Referral Rules to Live By (2.20.2026) Save

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.

1. 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) were all-cause hospitalisation 92, malignancy 15.3, ILD 6.4, and myocarditis 2.1 https://t.co/DJqKGNGX76
2. 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
3. J Rheum full read editorial on What HLA-B27 Can—and Cannot—Tell Us!. HLA-B27 also holds prognostic and theragnostic value, given its association with greater structural damage, higher inflammatory burden, and better response to tumor necrosis factor and interleukin 17 inhib. https://t.co/XHdJSEXmWm
4. FDA has Changed labels for 6 Menopausal Hormone Therapies (HRT) removing black box warnings for CV dz, breast CA, & dementia. 1st six HRTs includes estrogen-& progestogen-only Rx:Prometrium, Divigel, Cenestin, Enjuvia, & combo Rx Bijuva, & topical Estring. https://t.co/ZpcKkzYPKn
5. Genentech announced results of Phase III, MAJESTY OL study of obinutuzumab vs tacrolimus in 142 pts w/ primary membranous nephropathy & found signif more complete remissions at 2 yrs in obintuzumab Rx pts. Obintuzumab (Gazyva) if FDA approved for lupus nephritis. https://t.co/maJbvUCkBe
6. Screening study of lung US (LUS) vs HRCT in 73 RA pts (DAS28 3.47) Chest HRCT identified ILD in 29%. LUS identified ILD in 22% of patients. LUS sensitivity was 59%; specificity 94%. ROC. This study demonstrates the good diagnostic performance of LUS in RA- ILD detection https://t.co/E8avnbvUiw
7. 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
8. Referrals - Orthopedics or Rheumatology?
9. Together PSO Trial - Combination Ixekizumab and Tirzepatide
10. https://rheumnow.com/news/together-pso-trial-combination-ixekizumab-and-tirzepatide   
11. Can I Use JAK Inhibitors During Pregnancy?