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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Screening High Risk Myositis Patients for Cancer
An Italian retrospective study of 411 idiopathic inflammatory myopathies (IIM) patients applied IMACS criteria to assess the risk of cancer and found significantly more cancers in those at high risk.
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ILD in RA – Dr. Jeffrey Sparks
In this https://t.co/4UQlqwujiR 2026 podcast, Dr. Jeffrey Sparks reviews the latest advances shaping diagnosis and management of ILD in RA.
🎧 Listen here: https://t.co/U5cZVlgAka
#Rheumatology #ILD #RNL2026 https://t.co/LidiS3Wj9d
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COMMON - Incidental Rotator Cuff Abnormalities on MRI
In this cross-sectional study of 602 Finnish adults undergoing bilateral shoulder magnetic resonance imaging (MRI) and clinical assessment, abnormalities were found in nearly everyone over age 40 years, regardless of whether https://t.co/2n58lglVP0
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Top Four and More (4.10.2026)
Dr. Jack Cush reviews the news and journal reports from RheumNow.com this week - including his top four favorite subjects.
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JAMA Guideline on the Management of Crohn Disease
JAMA has published a current Clinical Guidelines Synopsis on the Management of Crohn Disease (CD) in Adults.
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COMMON - Incidental Rotator Cuff Abnormalities on MRI
In this cross-sectional study of 602 Finnish adults undergoing bilateral shoulder magnetic resonance imaging (MRI) and clinical assessment, found abnormalities in nearly everyone over age 40yrs, regardless if asymptomatic or symptomatic.
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Update on Primary CNS Angiitis
The Journal of Neurology has posted a review and update of Primary CNS vasculitis (PCNSV), also termed primary angiitis of the CNS (PACNS). PCNSV is rare, potentially fatal, and highly treatable, making timely recognition and accurate diagnosis https://t.co/cjGX1ig8Lp
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"When there are conflicting diagnostic possibilities, trust your excellent history and physical examination more than laboratory testing and imaging."
- Arthur Weinstein, MD
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What’s New PsA? (4.3.2026)
Dr. Jack Cush reviews the news and major articles from this week, including FDA safety warnings, reports from AAD, PsA trials.
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Review: Rheumatoid Arthritis–Associated Interstitial Lung Disease
RA-ILD represents the most severe extra-articular manifestation of rheumatoid arthritis, affecting an estimated 1% of the adult population in the US and Northern Europe. Prevalence estimates vary widely (up to 58%), reflecting different diagnostic criteria, imaging modalities, and study
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AXIS is an Intl prospective study of 409 psoriatic arthritis pts - found Axial involvement in 27.4% of pts. Axial PsA signif younger (45 vs 47.6 yrs) , male (56% vs 51.5%), more B27 positivity (22% vs 11%), inflammatory back pain (75% vs 43%), & ^CRP (53% vs 37%) https://t.co/XY5pf4BNNm
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Economic analysis of ESR & CRP testing (are they same or different?). Compared to doing either ESR OR CRP, they found the ESR + CRP testing was cost-effective strategy, reducing misdiagnoses, followup costs and overall healthcare costs. https://t.co/UU15bxuPKP https://t.co/7aWwBM8CdY
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AI model was superior in diagnosing Acromegaly from dorsal hand photographs - w. sensitivity 0.89, specificity 0.91, PPV 0.88, NPV 0.93, F1-score of 0.89, AUC 0.96, outperforming specialists, Study of 716 pts (317 acromegaly; 399 controls) & 11480 images, from 15 Japanese https://t.co/8RM4wf8vGi
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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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Is Giant cell arteritis over diagnosed or over-referred? Caution IF the patient is: 1) under age 50yrs; 2) has Hx of chronic HA or migraine; 3) has normal ESR/CRP. Why not consider screen w/ Giant Cell Arteritis Probability Score (needing 9.5/32 points) https://t.co/qnCWgzjYJ4 https://t.co/LT6atm0m8f
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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.
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Paradoxical Reactions, Target Selection & the Future of Imaging in Psoriatic Care
At RheumNow Live, Dr. Joseph Merola presented a compelling discussion on paradoxical immune reactions in psoriatic disease. He began with a case of a 60-year-old woman with mild psoriasis who, https://t.co/AVIOO42vfP
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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
Links:
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Diagnosing and Managing GCA and Takayasu’s Arteritis
Giant-cell arteritis and Takayasu’s arteritis are both large-vessel vasculitides, but each brings its own diagnostic and management challenges. Many of the difficulties overlap because they are rare, heterogeneous, and lack perfect diagnostic tests or specific biomarkers.
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Referrals - Orthopedics or Rheumatology?
“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
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Paradoxical Reactions, Target Selection & the Future of Imaging in Psoriatic Care
From paradoxical psoriasis to IL-23 vs IL-17 to imaging in PsA, speakers in RheumNow Live's "Decisions in Psoriatic Arthritis" pod delivered valuable, clinically relevant education.
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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
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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 )
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/PR4h2qniEL
Links:
Dr. John Cush @RheumNow( View Tweet )
Therapeutic Updates
Diagnosis of PMR
RheumNow
Nine perspectives now available: Red Flags in the Diagnosis of PMR; Epidemiology of PMR; Role of the PCP in Diagnosis and Care; Importance of Diagnostic Imaging; ESR/CRP in PMR; PMR Must Rule Outs; Which PMR Patients Should Rheumatologists See?; Is There Hidden GCA?; and PMR Mimics.
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Recent Blogs
For decades we've been screening GCA with a patient history and exam. Doing so with imaging would be a sharp departure from the current standard of care. And you may be asking yourself, well, yeah, but what could it hurt? Don't you want to catch GCA early?
Let me tell you the problems with this.
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PMR might be one of the most rewarding diagnoses to make in real practice: the patient comes to you in severe debilitating pain, and you prescribe steroids, giving them their lives back! As much as this impressive response makes your intervention appear almost magical, there is the often-forgotten story about the implications of such a diagnosis and treatment on patients' daily lives.
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Podcasts
ACR Podcast - Day1A
