Dr. John Cush

Socioeconomic Status of Communities With Primary Care Practices With NPs This cross-sectional study compares the socioeconomic characteristics of communities that have primary care practices with or without nurse practitioners (NPs).

Cross-sectional study of 79 743 US primary care practices compared those with and without NPs. NP practices were more likely to be located in lower incomes and lower educational communities. NPs predominated in areas with highest need but lowest supply of PCPs. jamanetwork.com/journals/jam...

Association between sleep disorders and rheumatoid arthritis in U.S. adults - Arthritis Research & Therapy Background Evidence on the association between sleep disorders and rheumatoid arthritis (RA) remains limited. This study aimed to investigate this relationship in U.S. adults using data from the…

2018 NHANES population survey of 28,040 individuals, 4168 (14.32%) identified with sleep disorders, and 1589 (4.28%) had #RA. Thus, sleep disorders were significantly associated with increased odds of RA (OR = 1.76, 95% CI: 1.46–2.13, P < 0.001). link.springer.com/article/10.1...

APPs in the news (12.5.2025)

Dr. Jack Cush reviews the news and journal reports from RheumNow.com, including info on scleroderma, dermatomyositis and malignancy, rheumatologist and APP salaries concerns.

rheumnow.com/video/apps-n...

QD Clinic: CAR-T Cell Therapy for Lupus

Philip Mease, MD, and Cayla Alexander, DNP, ARNP, in Seattle, discuss a lupus patient's CAR-T cell therapy case for RheumNow's "Mission: APP Partners in Care" December campaign.

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The impact of non‐steroidal anti‐inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: 10‐year results from an inception cohort Objectives This study aims to investigate the impact of non-steroidal anti-inflammatory drug (NSAID) intake on radiographic spinal progression in axial spondyloarthritis (axSpA), considering…

GESPIC - German SpA study of 252 SpA (139 nr- axSpA, 113 r-axSpA), followed w/ serial Xrays and mSASS Scores over 2 yrs. 80% were on NSAIDs. Higher NSAID intake, particularly COX2i, on slowing radiographic progression in axSpA acrjournals.onlinelibrary.wiley.com/doi/abs/10.1...

Low Dose Naltrexone for Fibromyalgia Pain - Use it or Lose it?

Medscape recently reviewed off-label use of LDN in FM and found it is deemed effective by some clinicians and patients, but 1) there is no FDA indication for LDN use in FM and 2) the data supporting its use is limited.

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Cochrane review of nurse-led care (NLC) in RA, included 14 articles & 3369 RA pts. NLC proves was effective in managing RA, surpassing usual care and equating to rheumatologist-led care in dz activity and some secondary (self efficacy, pain, QOL) outcomes bmjopenquality.bmj.com/content/14/1...

Painful Hand Swelling With Finger Contractures A 56-year-old woman with no history of rheumatic disease or hand injury had swelling and tenderness of the bilateral wrists, metacarpophalangeal and proximal interphalangeal joints, nodular palmar…

JAMA Case Challenge - Painful Hand Swelling With Finger Contractures
56-yoF w/ BL hand contractures, 15 mos BL hand pain/swelling/stiffness. No or partial relief w/ ibuprofen, 30 mg prednisone, MTX 10-20 mg/wk. All labs were normal. Whats the Dx? jamanetwork.com/journals/jam...

"Act as if what you do makes a difference. It does." – William James

Survey of 500 Rheum Pts, 37% reported having APPs (NP, PA) as primary rheum providers. APP patients had greater ease scheduling& more prefer to see APPs over rheumatologists (P < 0.01) & recommend APPs . No difference between MD vs APP experience acrjournals.onlinelibrary.wiley.com/doi/abs/10.1...

Predicting Malignant Disease in Adult Patients With Dermatomyositis This cohort study validates the usefulness of a novel prediction model for cancer-associated likelihood in adult patients with dermatomyositis.

Retrospective study of 546 DM or clinically amyopathicDM. 5 factors were signif assoc w/ cancer (1 point ea): 1) TIFF-1-γ Ab (OR 3.8), poikiloderma (OR 3.1), DM subtype (2.8), anemia (2.4); ILD was protective (OR 0.4). Elevated DM cancer risk seen w/ scores 4-5 jamanetwork.com/journals/jam...

Changing Loan Limits for APPs

The "One Big Beautiful Bill" (OBBB) changes healthcare education funding by lowering loan limits for graduate programs--this aims to address the federal budget, reduce the DOE's role, and counter claims that unlimited loans raise tuition in the USA.

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ICYMI: Inflammatory vs. Noninflammatory Pain

rheumnow.com/resource/icy...

High Cost of Cancelling Knee Replacement Surgery

NHS knee replacement surgeries are often cancelled at short notice each year for preventable reasons, leading to millions in costs and longer waiting times for patients in severe pain, according to a study released on December 1st.
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Legislative Issues Affecting APPs

Major interstate “compacts” allow for cross state licensing for physicians. However, compacts for Advanced Practice Registered Nurse (APRN) are fewer and currently on hold - thereby limiting healthcare manpower and patient care.

rheumnow.com/news/legisla...

Hiring, Onboarding and Training APPs

Watch our kickoff webinar for this month's Mission: APP — Partners in Care campaign. Our panel of rheumatologists and experienced advanced practice providers share insights into hiring, onboarding, training, compensation, and more.

rheumnow.com/video/hiring...

QD Clinic: Flare or Beware

Lindsay Tom, PA-C and Phong Nguyen, MD, Reston, VA discuss today's case called "Flare or Beware", involving a patient who has psoriatic arthritis mutilans, presented as part of RheumNow's "Mission: APP Partners in Care" campaign.

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RheumNow Live 2026
Where the data meets the dialogue.
Join leading rheumatologists, researchers, and innovators at RheumNow Live 2026 — the meeting redefining rheumatology education.

🕓 Early Bird registration is open until 12/1.
Save now ➡️https://rheumnow.live

A substantial number of patients with PsA, have difficult, persistent and hard-to-treat disease. A GRAPPA task force has developed a consensus terminology for two distinct states:

Complex-to-manage PsA (C2M-PsA)
Treatment-refractory PsA (TR-PsA)

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Hematologic Malignancies Increased in Systemic Sclerosis

Swedish national study found that among a cohort of systemic sclerosis (SSc) patients a two-fold increase risk of hematological malignancies was seen.

rheumnow.com/news/hematol...

Long-Term APP Retention: Building Success for Practices and Providers

Long-term APP retention is vital in rheumatology due to rising patient numbers and the need for prompt care. Integrating APPs improves practice efficiency, patient access, and clinician workload balance.

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Turkey Tryptophan (11.28.2025)

Dr. Jack Cush reviews the news and reports from this past week on RheumNow, including reports on FDA resurrections, FM seasonal worsening, and do you fight switch or swap biologics in PsA TNFi nonresponders?

rheumnow.com/news/turkey-...

WHO recommendations on GLP-1 agonists: 1) conditional recommendation - GLP-1 drugs can be used for for long-term obesity treatment by adults, except pregnant women; 2) GLP-1a use should be paired with a healthy diet and physical activity. Access is a problem. www.reuters.com/business/hea...

U Colorado compared 10K Traditional Rheum consults (TC) to 670 eConsults. 75% eConsults completed without F2F & 73% w/in 3 days. eConsults referred to F2F had better 180d completion rates (36% vs 19% TC). Dx & Rx rates were similar. Most from PCPs. acrjournals.onlinelibrary.wiley.com/doi/abs/10.1...

7 Fast Facts About Rheumatologist Compensation Limited pay increases and pay dissatisfaction continue to challenge many rheumatologists. Learn about key trends in the specialty's pay and compensation.

Fast Facts About Rheumatologist Compensation 2025:
- Rheum among lowest paid (~$284k)
- 2024 salaries rose 2%
- 53% say theyre underpaid
- 41% supplement their income
- 6/10 recv incentive bonuses resources.healthgrades.com/pro/6-surpri...

Sodium Glucose Co-Transporter-2 inhibitors in patients with systemic sclerosis with or without heart failure Patients with systemic sclerosis are at heightened risk of developing heart failure. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown cardio-renal benefits in diverse populations with…

TriNetX retrosp cohort study of 1402 propensity matched Systemic Sclerosis pts on vs off SGLT2 inhib(2013-2025) & found SGLT2i significantly lowered all-cause mortality (HR 0.54), stroke (HR 0.64), & hospitalizations (HR 0.76), moreso in SSc without Hx of CHF (HR 0.62) www.amjmed.com/article/S000...

Coccyx and Sacrococcygeal Joint Disorders

Coccyx and sacrococcygeal disorders cause rare and difficult-to-diagnose pain, often confused with lumbosacral, pelvic, or gastrointestinal issues. This review discusses the epidemiology, anatomy, biomechanics, symptoms, and more.

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RNL 25 Replay: Vasculitis

Enjoy these excerpts from the RNL 2025 meeting, and join us for RNL 2026 in Dallas, TX - registration is now open! Visit rheumnow.live for complete details.

rheumnow.com/video/rnl-25...

Treating Refractory Still's Disease
A systematic review article explored treatment options for systemic juvenile idiopathic arthritis, or Still’s disease, focusing on patients with persistent arthritis, challenging macrophage activation syndrome (MAS), or interstitial lung disease.

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SARS-CoV-2 vaccination and myositis in Norway and Sweden AbstractObjectives. To characterize the risk of myositis after SARS-CoV-2 vaccination with mRNA or adenoviral vector vaccines.Methods. We conducted a popul

Scandinavian study of > 13.6 million PYs shows NO increased risk of myositis after SARS-CoV-2 (mRNA & adenoviral vector) vaccines. Data from 101 myositis events in 7,002 398 unvaccinated PYs. Adj IRR 180d risk was 0.84 (0.63–1.11) and 1.31 (0.72–2.36) respectively academic.oup.com/rheumatology...