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Referral Rules to Live By (2.20.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com. Highlights include referral rules, combination biiologics in psoriasis and don't use JAK inhibitors in pregnancy.

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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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Slim,waist,obese,obesity

Together PSO Trial - Combination Ixekizumab and Tirzepatide

Jack Cush, MD

Today Lilly announced top line results of the TOGETHER-PsO open-label, Phase 3b trial demonstrating the significant benefits of concomitant ixekizumab (IXE: an IL-17A inhibitor) and tirzepatide (TIR: GLP-1agonist) over IXE alone.

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Olsen RNL26

Prevention in Lupus and Therapeutic Evolution in Sjögren’s

Audrey Gibson, PA-C

The notion of intervening in autoimmune disease prior to the onset of irreversible tissue damage has evolved beyond a theoretical framework; it is presently undergoing empirical evaluation. Recent discussions on incomplete lupus and the SMILE trial, alongside advances in Sjögren’s therapeutics, highlight both the promise and complexity of prevention and precision treatment in systemic autoimmunity.

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AS.Sacroiliitis.CT_.SpA_.jpg

What's New in Spondyloarthritis

Robert Chao, MD

Dr. Arthur Kavanaugh and Dr. Eric Ruderman gave an update on what's new in spondyloarthritis at the 2026 Rheumatology Winter Clinical Symposium (RWCS) in Maui, Hawaii. Here's a summary.

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GLP-1s are known to improved knee OA. Using a mouse OA model w/ obesity, semaglutide yielded less pain, osteophytes & had strong chondroprotective effects, fia a wt loss-independent way. Changing from glycolysis to oxidative phosphorylation resulted in cartilage restoration. https://t.co/YySGDHX9KO
Dr. John Cush RheumNow ( View Tweet)
What's New in Spondyloarthritis Dr. Arthur Kavanaugh and Dr. Eric Ruderman gave an update on what's new in axial spondyloarthritis (axSpA) at the 2026 Rheumatology Winter Clinical Symposium (RWCS) in Maui, Hawaii. https://t.co/X9MfrZLNBq https://t.co/VS04Ra5RZK

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Dr. John Cush RheumNow ( View Tweet)
The vasculitis session at #RNL26 was a fantastic update on inflamed blood vessels, large and small, by two experts in the field. https://t.co/KuVei8jiFu https://t.co/47cI4WSSkU

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Dr. John Cush RheumNow ( View Tweet)
New studies posted this week in Arthritis & Rheumatology: Adalimumab ± MTX as first-line therapy for childhood-onset chronic uveitis https://t.co/L4QiZZBBG7 Bisphosphonates & PPI/H2RA coprescriptions in polymyalgia rheumatica https://t.co/62Pqt5Ab58 Phase 3b SOLSTICE trial: https://t.co/MsK4XC3eNh

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American College of Rheumatology ACRheum ( View Tweet)
You gotta be kidding me @mims gift link https://t.co/wf9kLhSu8a https://t.co/jB3ZYyB549

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Eric Topol EricTopol ( View Tweet)
Population survey of 21 000 US adults, 62.3% reported recent use of any OTC or prescription meds. Past-7-day prevalence of any OTC medication was equal to RX med use (46%) and increased use with age among both male and female individuals. https://t.co/xeWBQ0DnlB https://t.co/c8lqXOmAaT

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Dr. John Cush RheumNow ( View Tweet)
Comorbidity & Health Management https://t.co/cSwCEDKL28 https://t.co/WP7yIdWPVY

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Dr. John Cush RheumNow ( View Tweet)
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 The new kid on the block in RA-ILD (and other PPF). Nerandomilast, an anti-fibrotic with additional anti-inflammatory/immunomodulating functions. Demonstrated significant mortality benefit in ILD. #RNL26 https://t.co/8DU3WyPQGy
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinMD #RNL26 Prosthetic joint infection vs flare? - PJI risk 50-80% higher in RA (OR 1.47-1.8) - Immunosuppressants, intra-artic injections, RA activity, BMI incr risk - Delay in diagnosis https://t.co/XTozafDQyf
Dr. John Cush RheumNow ( View Tweet)
Spectrum of skin Sxs in 518 pts w/ Stills dz from AutoInflammatory Dz Alliance (AIDA) Network Registry dedicated to Still’s disease includes Salmon evanescent rash (64%), macules (7.7%), urticaria (6%), persistent pruritic papules & plaques (PPPP) (4.8%) https://t.co/DW9NoaxNPP https://t.co/U5GrCutYT0

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Dr. John Cush RheumNow ( View Tweet)
Maui Potpourri (2.13.2026) Dr. Jack Cush reviews the hot item takeaways from last week's RheumNow Live 2026. https://t.co/ieRhIVZb2D https://t.co/KaYtSnHUIL

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Dr. John Cush RheumNow ( View Tweet)
Rotator cuff abnormalities are nearly universal after age 40, & incr w/ age; routine imaging should not guide Dz or Tx of atraumatic shoulder pain. Study of 602 having MRI (58yrs) RC abnormalities in 98.7%;; 25% tendinopathy, 62% Partial & 11% Full thickness tears https://t.co/Jw9rMUQBLs
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinMD #RNL26 Arthroplasty risks in RMD AxSpA - Respiratory complications (OR 1.7), PNA (2.2) SLE - complications ass w/ severity/activity. Renal failure, PE, sepsis, stroke, mortality depending on activity PsA - complications related to co-morbidities, not PsA https://t.co/jr0hwh3CPe
Dr. John Cush RheumNow ( View Tweet)
RNL 26 Report: Spondyloarthritis Audrey Gibson, PA-C, reports from RheumNow Live 2026 in Dallas, Texas, about lectures presented during the "Staying Ahead of Spondyloarthritis" session. https://t.co/UjvauWoga5 https://t.co/Zv8dmUuVyD

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Dr. John Cush RheumNow ( View Tweet)
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