia - 58 FM pts were surveyed wtih FIQ, SSS, BASDAI. BASDAI was ≥ 4 points in 91.4% of FM (vs 13% controls (p < 0.001). BASDAI correlated w/ the FIQ (pain, fatigue, stiffness) & SSS scores (r = 0.88, p < 0.00). Could BASDAI be used in FM? https://t.co/VF94ru0o3Q
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2023 National Health Interview Survey studied arthritis-attributable work limitations (AAWL) in US adults (18-64 yrs) - it was 38.8% (unchanged from 2019). AAWL was higher in Hispanics (50%), American Indian/Alaska Natives (56%), & disabled (62%), & veterans (52%) https://t.co/sE3En74zfq
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JAMA review of Peripheral Neuropathy - affects ~ 1% of adults worldwide and may cause sensory, motor, and autonomic Sxs. Diabetes is the most common cause. 1st line Rxs include gabapentin, pregabalin, duloxetine, amitriptyline. (FOR AMA MEMBERS) https://t.co/sof15I1GpU https://t.co/PN0KMeUsGA

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Partial vs Total Knee Replacement: Is One Superior? Patients with osteoarthritis (OA) primarily affecting only one knee joint compartment did just as well with partial knee replacement (PKR) as with total arthroplasty after 10 years in a randomized trial -- and maybe a little https://t.co/abER7mS3QR
Dr. John Cush RheumNow ( View Tweet)
Retrospective analysis of 2614 FM pts in the Italian Fibromyalgia Registry underscores the seasonal changes in FM pain, w/ signif. differences in FM assessment tools WPI p=0.042 & FASmod p=0.037); these changes were only seen in female patients, not males https://t.co/LqXnTgGIMB https://t.co/ihw1yJqKLC

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ILD in Patients with Connective Tissue Disease Dr. Janet Pope reports on abstract 0154 (Incidence and Prevalence of Connective Tissue Diseases with Interstitial Lung Disease (CTD-ILD) in the United States) at #ACR25. https://t.co/WrJhsMizwV https://t.co/rkFny5ZjZQ

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RNL 25 Replay: Spondyloarthritis Enjoy these excerpts from the RNL 2025 meeting, and join us for RNL 2026 in Dallas, TX - registration is now open! Visit https://t.co/o78Pc8LPsQ for complete details. https://t.co/OuVLKKbA6U https://t.co/zPiuSH47Fg

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A New Disease Activity Score for Antiphospholipid Syndrome? APS is a systemic autoimmune disorder. It is characterised by the presence of antiphospholipid antibodies and a broad spectrum of clinical features, causing obstetric as well as thrombotic, microvascular and https://t.co/eouynDPLUX
Dr. John Cush RheumNow ( View Tweet)
In 2024, 77 pts referred to Rheum for possible PMR were ultimately Dx w/ B19 viral infx. 96% had arthralgia & 7% had PMR-like features (5/5 w/ BL shoulder/neck. prolonged AM stiff, fever & Hi CRP/ESR - none had hip pain. 4/5 were male, w/ mean age of 55 yrs. None were RF/CCP+ https://t.co/lIX4gDLjqd
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