Prescribing Lessons (4.17.2026)
Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.
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Cross-sectional study from UK Clinical Practice Research Datalink Aurum looked at > 40K w/ #PMR Rx w/ steroids - 67% were coprescribed bisphosphonates (BP) & 79% Rx PPIs/H2RAs (less in males & pts deprived areas) resulting more Fx w/in 12 mos (2.32% vs 1.4%). https://t.co/b2DFJMjqCu
Dr. John Cush @RheumNow( View Tweet )
Predictors of Calcinosis Cutis in Systemic Sclerosis
Calcinosis cutis (CaC) is a common and disabling non-lethal manifestation in systemic sclerosis (SSc). This study used SSc patients from the EUSTAR database to clinically characterize patients and identify risk factors for https://t.co/uXbcCa04Lv
Dr. John Cush @RheumNow( View Tweet )
Portugese multicentre retrospective of 748 adults with JIA (age 28 yrs; Dz duration 21 yrs). Oligoarticular JIA was the most common subtype (29.9%). HTN (9%), psychiatric dz (8%), & osteoporosis (5%) were most prevalent comorbidities. bDMARD use reduced risk of psych Dz https://t.co/xCrTDxirlj
Dr. John Cush @RheumNow( View Tweet )
#Glucocorticoid-induced #osteoporosis results from direct suppression of osteoblast & osteocyte function, a transient stimulation of osteoclast formation & activity, catabolic effects on #bone matrix & muscle protein, and metabolic alterations https://t.co/ZmMFAOJkmw
#OpenAccess https://t.co/6CubKRbjin
Links:
The Lancet Diabetes & Endocrinology @TheLancetEndo( View Tweet )
b/ts-DMARDs Do Not Arrest Bone Loss in RA
In RA, the goal is to control or arrest inflammation such that articular and bony damage is halted. While we have many effective therapies, it is not clear that biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) can prevent or improve osteoporosis outcomes in RA. A
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Osteoporosis: Thinking outside the box
As rheumatologists, most of us manage osteoporosis in some form every single day. We have newer agents, newer sequencing strategies, and an increasing number of patients asking for “less medicinal” options that go beyond a prescription. At RWCS, Dr. Gina Woods opened her talk by reframing
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3 Months of Romosozumab in Postmenopausal Osteoporosis
A report in The Lancet Diabetes & Endocrinology suggested that 3 months of romosozumab (ROMO) followed by denosumab is as effective at increasing hip bone mineral density (BMD) as the standard 12-month course. https://t.co/HPM7DdRFBM
Dr. John Cush @RheumNow( View Tweet )
3 Months of Romosozumab in Postmenopausal Osteoporosis
A report in The Lancet Diabetes & Endocrinology suggested that 3 months of romosozumab (ROMO) followed by denosumab is as effective at increasing hip bone mineral density (BMD) as the standard 12-month course. https://t.co/6HfGFZqavF
Dr. John Cush @RheumNow( View Tweet )
3 Months of Romosozumab in Postmenopausal Osteoporosis
A report in The Lancet Diabetes & Endocrinology suggested that 3 months of romosozumab (ROMO) followed by denosumab is as effective at increasing hip bone mineral density (BMD) as the standard 12-month course.
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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
Links:
American College of Rheumatology @ACRheum( View Tweet )
A Modern Approach to Osteoporosis Management
Currently, fewer than half of patients diagnosed with osteoporosis receive appropriate pharmacologic therapy. This treatment gap reflects several challenges in osteoporosis management, including limited disease awareness, barriers to medication access, clinician discomfort with therapy selection
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RT @richardPAconway
Updated data on RA-ILD from Olmstead County. Cumulative incidence of 15.3% over 20 years! #RNL26 https://t.co/wVrTc3QM6Y
Dr. John Cush @RheumNow( View Tweet )
TOPKAT Trial: Partial vs Total Knee Replacement
Patients with osteoarthritis (OA) primarily affecting only one knee joint compartment did just as well with partial knee replacement (PKR) as with total arthroplasty after 10 years in a randomized trial -- and maybe a little bit https://t.co/MNpVeHQbJ2
Dr. John Cush @RheumNow( View Tweet )
Canada's 2025 Top 10 Funded Rheumatology Projects
Arthritis Society
Arthritis Society Canada (ASC) is Canada’s largest charitable funder of cutting-edge arthritis research, investing more than $240 million in research projects since its founding, and over $7 million invested in 2024-2025. Below are the investigators and projects that were funded in 2025.
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Consensus on Managing Vertebral Fractures in Advanced CKD
A coalition of leading international experts has released the first comprehensive Consensus Statement on the Management of Vertebral Fractures in Chronic Kidney Disease (CKD) Stages G4–G5D. The statement highlights a https://t.co/gilX13EaUi
Dr. John Cush @RheumNow( View Tweet )
Rheum Survey> 40 yoF RA pt on Prednisone 5 mg/d is at increased risk for ?
Dr. John Cush @RheumNow( View Tweet )
Rheum Survey> 40 yoF RA pt on Prednisone 5 mg/d is at increased risk for ?
Dr. John Cush @RheumNow( View Tweet )
In Dec 2025, the FDA qualified total hip bone mineral density (BMD) assessed by DXA as a validated surrogate endpoint for osteoporosis clinical trials. Previously OP trials required fracture endpoints as primary efficacy measures, necessitating large 2-5 yr studies https://t.co/5t9rftwX4A
Dr. John Cush @RheumNow( View Tweet )
FIBROSCANS in 60 RA pts on #MTX for 5 yrs w/ liver studies. Mean age = 39.5yrs, w/ Dz Dur 8.2 yrs, mean BMI 24.4 & MTX 12.5–25 mg for ~8 yrs (cum dose 6728mg). All had normal AST, ALT, APRI, Abd US; fibroscan score = 170 ((steatosis grade 0). Only 4(6.7 %) had mild, fibrosis https://t.co/7SACsEYi37
Dr. John Cush @RheumNow( View Tweet )
In Dec 2025, the FDA qualified total hip bone mineral density (BMD) assessed by DXA as a validated surrogate endpoint for osteoporosis clinical trials. Previously OP trials required fracture endpoints as primary efficacy measures, necessitating large 2-5 yr studies https://t.co/q8a7QmoIXs
Dr. John Cush @RheumNow( View Tweet )
FIBROSCANS in 60 RA pts on #MTX for 5 yrs w/ liver studies. Mean age = 39.5yrs, w/ Dz Dur 8.2 yrs, mean BMI 24.4 & MTX 12.5–25 mg for ~8 yrs (cum dose 6728mg). All had normal AST, ALT, APRI, Abd US; fibroscan score = 170 ((steatosis grade 0). Only 4(6.7 %) had mild, fibrosis https://t.co/OOctcfI1sT
Dr. John Cush @RheumNow( View Tweet )
Glucocorticoid Injections in Knee Osteoarthritis
A randomized clinical trial of 60 patients found that glucocorticoid injections into the infrapatellar fat pad (IPFP) did not significantly reduce pain scores in patients with inflammatory knee osteoarthritis (compared to placebo).
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Best of 2025: Targeting Obesity in Rheumatic Disease Patients
Sattar et al. has published an informative overview of the effect of obesity on rheumatic and musculoskeletal diseases (RMDs). They estimate that nearly 70% of RMD patients are overweight or obese.
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Best of 2025: Vitamin D for Prevention of Disease
JAMA has published a clinical guideline on the use of vitamin D to prevent disease in children and adults.
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