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Referrals - Orthopedics or Rheumatology?
“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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Maui Potpourri (2.13.2026)
Dr. Jack Cush reviews the hot item takeaways from last week's RheumNow.Live 2026.
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ALTO: Long-Term Abatacept Outcomes in At-Risk RA
Lancet Rheumatology has published the ALTO results - long term outcomes of the APIPPRA trial, demonstrating that treatment with abatacept (ABA) in at risk patients can delay progression to rheumatoid arthritis (RA) for up to 4 years.
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Giant Cell Arteritis Outcomes in Canada
A retrospective cohort study of patients with giant cell arteritis (GCA) demonstrates relapses are common and seen in nearly half of patients, were common after treatment is stopped and is not effectively averted by methotrexate (MTX).
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RT @RichardPAConway
Odds ratios for ILD in early RA from SAIL-RA study. Again disease activity stands out. #RNL26 https://t.co/9cXjOFl3Th
Dr. John Cush RheumNow ( View Tweet)
RT @richardPAconway
Lifetime risk of ILD by RA/sex/MUC5B status. We can see the synergistic effect. Also note RA>MUC5B in general. #RNL26 https://t.co/L5MOVVGIt3
Dr. John Cush RheumNow ( View Tweet)
RT @richardPAconway
MUC5B is strong risk factor for RA-ILD. Specifically for UIP. Associated with both older-onset RA, and ILD earlier following RA presentation. #RNL26 https://t.co/qeLp1BqOEM
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/DxGhhFL1gO
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)
RT @richardPAconway
Dr Sparks. RA-ILD is common. Pooled prevalence of 11% from recent meta-analysis. Less common than SSc or IIM, but more frequent than we think! #RNL26 https://t.co/TCsDfeQjZC
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinmd
Mortality risk in RA #RNL26
Myasoedova
Most common mortality:
1.5-1.6x increase risk CVD
2-3x increase risk ILD
+ACPA increases risk in both https://t.co/Luwyy6UFg6
Dr. John Cush RheumNow ( View Tweet)
Factors that may augment future development of SLE - includes Vitamin D levels, poor sleep, EBV reactivation & social determinants of health. Can you Prevent SLE? Dr. David Karp lecturing at UTSW @drdavidkarp @utswrheum https://t.co/2J1JBjeXKU
Dr. John Cush RheumNow ( View Tweet)
Air pollution ups ANA+: Ontariio Canadi study of 3548 serum samples (2010-13) corrlated particulate matter (PM2.5) w/ serologies. Highest vs lowest quartile PM2.5 showed higher risk of ANA ≥1:640 (OR 1.46) & ≥1:1280 (OR 1.54). Pollution has systemic immune effects! https://t.co/iyC68qh49R
Dr. John Cush RheumNow ( View Tweet)
NEXT STEPS: Karp and investigators are engaged in the MONA LISA study - Using smile Data and biospeciments – they intend to look for biomarkers that may better predict the future development of SLE Dr. David Karp lecturing at UTSW @drdavidkarp @utswrheum https://t.co/acZD1kmNhq
Dr. John Cush RheumNow ( View Tweet)
Factors that may augment future development of SLE - includes Vitamin D levels, poor sleep, EBV reactivation & social determinants of health. Can you Prevent SLE? Dr. David Karp lecturing at UTSW @drdavidkarp @utswrheum https://t.co/e3TKATcxXB
Dr. John Cush RheumNow ( View Tweet)
Can you Prevent SLE? Dr. David Karp lecturing at UTSW Showing that autoantibodies exist long before the onset of SLE @drdavidkarp @utswrheum https://t.co/zPAYbSlIBS
Dr. John Cush RheumNow ( View Tweet)
Notch and TGFβ Signaling in Refractory Rheumatoid Arthritis
Spatial transcriptomic profiling of rheumatoid arthritis (RA) synovial biopsies (pre- and post-treatment) has revealed new insights into the pathobiology or treatment resistent RA.
https://t.co/vCvFpnIOvS https://t.co/EV6OihT0br
Dr. John Cush RheumNow ( View Tweet)
Air pollution ups ANA+: Ontariio Canadi study of 3548 serum samples (2010-13) corrlated particulate matter (PM2.5) w/ serologies. Highest vs lowest quartile PM2.5 showed higher risk of ANA ≥1:640 (OR 1.46) & ≥1:1280 (OR 1.54). Pollution has systemic immune effects! https://t.co/fJrhypNE2A
Dr. John Cush RheumNow ( View Tweet)
Testing for RF, CCP, ESR and CRP
Check out the accompanying Advanced Practice Rheum: Rheumatoid and Inflammation Testing video.
https://t.co/4hkDO1M2UD https://t.co/APRKYLAS3k
Dr. John Cush RheumNow ( View Tweet)
Minnesota Mayo clinic retrospective, population study of RF & CCP in 1373 incident RA pts. At Dx, 37% dual seropositive, 13% +CCP only, 12% +RF only, & 38% seronegative. zDual seropositives had more erosions (31%) & flares (69% vs 51%). But +RF only highest mortality (adj 2.18) https://t.co/hPQewVgPoq
Dr. John Cush RheumNow ( View Tweet)
