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Three Things to Know About Hiring, Onboarding, and Training APPs
As the utilization of APPs (nurse practitioners and physician assistants) in rheumatology becomes more prevalent, here are three things to consider if you are thinking about adding an APP to your practice.
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Telling You Where to Go (12.19.2025)
Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com. Who would've thunk - a PsA FMF connection? Labs to diagnose SSc-ILD? IgA-RF may be important or RZV may not work in JAK inhibitor treated patients?
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Tricks of the Trade – Clinic Advice from APPs
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J. Cush and many APPs
December 2025 is focused on advanced practice providers, their impact, education and priorities. In seeking and soliciting the help and advice of leaders in the rheumatology APP world, I have been impressed by APP pride, dedication and passion for what they do.
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Hidden in Plain Sight: IBD
As a PA with six years of experience in rheumatology and a background in gastroenterology, today I'm discussing the clinical overlap between inflammatory arthritis—particularly psoriatic arthritis and spondyloarthropathies—and inflammatory bowel disease.
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Disease Activity Criteria for Adult-Onset Still's Disease: EULAR Points to Consider
EULAR has published a "points to consider" (PtCs) guidance on the development of criteria for the assessment of the disease activity in adult-onset Still’s disease (AOSD).
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Five Fractures You Don’t Want to Miss
In orthopedic practice, missing the wrong fracture can significantly alter a patient’s outcome. Certain injuries may appear subtle on initial imaging yet carry serious consequences if not promptly recognized and managed. https://t.co/zyCRdUkMua
Dr. John Cush RheumNow ( View Tweet)
Cases & Guidelines: Tuesday Night Rheumatology
Panelists discuss their approaches to a range of difficult cases in multiple areas, including RA, PsA and PMR. Panelists: Audrey Gibson, PA-C; Benjamin A. Smith, PA-C; Emma Bavage, ANP; Jack Cush, MD
https://t.co/vl5J9NYUKZ https://t.co/nsTf370bu9
Links:
Dr. John Cush RheumNow ( View Tweet)
Lilly announced phase 3 RCT TRIUMPH-4, where Retatrutide, a new GIP, GLP-1 & glucagon recpt agonist, was given to obese (BMI >35), knee osteoarthritis pts *without diabetes*. Wt loss at 68 wks was 28.7% with reduced WOMAC pain scores of -4.5 points (75.8%) https://t.co/73yIyvwRtL
Dr. John Cush RheumNow ( View Tweet)
Lyme disease is endemic in Massachusetts. EHR study shows Lyme dz incidence declined from 211 per 100 000 patients in 2012 to 86 per 100 000 in 2024 (P< .001), but this decr. was driven by 1 large practice group implemented a new initiative to reduce Lyme Dx & Rx in pts w/ https://t.co/lMCUA9o4Uc
Dr. John Cush RheumNow ( View Tweet)
🦴 Genant-Modified Sharp Scoring System
🧮 A radiographic scoring system used to quantify joint damage in Rheumatoid Arthritis (RA), especially in clinical trials and long-term follow-up.
🔍 What does it assess?
X-rays of hands and feet for:
•Erosions
•Joint Space Narrowing https://t.co/r5bvzFliBP
Ravi Kumar RheumattDoc ( View Tweet)
Lancet review of skin cancer risk w/ inflammatory arthritis - both melanoma and Non-melanoma skin cancers are increased in RA & inflammation. Also Package inserts for TNFi say all TNFi Rx pts should have complete skin exams "periodically". Skin cancer screening advised. https://t.co/MNuQO6Dw5b
Dr. John Cush RheumNow ( View Tweet)
MEDISPO study of 38 mild-mod psoriasis pts, 16-wk Mediterranean diet vs low-fat diet. Mediterranean diet did much better w/ PASI change −3.4 vs 0, more pts achieving a PASI 75 reduction (47.4% vs none) https://t.co/ZJU58VanGr https://t.co/x6juAT672B
Dr. John Cush RheumNow ( View Tweet)
Recent study shows that betw 2018-2023 # of Concierge medicine practices in the USA has increased 78.4% (3,935 to 7,021); mostly in Texas (402), California (387), Florida (352), Georgia (139).” Notably a signif growth of corporate owned practices, increased from 9.2% to https://t.co/nVRPfnwjZv
Dr. John Cush RheumNow ( View Tweet)
IN RA: IgA-RF seen in 50%, IgA-ACPA in 20-40% (& are very specific). IgA-RF or -ACPA found in serum, saliva & syn.fluid.& may underlie "mucosal hypothesis" of RA. IgA-RF assoc w/ more severe RA, worse outcomes, Xtra-articular manifestations, & blunted TNF inhibitor responses https://t.co/SVUJmrIy2F
Dr. John Cush RheumNow ( View Tweet)
Wolters Kluwer surveyed 203 PAs:
- 62% wish for more clinical experience prior to
- Most adopted AI, majority need more AI training
- 45% prefer title of “physician associate” https://t.co/96Hkh21wSr https://t.co/j7Xep47qMN
Links:
Dr. John Cush RheumNow ( View Tweet)
Japanese retrospective study-194 #RA pts Rx w/ JAK inhib (74 vaccinated w/ recombinant zoster (RZV) & 120 Not-Vax). H.zoster lower w/ RZV (4.8/100PY) vs UnVax (7.8/100PY) w/ overall efficacy of 59.1%. RSV Vax pts who got HZ had signif lower lymphocyte #s, higher SDAI & CDAI. https://t.co/4VMWPhzXeL
Dr. John Cush RheumNow ( View Tweet)
French ESTIVAL study - DB, sham trial of auricular vagal N stimulation in 148 Erosive hand OA (eHOA) pts w/ erosion + synovitis by US. @12wks, no signif difference in VAS pain (–16·0 vs –6 sham; p=0·22) w/ no safety issues. Was this a failed study or encouraging outcome? https://t.co/KI86H9izYS
Dr. John Cush RheumNow ( View Tweet)
76 PsA pts asked 32 questions submitted to Chat-GPT4 & 12 specialists. Answers were scored (accuracy, completeness). Both equally accurate, ChatGPT scored lower in completeness. Other pts reviewed answers; they preferred ChatGPT 49% vs clinician 34%. ChatGPT was more readable.
Dr. John Cush RheumNow ( View Tweet)
Study of 177 #SSc pts (116 w/ SSc-ILD vs 61 without ILD). SSc-ILD had more dcSSc, Raynaud’s & GI Dz. SSc-ILD predicted by triad of elevated NLR, PT, anti-SCL-70 (AUC of 0.879; sensitivity 82.6%; specificity 85.0%). NLR: neutrophil to lymphocyte ratio; PT: prolonged prothrombin https://t.co/iI6ZnZgJE7
Dr. John Cush RheumNow ( View Tweet)
Austrian 1K Paracelsus cohort study; from 9,665, 296 (3.1%) had RA. CKD prevalence was higher in RA vs controls (11.8% vs. 6.7%, p<0.001). Albuminuria was dominant renal dz in RA (6.8% vs 4.2%, p=0.027), but missed signif after adjustments (OR 1.43; 0.96–2.13) https://t.co/qf0IpZC50Q
Dr. John Cush RheumNow ( View Tweet)
