Top Four and More (4.10.2026)

In this episode of the Rheumnow Podcast, host Dr. David T. T. Lee shares his 'top four' public health concerns in rheumatology, beginning with the persistent obesity epidemic in the U.S., with 40.3% of adults classified as obese as of 2023. He emphasizes the critical need for routine mental health screening—particularly using tools like PHQ-2 or PHQ-9—for autoimmune patients, citing a UK study showing significantly higher rates of depression and anxiety in this population. The opioid crisis remains a concern despite declining long-term use, and the rising use of gabapentin raises red flags due to weak evidence and potential misuse. The fourth 'Jack Cush problem' is Still’s disease, with a focus on predicting the deadly complication macrophage activation syndrome (MAS) using machine learning. The episode also covers key research findings: itch in systemic sclerosis affecting 35–40% of patients, mucocutaneous lupus in 36% of a large cohort, flares in dermatomyositis linked to cancer risk, and a five-year Italian study showing elevated cancer risk in autoimmune patients—especially in the first year post-diagnosis. Additional highlights include PJP prophylaxis in AAV, diagnostic accuracy in polymyalgia rheumatica, surprising parity in RA management between orthopedists and rheumatologists in Japan, and cost-effective results of tofacitinib over methotrexate in a Chinese trial. The episode concludes with a caution against overinterpreting rotator cuff findings on MRI, noting that abnormalities are nearly universal in older adults regardless of symptoms.