Articles By Jack Cush, MD
NP and PA Growth in the USA
Forbes has published a thoughtful perspective on the declining number of US physicians and the growth in the number of advanced practice providers or APPs (nurse practitioners and physician assistants) in the US clinical workforce. Gastroenterologist Dr. Spencer Dorn writes that in the US, there are fewer physicians per capita (2.6 per 1,000) than most developed nations (average 3.6 per 1,000), with a physician shortfall of 125,000, that is projected to be ~200,000 by 2037.
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Adrenal Dysfunction after Steroids in PMR and GCA Patients
JAMA has published a study of PMR and GCA patients who stopped glucocorticoid (GC) therapy and noted a low (1.2%) risk of GC-induced adrenal insufficiency after planned cessation.
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PAFLAR Guidelines for Polyarticular Juvenile Idiopathic Arthritis
The Pediatric African League against Rheumatism (PAFLAR) initiative has published its guidelines for the diagnosis and treatment of polyarticular juvenile idiopathic arthritis (pJIA).
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Axial Involvement in Psoriatic Arthritis
Analysis of a Greek Psoriatic Arthritis (PsA) cohort shows that nearly one quarter of patients have axial involvement, and among them, ∼30% have isolated spinal axPsA and nr-axSpA, respectively.
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Mizoribine Effective in Lupus Nephritis
A randomized clinical trial has shown that oral mizoribine, a common immunosuppressant in Japan, was noninferior to intravenous cyclophosphamide (CTX) as induction therapy in patients with active lupus nephritis.
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World Changers (3.14.2025)
Dr Jack Cush and his podcast friends are out to change the world. Here is his weekly review of the news and journal reports from the past week on RheumNow.
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Channeling Bias and Cancer Risk with Biologic or Targeted Synthetic DMARDs
A retrospective US administrative claims cohort study of RA patients on tumor necrosis factor inhibitors (TNFis), non-TNFi biologics, or Janus kinase inhibitors (JAKis) found a statistically significantly higher risk of incident cancer in patients receiving rituximab, abatacept, or JAKis (compared with TNFis).
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Glucocorticoid Toxicity Index
Dr. John Stone has led the effort to develop the GTI - glucocorticoid toxicity index. In this review article he acknowledges the need and benefit of steroids, but details a novel means to identify and limit the untoward effects of glucorticoids (GC).
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2024 Rheumatology Year in Review
2024 was a year of surprising new growth in technology, with the expansion of new therapeutic options for many patients and clinicians. While these many advances offer new hope, they are countered by disappointments and gapping unmet needs in rheumatology. Below is my top 10 list (in no particular order) of 2024 developments and desires that may change rheumatologic practices.
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Cardiovascular and Fracture Risk with Denosumab Versus Bisphosphonates in Dialysis Patients
Annals of Internal Medicine has published a Japanese administrative claims database study showing that, compared with oral bisphosphonates (BIS), denosumab (DEN) lowered fracture risk by 45%, but increased the risk for major adverse cardia
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