New national data on giant cell arteritis: even after years of "steroid-sparing" messaging, patients still averaged 7.6 g of prednisone over two years — and every gram tracked with higher mortality. There is no free steroid dose. doi.org/10.1136/rmdopen-2026-006866

What a great article not only on faculty workloads, but how little our salaries actually factor in to most university budgets. A few highlights. First, our salaries are falling:

New insights in lupus nephritis show abnormal IgG glycosylation triggers podocyte injury via CLEC7A-SYK signaling. Blocking this pathway preserved podocyte function, uncovering a potential novel therapeutic strategy for LN Arthritis & Rheumatology doi.org/10.1002/art....

NIH wants to cap how many grants one scientist can hold. Sounds tidy — in practice it kneecaps the most productive labs and the trainees they fund. Public comment's open till Aug 3, and anyone can write one: https://grants.nih.gov/grants/guide/notice-files/NOT-OD-26-086.html

New Health Affairs piece names what most of us already feel: AI is no longer just "decision support" — it's quietly making prior-auth calls. https://doi.org/10.1093/haschl/qxag141

A House committee is now pressing NIH over the OMB rule that would rewrite how research gets funded. You don't need a lab to weigh in — public comment is open to anyone through July 13. Two minutes: https://www.regulations.gov/commenton/OMB-2026-0034-0001

New EGPA data (30-patient retrospective study): mepolizumab started within 30 days of steroids roughly halved a year's cumulative prednisolone — 25 vs 69 mg/kg. Hypothesis-generating, not practice-changing, but the right direction. https://pubmed.ncbi.nlm.nih.gov/42324522/

New on the Rheumify Substack — Osteoporosis Module 1: bone remodeling and why the osteoclast/osteoblast tug-of-war decides who fractures. https://open.substack.com/pub/rheumify/p/osteoporosis-module-1

The free Notion template I built to run the academic publishing cycle — manuscripts, submissions, paper ideas, abstracts — just added AI agents that draft cover letters and suggest target journals. Still free for rheum: notion.com/templates/scriptcycle

Vision loss in GCA is usually arteritic anterior ischemic optic neuropathy — from occlusion of the posterior ciliary arteries that supply the optic nerve head, not the central retinal artery. Once it's lost, it rarely comes back. pubmed.ncbi.nlm.nih.gov/9559737

Most prior-auth denials are never appealed. In Medicare Advantage, only 11.7% of denied requests were appealed in 2023 — and when patients did appeal, 81.7% were overturned. The friction is the point: deny, and bank on people not fighting back. kff.org

Post a comment to the Federal Register: USPS to impose regulations that impact mail in ballots - based on an Executive Order www.federalregister.gov/documents/20...

GCA is filed under "headache and vision loss," but a 12,955-patient cohort tells a quieter story: higher all-cause mortality and markedly more MI, stroke, and heart failure. It's a cardiovascular disease wearing a temporal-artery disguise. pubmed.ncbi.nlm.nih.gov/42249005

Three federal comment deadlines are quietly stacking up, but this one closes first: the OMB rule that would let political appointees cancel research grants at will. Comment by July 13. regulations.gov/commenton/OMB-2026-0034-0001

New PMR/GCA trial (RESCUE): even on ≤5mg prednisolone, patients can develop adrenal insufficiency that quietly tanks quality of life. It's testing "sick-day" hydrocortisone for the fatigue we too often wave off as "just the disease." pubmed.ncbi.nlm.nih.gov/42276802

The new NIH plan to cap how many grants one scientist can hold won't spread money to the little guy — it'll gut the labs running the trials that gave my lupus and vasculitis patients their drugs. Comments open till Aug 3. NOT-OD-26-086: regulations.gov

ANCA vasculitis: the FDA is moving to withdraw avacopan (Tavneos), alleging ADVOCATE remission endpoints were re-adjudicated after database lock — flipping a nonsignificant result to significant — and citing 76 serious liver-injury cases. Comment by June 29. fda.gov/media/192160/download

Medicaid "work requirements" don't create jobs — they create paperwork that drops eligible, working people from coverage. For my lupus and vasculitis patients, a month off meds can mean a kidney or an eye. Public comments open through the Federal Register: regulations.gov

As of this month in Washington, an AI can approve your prior authorization — but it can't deny it. Only a human can. It sounds like a small rule. It's one of the more sensible sentences in health policy this year, and it should be the national floor. healthcaredive.com

I'm a rheumatologist. About 1 in 4 of my patients is on Medicaid, and many are seriously ill. The proposed Medicaid work requirement (CMS rule, public comments open through July 31) will hurt them. Here's why I'm commenting against it. 🧵

If your coverage is a self-funded employer (ERISA) plan, state "bad faith" law is preempted. Half of insured Americans are in these plans. blog.ifebp.org/erisa-preemption-101/

New French cohort (~13,000 patients): giant cell arteritis carries higher long-term risk of MI, stroke, heart failure, and death vs matched controls. We treat GCA to save vision — but it's a cardiovascular disease too, and we should manage it like one. pubmed.ncbi.nlm.nih.gov/42249005/

There's a federal rule that would let political appointees shape which science gets funded. Comments close July 13. The drugs that keep my GCA patients from going blind exist because review used to reward merit, not loyalty. regulations.gov/commenton/OMB-2026-0034-0001

A federal panel just told Congress what every rheumatologist already knew: an algorithm shouldn't get to deny your medication. MACPAC wants every prior-auth denial reviewed by an actual human with relevant expertise. The bar is on the floor — and we still had to ask. macpac.gov

Massachusetts just killed prior auth for primary care, ER/urgent, maternity, PT/OT, cancer imaging, and certain meds. The paperwork wall between patients and basic care — gone. I hope every other state copies this.

The OMB wants the power to weigh research grants by political fit and cancel awards at will. Comment period closes July 13. Every biologic I prescribe came from merit-reviewed federal science. You don't have to be a scientist to say this is a bad idea. regulations.gov (OMB-2026-0034-0001)

New French cohort, ~13,000 giant cell arteritis patients: higher risk of heart attack (1.6×), stroke, heart failure and death vs controls. GCA isn't just a threat to vision — it's vascular disease end to end. Screen the heart, not only the temporal artery. pubmed.ncbi.nlm.nih.gov/42249005/

The drugs I reach for in vasculitis clinic — tocilizumab, rituximab — exist because federally funded research was judged on whether the science was sound. A proposed OMB rule would change that. Public comment's open through July 13: regulations.gov/commenton/OMB-2026-0034-0001

Mnemonic Monday "GrandPA Cs the PR3tty cytoplasm." GPA = c-ANCA = anti-PR3, cytoplasmic staining. Flip side: Perinuclear (p-ANCA) = anti-MPO = MPA & EGPA. This week: ANCA-associated vasculitis.

Why Rheumify is moving to its own site!

A baby is denied coverage for a NICU stay by @unitedhealtcare.bsky.social

That one time when my son asked Claude if the moon was flat…

How I set up my son to with Claude

Why you need a morning briefing! So powerful and sets me up for an excellent week.

The original federal PA reform rule excluded drugs entirely — biologics, specialty meds, all of it. CMS just proposed fixing that with CMS-0062-P. Comment period closes June 15. Rheumatologists, you know what to do.

I’m horrified by our president’s genocidal threats - I have called, texted and faxed my representatives. Please do the same if you do not believe in the murder of innocent people.

I did a hackathon because, why not??

Give Claude a Gmail account to increase efficiency and limit privacy concerns! rheumify.substack.com/p/claude-cow...

THREAD: Cherise Doyley was in her 12th hour of contractions at the hospital when a tablet was brought to her bedside. On the screen was a Zoom call with a judge and several lawyers and doctors. She was in court, a nurse told her. The reason? For failing to agree to a C-section.

I made a promise to Alex’s parents to continue to tell his story. An ICU nurse at the VA, an outdoorsman, a deeply generous, compassionate friend and family member, and a true son of Minnesota. Rest in peace, Alex.

I made my calls today, did you?

They think they can provoke us into abandoning our values. They are wrong. We will keep the peace. We will secure justice for our neighbors. And we will see this occupation end.

Every time this post or similar ones come back up on my feed I do tear up. I didn't know Alex, but I remember the nurses in residency who had my back, even when I didn't know anything and they could have just been rude to me for being in the way. I hope others get what a great guy he was.

Alex Pretti was a colleague at the VA. We hired him to recruit for our trial. He became an ICU nurse- I lover working with him. He was a good kind person who lived to help and these fuckers executed him. White. Hot. Rage.

Some ways to support Minnesota as people are murdered in the street by the government

I am a 37 year-old healthcare worker who does clinical research ICE just murdered a 37 year-old healthcare worker who does clinical research

I just spoke with the White House after another horrific shooting by federal agents this morning. Minnesota has had it. This is sickening. The President must end this operation. Pull the thousands of violent, untrained officers out of Minnesota. Now.

JUST IN: The incident, which was caught on video, marks the second deadly shooting by federal officers in Minneapolis in less than a month.