Osteoarthritis

Nordic Registry Study on NSAID use of ~750K, w/ 34-40% under 60 yrs. 48-58% started NSAIDs before Dx of OA. NSAID use incr w/ age from 18 to 55 yrs, then declined. OA pts have a substantial risk of GI complications in all age groups, including those under 60 yrs. Need to consider https://t.co/PLoUVI4Hys
Dr. John Cush @RheumNow( View Tweet )
VA registry study; among 2771 RA pts (~65y), 64 (2.3%) had CPPD by ICD9/10 codes. RA+CPPD pts signif older [68 v. 64y], w/ more comorbidity/OA (94 v 80%), spine Dz, DM, but less ACPA (63 v 78%). SNRA+CPPD achieved less LDA, more use of pred & b/tsDMARDs (OR >2), death, TJR. Is https://t.co/hUPJzDseVc
Dr. John Cush @RheumNow( View Tweet )
Obesity and Low Back Pain A large patient population study finds weight gain, increases risk for low back pain - the risk increased 7% for every BMI unit or 10 pounds over ideal weight. https://t.co/EZQwhLpNjg https://t.co/tIlEQmedp7

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Dr. John Cush @RheumNow( View Tweet )
Adult co-twin study of 1261 pairs, 1/2 Rx w/ metformin. Although metformin Rx Twin had higher BMI, they had significantly less incident peripheral OA (adjusted HR 0.60; 0.44–0.82). @ 10 yrs, 6.7% of treated twins, vs 9.7% of non-treated twins had incident OA, with difference of https://t.co/7KpiGssFSo
Dr. John Cush @RheumNow( View Tweet )
Knee,injection

Glucocorticoid Injections in Knee Osteoarthritis

Jack Cush, MD

A randomized clinical trial of 60 patients found that glucocorticoid injections into the infrapatellar fat pad (IPFP) did not significantly reduce pain scores in patients with inflammatory knee osteoarthritis (compared to placebo).

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Obesity and Low Back Pain

EurekAlert!

A large patient population study finds weight gain,  increases risk for low back pain - the risk increased 7% for every BMI unit or 10 pounds over ideal weight. 

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Comprehensive review of the management of knee osteoarthritis - topicals, analgesics, narcotics, intraarticular, metabolic, nutraceuticals, TENS, acupuncture and biologics. https://t.co/3UjPQeZut9 https://t.co/z0dzENSbtX

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Dr. John Cush @RheumNow( View Tweet )
Lilly announced phase 3 RCT TRIUMPH-4, where Retatrutide, a new GIP, GLP-1 & glucagon recpt agonist, was given to obese (BMI >35), knee osteoarthritis pts *without diabetes*. Wt loss at 68 wks was 28.7% with reduced WOMAC pain scores of -4.5 points (75.8%) https://t.co/73yIyvwRtL
Dr. John Cush @RheumNow( View Tweet )
French ESTIVAL study - DB, sham trial of auricular vagal N stimulation in 148 Erosive hand OA (eHOA) pts w/ erosion + synovitis by US. @12wks, no signif difference in VAS pain (–16·0 vs –6 sham; p=0·22) w/ no safety issues. Was this a failed study or encouraging outcome? https://t.co/KI86H9izYS
Dr. John Cush @RheumNow( View Tweet )
Dr, Tuhina Neogi writes its time for a new understanding of OA; its not just wear n tear. Based on preclinical and clinical evidence, OA is a systemic, whole-body disease and that this should change future research and treatment of #OA. https://t.co/gn9xt6CafP https://t.co/2iSKiyiCX4

Links:

Dr. John Cush @RheumNow( View Tweet )
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Reefer Madness (12.12.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal and regulatory reports from this past week on RheumNow.com.  B cell drugs in SLE and ITP, biomarkers in GCA & PSS and great videos by APPs.

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cannabis,weed,marijuana

Medical Cannabis for Pain Management

Jack Cush, MD

Recent research and publications have underscored the use, efficacy, safety and limitations to the use of cannabis for arthritis and pain patients.

Chronic pain affects more than one in five American adults, yet practitioners are limited in treatment alternatives. Even if we exclude the

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Phase 1 trial of IL-6 targeting immunotherapy (PPV-06) in 24 pts w/ inflammatory knee osteoarthritis (KOA) demonstrates safety, Abs that neutralize IL-6, decreasing CRP values and improved clinical outcomes, determined by changes in KOOS scores https://t.co/urZupN62Kw https://t.co/sru1SnsOig

Links:

Dr. John Cush @RheumNow( View Tweet )
Dr, Tuhina Neogi writes its time for a new understanding of OA; its not just wear n tear. Based on preclinical and clinical evidence, OA is a systemic, whole-body disease and that this should change future research and treatment of #OA. https://t.co/HQWI14WSXg https://t.co/5bIWgqaETU

Links:

Dr. John Cush @RheumNow( View Tweet )
Coccyx and Sacrococcygeal Joint Disorders Pain from coccygeal or sacrococcygeal disorders is rare, often presenting as a diagnostic challenge. Coccygeal pain is often mistaken for lumbosacral, pelvic, or gastrointestinal disorders. This review presents the epidemiology, https://t.co/zrGDwULms5
Dr. John Cush @RheumNow( View Tweet )
Coccyx and Sacrococcygeal Joint Disorders Pain from coccygeal or sacrococcygeal disorders is rare, often presenting as a diagnostic challenge. Coccygeal pain is often mistaken for lumbosacral, pelvic, or gastrointestinal disorders. This review presents the epidemiology, https://t.co/u4w3b915my
Dr. John Cush @RheumNow( View Tweet )
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High Cost of Cancelling Knee Replacement Surgery

Jack Cush, MD

Thousands of NHS knee replacement operations are cancelled at short notice every year, many for avoidable reasons, according to a new study published December 1st. This costs the NHS millions of pounds and increases waiting times for patients, many of whom are in severe pain.

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coccyx

Coccyx and Sacrococcygeal Joint Disorders

Jack Cush, MD

Pain from coccygeal or sacrococcygeal disorders is rare, often presenting as a diagnostic challenge. Coccygeal pain is often mistaken for lumbosacral, pelvic, or gastrointestinal disorders. This review presents the epidemiology, anatomy, biomechanics, presentations, diagnostic evaluation,

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Partial vs Total Knee Replacement: Is One Superior?

Patients with osteoarthritis (OA) primarily affecting only one knee joint compartment did just as well with partial knee replacement (PKR) as with total arthroplasty after 10 years in a randomized trial -- and maybe a little bit better. Final results of the landmark TOPKAT study indicated that

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Colchicine prevents total joint arthroplasty (TJA). Study of 31,478 colchicine initiators, followed 4.5 yrs. W/ an overall 12% lower risk of TJA (HR 0.88 95% CI 0.81 to 0.96), and a 23% lower risk of TJA in those with knee/hip OA (HR 0.77) https://t.co/1JsZd8K0sI

Links:

Dr. John Cush @RheumNow( View Tweet )

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Vitamin D and Lupus Outcomes (11.21.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.

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Target emulation trial of 12,145 Pts (87% female; age 80 yrs), shows that compared to teriparatide, Rx w/ romosozumab was assoc w/ significantly lower risk of osteoarthritis (RR 0.79); especially for knee OA (0.79). https://t.co/nEdENoNae7 https://t.co/JiyRd6ThXu

Links:

Dr. John Cush @RheumNow( View Tweet )
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Treating During Pregnancy (11.14.2025)

Jack Cush, MD

Dr. Jack Cush reviews the journal articles, news and guidelines from this past week on RheumNow.com

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Can EMR Treatment Suggestions Improve Decision Making?

EurekAlert!

In a new study involving 402 U.S.-based primary care physicians, researchers from Northwestern University and the University of Sydney identified a “sweet spot” in clinical decision-making. By presenting just the right number of treatment alternatives in the electronic health record (EHR) system

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There is a growing burden of #OA among middle-aged adults, rising by 123.7%, from 11.8 million in 1990 to 26.4 million in 2021. 56.5% of incident cases & 38% of prevalent cases occur in middle-aged group (70% higher than the elderly (>60 years) population). Highest in hi-income. https://t.co/JVpZ96qe0E
Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

Best of 2023: PMR: glad or bad tidings?

Sarah Mackie, MRCP, PhD
Smile feedback opinion yes no good back opinion
Please don’t tell your patient that PMR “typically” lasts two years. According to real-world data from the UK, one in four patients with PMR is prescribed steroids by their primary care physician for over four years. But nobody tells them this at the start, and that causes big problems later on. Read Post

PMR: glad or bad tidings?

Sarah Mackie, MRCP, PhD
Smile feedback opinion yes no good back opinion
Please don’t tell your patient that PMR “typically” lasts two years. According to real-world data from the UK, one in four patients with PMR is prescribed steroids by their primary care physician for over four years. But nobody tells them this at the start, and that causes big problems later on. Read Post
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