Labs/Biomarkers

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Pitfalls of autoimmune serologic testing

Jack Cush, MD

Misuse of laboratory testing may lead to misdiagnoses and mismanagement; this is particulary prevalent when clinicians consider the use of the diagnostic use of  serological autoimmune markers. 

A current review focuses commonly used serologies and autoimmune tests to identify

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Worldwide Trends in Hyperuricemia

Jack Cush, MD

A Lancet Rheumatology systematic review shows the prevalence of hyperuricaemia has risen markedly over the past two decades in both men and women, owing to population growth, aging, and increasing age-specific rates

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Metanalysis of calcineurin inhib. in RA - 11 RCTs, 1793 RA pts. Cyclosporin (CSA( (RR 1.6 & Tacrolimus (TAC (RR 2.1) signif improved ACR20 responses. CSA was dose dependent, less so w/ TAC. Both require serum Creat. monitoring consistent increase in s-Cr https://t.co/OxNGYbupnt https://t.co/F08vDCMYtr

Links:

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Rheumatic Immune-related Adverse Effects with Checkpoint Inhibitor Therapy

Jack Cush, MD

A retrospective study of patients who developed rheumatic immune-related adverse events (R-irAEs) after receiving immune checkpoint inhibitors (ICIs) at two oncology centers in Spain suggests that early recognition can lead to effective management that allows continuation of cancer therapy.

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Managing Gout in CKD Patients

Jack Cush, MD

A current review article addressed the management of gout patients with chronic kidney disease (CKD).  This full read review addresses the epidemiology, challenges, treatment decisions and outcomes. 

The prevalence of gout rises with each stage of CKD; from 4%, 6% to 10%, 11%

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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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NEJM: Obinutuzumab in Active Systemic Lupus Erythematosus

Jack Cush, MD

A phase 3 trial of obinutuzumab, an anti-CD20 monoclonal antibody, showed potent B-cell depletion and clinical efficacy active systemic lupus erythematosus without evidence of nephritis.

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Update on FDA complete response letter to AZ regarding BLA hold for anifrolumab (Saphnelo) for SC use in SLE. CRL originally issued 10/10/25, but announced 2/3/26. FDA CRL cites critical data quality w/ key analyses in SC-TULIP study. A BLA decision expected in 1st half of 2026 https://t.co/zuwtsdL6I9
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US Epidemiologic survey data from NHANES gout prevalence is incr. in RA pts vs controls (10.3% vs. 4.8%, P < 0.001), increasing trend over time. RA is as an independent risk factor for gout (OR: 2.67), strongest in SNRA. Evidence for the converse may not be as strong. https://t.co/hhRT9NCzVG
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UBER Rheumatology Ride (3.6.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this week on RheumNow.com

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Metanalysis of 8 articles, 2655 gout pts shows that ELEVATED neutrophil-to-lymphocyte ratio (NLR; SMD: 0.75; 95% CI: 0.48–1.03) and platelet-lymphocyte ratio (PLR; SMD: 0.52; 95% CI: 0.24–0.79) showed significant value in predicting acute gout attacks https://t.co/RaArPdoc2s https://t.co/Qi2WDSPlde

Links:

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Open-access Arthralgia Clinics

Jack Cush, MD

The early diagnosis in inflammatory arthritis (IA), particularly rheumatoid arthritis (RA), hinges on efficient referral and screening of arthralgia patients. Yet most rheumatology practices are ill equipped or don't
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Treat-to-Target and Cardiovascular Benefits in Gout

Jack Cush, MD

A new user cohort study of 109 504 gout patients, achieving a serum urate level less than 6 mg/dL, was associated with a significantly lower risk of cardiovascular events.

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US Epidemiologic survey data from NHANES gout prevalence is incr. in RA pts vs controls (10.3% vs. 4.8%, P < 0.001), increasing trend over time. RA is as an independent risk factor for gout (OR: 2.67), strongest in SNRA. Evidence for the converse may not be as strong. https://t.co/VzDcJ2hTKw
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Antimitochondrial antibodies (AMA)in systemic sclerosis? Retro study of 165 SSc pts (20% diffuse, 33% ILD, 7% PAH); 51% centromere AB+; 29% topoisomerase I+, 12% RNA polymerase III+)-- 22% AMA-positive: assoc w/ GI vascular dz(OR 13.3), gastric antral vascular ectasia (OR 8) & https://t.co/FRhn9qIfOW
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SATISFACTION (2.27.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.

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UK Retrospective analysis of 2 RA cohorts, 2,701 pts (F/U 6 yrs) = 101 (3.7%) Dx with ILD. (12 @ baseline, 46 w/ F/U, 43 @ death). ILD Dx signif. assoc w/ onset age (aOR 1.03), seropositivity (aOR 2.58), ever smoking (aOR 1.7). https://t.co/Zvkb1Wjpa4 https://t.co/YMkWDc3rMr

Links:

Dr. John Cush @RheumNow( View Tweet )
Case-control study of 72 estab. & 56 early RA pts the diagnostic performance of 14-3-3η testing showed AUC ≥0.85 for early & estab.RA. Early RA, -CCP had better specificity (96.4%) and a positive likelihood ratio (21.2%), while 14-3-3η had higher sensitivity (88.1%) https://t.co/jaUux9quy6
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Antimitochondrial antibodies (AMA)in systemic sclerosis? Retro study of 165 SSc pts (20% diffuse, 33% ILD, 7% PAH); 51% centromere AB+; 29% topoisomerase I+, 12% RNA polymerase III+)-- 22% AMA-positive: assoc w/ GI vascular dz(OR 13.3), gastric antral vascular ectasia (OR 8) & https://t.co/epMgfbj5uW
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Early vs Delayed Belimumab in Lupus

Jack Cush, MD

An economic evaluation of early vs delayed use of the Blys inhibitor, belimumab (BEL), in systemic lupus erythematosus (SLE) has shown both cost effectiveness and clinical utility of early BEL initiation in active lupus patients.

While most would advocate for using your best therapy

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Referral Rules to Live By (2.20.2026)

Jack Cush, MD

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.

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Referrals - Orthopedics or Rheumatology?

Jack Cush, MD

“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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RT @RichardPAConway Odds ratios for ILD in early RA from SAIL-RA study. Again disease activity stands out. #RNL26 https://t.co/9cXjOFl3Th
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Maui Potpourri (2.13.2026)

Jack Cush, MD

Dr. Jack Cush reviews the hot item takeaways from last week's RheumNow.Live 2026.

  1. Diet & Obesity Management in Rheumatology - Uzma Haque, MD
  2. Mitigating risk for Rheum patients undergoing orthopedic surgery - Susan Goodman, MD
  3. Paradoxical skin reactions – Joseph
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RT @richardPAconway Lifetime risk of ILD by RA/sex/MUC5B status. We can see the synergistic effect. Also note RA&gt;MUC5B in general. #RNL26 https://t.co/L5MOVVGIt3
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Therapeutic Updates

ILD Treatment and Guidelines

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Watch our 11-video series on ILD Treatment and Guidelines including videos on assessing ILD, guidelines caveats and concerns, and more.
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Rheumatoid & Inflammation Testing

Jack Cush, MD
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Master the dos and don'ts of ordering RF, CCP (ACPA), and inflammatory markers that could transform your diagnostic accuracy.
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CNS Lupus (NPSLE)

Jack Cush, MD
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29 yr. old woman with SLE and transverse myelitis. Is this NPSLE; how to diagnose?
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Unpopular opinion: spinach can be bad for you

Lara El Khoury, MD
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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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