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Ortho v Rheum

Referrals - Orthopedics or Rheumatology?

Jack Cush, MD

“Orthopedics or rheumatology, who should I see?" A question, often asked with urgency, posed by those who genuinely don’t know who to see for a musculoskeletal (MSK) complaint.  Inquiring patients, family, or other physicians may be one forum for such a request. Another occurs in the hospital and clinic when referrals for MSK issues can go in either direction.  How would you guide such requests?  And what would your answers be based on?

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A Modern Approach to Osteoporosis Management

Adela Castro, MD

Currently, fewer than half of patients diagnosed with osteoporosis receive appropriate pharmacologic therapy. This treatment gap reflects several challenges in osteoporosis management, including limited disease awareness, barriers to medication access, clinician discomfort with therapy selection, and uncertainty regarding the optimal timing of treatment initiation.

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pregnancy,embryo,fetal

Can I Use JAK Inhibitors During Pregnancy?

Jack Cush, MD

In 2020, the ACR Recommendations on Reproductive Health notably avoided firm guidance on the use of JAK inhibitors (JAKi) during pregnancy stating, "There is no available evidence regarding use or safety of the new small- molecule agents, tofacitinib, baricitinib, and apremilast, during pregnancy."

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Maui Potpourri (2.13.2026)

Jack Cush, MD

Dr. Jack Cush reviews the hot item takeaways from last week's RheumNow.Live 2026.

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Haque and Goodman

Obesity, Surgery, and Optimizing Patient Care

Eric Dein, MD

Rheumatologic care involves multidisciplinary approaches and collaboration with specialties to treat complex, systemic diseases. While many Pods at RheumNow Live are disease specific, the Pod II focused on Advancing Practice on important and emerging areas affecting rheumatologic patients. This session focused on two major areas of need: obesity and peri-operative management.

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RT @richardPAConway Data from Scott Matson's group showing that immunosuppressing RA-ILD (agnostic to agent) results in stabilisation of the previous downward trajectory of pulmonary function tests. #RNL26 https://t.co/MoYoM0K1cs
Dr. John Cush RheumNow ( View Tweet)
Comorbidity & Health Management https://t.co/cSwCEDKL28 https://t.co/WP7yIdWPVY

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Dermatomyositis outcomes w/ 2475 pts (claims) & 1196 pts (EHR). Half had myositis panels & 35% had + MSAbs. Steroid use common in 69% & 74%. HCQ, MTX, MMF. Outocmes (per 1000PYs) wereL all-cause hospitalisation 92, malignancy 15.3, ILD 6.4, and myocarditis 2.1 https://t.co/DJqKGNGX76
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UK Biobank registry analyzed assoc. betw sleep duration, insomnia, & shift with osteoarthritis endpoints (KOA, HOA, TKA, THA) - all incr/highest in pts w/ <6 hrs nightly sleep. Night shift workers had 24% higher knee OA risk (HR=1.24) & 28% higher TKA risk (HR=1.28). https://t.co/UnxXH2I92R
Dr. John Cush RheumNow ( View Tweet)
RT @RichardPAConway Comparative survival in incident RA-ILD 1955-1995 vs 1999-2014. We are getting better, althoug need to take into account the general survival improvement also. More work to do! #RNL26 https://t.co/VwV33tHgR8
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinMD #RNL26 @RheumNow Uzma Haque GLP1 on pts with  SLE and diabetes Retrospective study - major improvements in MACE HR 0.66 VTE HR 0.49 Renal progession HR 0.77 Mortality HR 0.26 A major tool for rheumatic care! https://t.co/qR3HKfsugZ
Dr. John Cush RheumNow ( View Tweet)
RT @gibson_rheumPAC Baseline serum urate &gt;8–9 mg/dL strongly predicts worse flares, hospitalizations, and joint damage over years. Urate level should inform urgency and intensity of therapy. #RNL26 https://t.co/4RBVXZxCCX
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinMD #RNL26 GLP on Knee OA STEP 9 Trial - 68 wk Mean WOMAC improved by 41.7 pts, compared to 27.5 in PBO, improved SF-36 7% stopped due to side effects https://t.co/LJzGzzlgq6 https://t.co/5ybyUdfNjZ

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Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinMD #RNL26 Dx Modification of OA @Tuhina_Neogi Challenge in drug develop: Models in young animal, not like human OA Trial enrollment in pts w late, establ OA- not early interv tx Many paths to OA - target mechanism to correct pt Slow progress of dx, $$ Endpt? Sx or

Dr. John Cush RheumNow ( View Tweet)

RT @ericdeinMD #RNL26 Placebo in Rheumatology - STEP talk Kerschbaumer What plays role in PBO? Treatment adherence effect w better background therapy - may appear to be PBO Impact in globalization of recruitment patterns, affects background PBO Education of pts bridges gap

Dr. John Cush RheumNow ( View Tweet)

RT @Gibson_RheumPAC Obesity doesn’t just increase risk of rheumatic diseases-it worsens outcomes. Patients with obesity have higher disease activity, poorer biologic response, and 20–25% lower remission rates in inflammatory arthritis. #RNL26

Dr. John Cush RheumNow ( View Tweet)

RT @Gibson_RheumPAC Nearly 50% of U.S. adults may meet criteria for obesity by 2030. For rheumatologists, it directly impacts disease activity, outcomes, and treatment response. #RNL26 https://t.co/cpy4LBBPHc
Dr. John Cush RheumNow ( View Tweet)
RT @gibson_RheumPAC Osteoarthritis affects 600 million people worldwide—yet we still have no approved disease-modifying therapies. A powerful opening to this talk on why OA drug development keeps missing the mark. https://t.co/wBUN3lux6X
Dr. John Cush RheumNow ( View Tweet)
Study of 90 adolescents (46 w. Juvenile fibromyalgia (JFM) & 44 controls) finds that JFM pts have greater sensitivity to non-painful sensory stimuli, such as sounds and bright lights; such hypersensitivity is closely related to the severity of the disease and brain function https://t.co/KGqzRK6e4a
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinMD Mucosal Hypothesis RA #RNL26 Demoruelle ACPA can predate RA development Nam et al: non-specific jt pain: 42% developed RA in 12 mos Circiumaro et al: MSK complaints 38% devel RA in 36 mo APIPPRA: 29% at 12 mo, 37% at 24 mo, StopRA 18% in 12 mo, 33% at 36 mo https://t.co/JYiWmn0N0g
Dr. John Cush RheumNow ( View Tweet)
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