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Lifestyle and Incretin Therapy Advice for Rheumatologists

Jack Cush, MD

As GLP-1/GIP receptor agonists become standard co-management tools for obese patients with RA, PsA, axSpA, and gout, this JAMA Insights perspective by Kushner, et al. reframes lifestyle counseling as an adjunct to pharmacotherapy - a reversal of the traditional model. This has with direct implications for how we counsel obese patients we start or co-manage on these agents.

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Glucocorticoids: Use vs.Toxicity

Jack Cush, MD

This review article addresses the recognition, prevention and management of glucocorticoid toxicity in rheumatic patients.

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Mentshlichkeit* (8.7.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and recent journal reports on RheumNow.com.

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JAMA Review of Hip Fracture

Jack Cush, MD

The July 16th edition of JAMA reviews the highly prevalent problem of hip fractures - a major global health burden: 14.2 million occur worldwide annually (280,000 in the US), with global incidence higher in women (833.9/100,000) than men (510.0/100,000). Lifetime risk at age 50 is 22.9% for women, 10.7% for men. Mortality is substantial.

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ACP Position Paper on Dietary Supplements

Jack Cush, MD

More than half of U.S. adults use dietary supplements, yet only a quarter use supplements recommended by a healthcare professional, and current law lets supplements reach the market with no premarket safety evaluation, unlike drugs or food additives.

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Do we need Better Strategies to Prevent Osteoporotic Fractures?

Jack Cush, MD

In a recent JAMA Viewpoints article, Dr. Susan Ott addresses several controversies in preventing osteoporosis (OP) related fractures.

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2024 death rates from unintentional falls among adults≥65 yrs were 74.8/100K for men (66.6 women) Rates were higher for men > women. Fall death rates incr w/ age: highest ≥85 years. https://t.co/b4RwFHbZKj https://t.co/8m9mGUewYu

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Earlier Dx of axSpA is assoc w/ lower long-term spinal structural damage. Swiss study compared xray outcomes betw 138 early (<2yrs) & 238 established axSpA pts w/ 11.5 yrs F/U. Differences became evident 10-15 yrs after Dx. https://t.co/E9oR37CEiD https://t.co/7FiaqJIRRC

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QD Clinic: Bariatric Surgery "Curing" Arthritis? Dr. Richard Conway, Dublin, presents this QD Clinic as part of RheumNow's "The Obesity Imperative" campaign, presented in September 2026. https://t.co/YwtSkroMta https://t.co/tl8eSrvGhq

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Join us for Tuesday Nite Rheumatology on September 22 for: 🔴 Obesity Treatment & Safety Experts will tackle: • GLP-1/GIP therapies • Lifestyle & bariatric interventions • Treatment selection & safety • Cost & compounding concerns • Sarcopenia & bone health • The future https://t.co/YNEsGofRR9
Dr. John Cush RheumNow ( View Tweet)
Join us for Tuesday Nite Rheumatology on September 22 for: Obesity Treatment & Safety Experts will tackle: • GLP-1/GIP therapies • Lifestyle & bariatric interventions • Treatment selection & safety • Cost & compounding concerns • Sarcopenia & bone health • The future of https://t.co/BCSOUot5FL
Dr. John Cush RheumNow ( View Tweet)
Bariatric Surgery in the Era of GLP-1RA Overweight/obesity is a chronic multi-system disease that can impair physical and mental health. It now affects almost 1 in 3 Canadians. Multiple recent guidelines have therefore suggested using waist measurements, in addition to BMI, to https://t.co/RaXnQ2d9Yr
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QD Clinic: GLP-1s and History of Thyroid Cancer? Daric Mueller, PA-C, St. Clair Shores, MI, presents this case as part of RheumNow's "The Obesity Imperative" campaign, presented in September 2026. https://t.co/uob8RlMV14 https://t.co/f42gB0IXl1

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Dr. John Cush RheumNow ( View Tweet)
Epic Cosmos study of GLP-1RA Rxs in 3.5 million children (8–11 yrs) - very few 0.6% recv a GLP-1RA (20,282 kids) - Rx went from 0.03% (2019) to 9.3% (2026-310-fold incr). More likely in older, girls, obese kids. Most GLP-1 kids had severe obesity (93.7 percent) https://t.co/JW6SXxJjA0
Dr. John Cush RheumNow ( View Tweet)
Obesity Journal Club https://t.co/CxAWoGBqpx

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Korean National Health Insurance claims study of 4,107 newly Dx gout on allopurinol x 24 mos (vs non-gout controls). Gout significantly higher risk of fractures (aHR 5.52_; 95% CI 4.19–7.26), highest in those with low-adherence to allopurinol (aHR 5.91). Consistent trends seen https://t.co/cTO4lGtYAy
Dr. John Cush RheumNow ( View Tweet)
New, Advanced Therapies in Gout https://t.co/7i6936H7ZS https://t.co/8oOzqVKLGF

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Why Do Gout Flares Start at Night? The striking propensity for gout flares to initiate at night has been recognized for centuries. More recent epidemiological research supports this observation, indicating that the risk of a gout flare is more than twice as high in the early https://t.co/FbCUmXEl2y
Dr. John Cush RheumNow ( View Tweet)
While not a validated Dx tool for gout, AI retinal scanning of digital fundus photography was tested on 107730 pts & showed high ROC - f NIDDM 0.833, Gout 0.832, OP 0.787, HTN 0.740, hyperlipidemia 0.736 & thyroid Dz 0.699 https://t.co/1yrlR04z4g https://t.co/c04YtVVERY

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New research shows synovial lining enriched in macrophages expressing SPP1 (encoding osteopontin) in proximity to fibroblasts and fibrin deposits. SPP1+ macrophages degrade fibrin & promote fibroblast proliferation that deposit collagen & does the damage, joint remodeling. A new https://t.co/hrJoQXpAH8
Dr. John Cush RheumNow ( View Tweet)
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