Labs/Biomarkers

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
Dr. John Cush @RheumNow( View Tweet )
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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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Ortho v Rheum

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
Dr. John Cush @RheumNow( View Tweet )
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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>MUC5B in general. #RNL26 https://t.co/L5MOVVGIt3
Dr. John Cush @RheumNow( View Tweet )
RT @richardPAconway MUC5B is strong risk factor for RA-ILD. Specifically for UIP. Associated with both older-onset RA, and ILD earlier following RA presentation. #RNL26 https://t.co/qeLp1BqOEM
Dr. John Cush @RheumNow( View Tweet )
RT @ericdeinmd Mucosal Hypothesis RA #RNL26 Demoruelle ACPA can predate RA development Nam et al: non-specific jt pain: 42% developed RA in 12 mos Circiumaro et al: MSK complaints 38% devel RA in 36 mo APIPPRA: 29% at 12 mo, 37% at 24 mo, StopRA 18% in 12 mo, 33% at 36 mo https://t.co/DxGhhFL1gO
Dr. John Cush @RheumNow( View Tweet )
RT @ericdeinMD Mucosal Hypothesis RA #RNL26 Demoruelle ACPA can predate RA development Nam et al: non-specific jt pain: 42% developed RA in 12 mos Circiumaro et al: MSK complaints 38% devel RA in 36 mo APIPPRA: 29% at 12 mo, 37% at 24 mo, StopRA 18% in 12 mo, 33% at 36 mo https://t.co/JYiWmn0N0g
Dr. John Cush @RheumNow( View Tweet )
RT @richardPAconway Dr Sparks. RA-ILD is common. Pooled prevalence of 11% from recent meta-analysis. Less common than SSc or IIM, but more frequent than we think! #RNL26 https://t.co/TCsDfeQjZC
Dr. John Cush @RheumNow( View Tweet )
RT @ericdeinmd Mortality risk in RA #RNL26 Myasoedova Most common mortality: 1.5-1.6x increase risk CVD 2-3x increase risk ILD +ACPA increases risk in both https://t.co/Luwyy6UFg6
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Factors that may augment future development of SLE - includes Vitamin D levels, poor sleep, EBV reactivation & social determinants of health. Can you Prevent SLE? Dr. David Karp lecturing at UTSW @drdavidkarp @utswrheum https://t.co/2J1JBjeXKU
Dr. John Cush @RheumNow( View Tweet )
Air pollution ups ANA+: Ontariio Canadi study of 3548 serum samples (2010-13) corrlated particulate matter (PM2.5) w/ serologies. Highest vs lowest quartile PM2.5 showed higher risk of ANA ≥1:640 (OR 1.46) & ≥1:1280 (OR 1.54). Pollution has systemic immune effects! https://t.co/iyC68qh49R
Dr. John Cush @RheumNow( View Tweet )
NEXT STEPS: Karp and investigators are engaged in the MONA LISA study - Using smile Data and biospeciments – they intend to look for biomarkers that may better predict the future development of SLE Dr. David Karp lecturing at UTSW @drdavidkarp @utswrheum https://t.co/acZD1kmNhq
Dr. John Cush @RheumNow( View Tweet )
Factors that may augment future development of SLE - includes Vitamin D levels, poor sleep, EBV reactivation & social determinants of health. Can you Prevent SLE? Dr. David Karp lecturing at UTSW @drdavidkarp @utswrheum https://t.co/e3TKATcxXB
Dr. John Cush @RheumNow( View Tweet )
Can you Prevent SLE? Dr. David Karp lecturing at UTSW Showing that autoantibodies exist long before the onset of SLE @drdavidkarp @utswrheum https://t.co/zPAYbSlIBS
Dr. John Cush @RheumNow( View Tweet )
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ALTO: Long-Term Abatacept Outcomes in At-Risk RA

Jack Cush, MD

Lancet Rheumatology has published the ALTO results - long term outcomes of the APIPPRA trial, demonstrating that treatment with abatacept (ABA) in at risk patients can delay progression to rheumatoid arthritis (RA) for up to 4 years.

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Giant Cell Arteritis Outcomes in Canada

Jack Cush, MD

A retrospective cohort study of patients with giant cell arteritis (GCA) demonstrates relapses are common and seen in nearly half of patients, were common after treatment is stopped and is not effectively averted by methotrexate (MTX).

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Notch and TGFβ Signaling in Refractory Rheumatoid Arthritis Spatial transcriptomic profiling of rheumatoid arthritis (RA) synovial biopsies (pre- and post-treatment) has revealed new insights into the pathobiology or treatment resistent RA. https://t.co/vCvFpnIOvS https://t.co/EV6OihT0br

Links:

Dr. John Cush @RheumNow( View Tweet )
Air pollution ups ANA+: Ontariio Canadi study of 3548 serum samples (2010-13) corrlated particulate matter (PM2.5) w/ serologies. Highest vs lowest quartile PM2.5 showed higher risk of ANA ≥1:640 (OR 1.46) & ≥1:1280 (OR 1.54). Pollution has systemic immune effects! https://t.co/fJrhypNE2A
Dr. John Cush @RheumNow( View Tweet )
Testing for RF, CCP, ESR and CRP Check out the accompanying Advanced Practice Rheum: Rheumatoid and Inflammation Testing video. https://t.co/4hkDO1M2UD https://t.co/APRKYLAS3k

Links:

Dr. John Cush @RheumNow( View Tweet )
Minnesota Mayo clinic retrospective, population study of RF & CCP in 1373 incident RA pts. At Dx, 37% dual seropositive, 13% +CCP only, 12% +RF only, & 38% seronegative. zDual seropositives had more erosions (31%) & flares (69% vs 51%). But +RF only highest mortality (adj 2.18) https://t.co/hPQewVgPoq
Dr. John Cush @RheumNow( View Tweet )
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Consensus on Managing Vertebral Fractures in Advanced CKD

EurekAlert!

A coalition of leading international experts have released the first comprehensive Consensus Statement on the Management of Vertebral Fractures in Chronic Kidney Disease (CKD) Stages G4–G5D. The statement highlights a neglected yet devastating complication of advanced

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Testing for RF, CCP, ESR and CRP Check out the accompanying Advanced Practice Rheum: Rheumatoid and Inflammation Testing video. https://t.co/o1sle6CKg5 https://t.co/roYXcbPdBh

Links:

Dr. John Cush @RheumNow( View Tweet )

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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Recent Blogs

Advanced Practice Rheum

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
Cush RhTh CNS
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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