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There's this low grade buzz from some rheumatologists about the potential analgesic benefits of low dose naltrexone. I haven't used it. Should you?
Recent News
In honor of World Arthritis Day (Oct. 12th), The Lancet has published a public Health Policy report is to "outline a globally relevant roadmap to address the osteoarthritis identity problem, focusing on health policy responses."Read Article
Dr. John Cush
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Study of Prognostic Nutritional Index (PNI) in 984 RA pts shows PNI is independently inversely corelated w/ RA dz activity, esp. PNI <45. PNI = ser albumin & lymphocyte count calculation (10 × s albumin [g/dL]) + (0.005 × lymphocyte count/mm³]). Other studies have shown modest https://t.co/AV3AGXwSfg
Dr. John Cush
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French National Health System study of 214,892 #RA pts (~40K on TNFi) found 562 demyelinating events (2008-2023) w/ cumulative 10 yr incidence of 0.32% w/ csDMARDs & 0.50% w/ TNFi (HR 1.47;1.11-1.95). Demyelinating events are rare in RA, but signif higher w/ TNFi https://t.co/6vUy5nsQ27
Dr. John Cush
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Washington Univ Medical School has recv $17 million from Advanced Research Projects Agency for Health to develop an intraarticular therapy using nanoparticles designed to regenerate osteoarthritis damage without any surgical intervention. https://t.co/hl5i3welwS https://t.co/M7LwbIYI88
Dr. John Cush
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Good Grief
When it rains it pours, but when it comes to grief, it’s like the rains that just won't let up.
https://t.co/fW1qqQbcv2
Dr. John Cush
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92 early (<2 yrs) systemic sclerosis pts were treated with #MTX; 79% diffuse SSc. At 3 mos, 34% of dcSSc ≥25% reduction in mRSS - increasing to 612% a@ 24 mos (29% at 24 mos ITT w/ non-responder imputation). GC did not improve skin. Dz progression seen w/ 75% of MTX monoTx D/C https://t.co/WvqyI8GKjT
Dr. John Cush
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Prescribing New GLP-1-Based Therapies
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article
Current ACR guidelines for the management of gout support anti-inflammatory prophylaxis, including colchicine, during urate lowering therapy initiation and uptitration. Aside from diarrhea, colchicine use is generally well tolerated, but its metabolism via the CYP3A4 cytochrome P450 enzyme pathway poses a potential risk of medication interaction. Statins are one of the most widely prescribed medication classes also metabolized by this pathway
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Hallux rigidus, or osteoarthritis of the first metatarsophalangeal joint (MTPJ), is common, but the treatment options and future outcomes are poorly known.
Dr. John Cush
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Dr. John Cush
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Are Concerns Over Avacopan Efficacy Overblown?
Avacopan (Tavneos), the complement pathway inhibitor for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), appeared strongly effective in an Italian registry study, maybe a step toward putting questions about https://t.co/4w2INKPFeT
Dr. John Cush
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EADV abstract showed daxdilimab (anti-ILT7; on plasmacytoid dendritic cells) was effective in mod-severe discoid lupus. Ph II RCT 72 refract. DLE RCT; DAX vs PBO - ↓ CLASI-A vs placebo @24 wks. wk 4 ≥50% CLASI-A ~62% vs 24% https://t.co/gJ4drxErGD https://t.co/TexG55dDBL
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Avacopan (Tavneos), the complement pathway inhibitor for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), appeared strongly effective in an Italian registry study -- a step, maybe, toward setting to rest questions about its efficacy, if not its safety.
Dr. John Cush
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Symptomatic hand OA (HOA) increased signif in past decade in the Netherlands (esp women & older adults). PCP EHR study of 1.8 million Dutch patients ≥30 yrs. Betw 2013 & 2023, prevalence incr 65% (5.7 to 9.4%); incidence rose 20% (7.1 to 8.5/1000PY) https://t.co/HyqdwJ70y4 https://t.co/CU0NGccI3k
Dr. John Cush
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Singapore center study of 119 IIM pts (DM 57%; ASyS 23%, OM 15%), IMNM 4%). MDA5 Abs seen in 35% DM. Vs ASyS, MDA5-DM had signif more Skin Sxs (ulcers, papules, Gottrons, heliotrope, periungual erythema). MSK Sxs equal & higher CK levels in ASyS MDA5. 79% DM-ILD were MDA5+ https://t.co/hWaaeLUYkz
Dr. John Cush
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On this week's podcast, Dr. Jack Cush reviews the news: Steroids are easy to start and hard to stop; hold the MTX but not the biologic or JAK, weighing in on avacopan, and age-old messages for old-age patients.
🎧 Read + listen: https://t.co/kK8WKgIxYT and subscribe wherever you https://t.co/xGTXyuRJU8
Dr. John Cush
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Ann Int Med report - 1/3 of advanced practice registered nurses trained at for-profit programs (CA 41%, FL 35%, TX 21%, IO 15%), up from just 2.4% in 2010. Estimated 1 APRN for every 2.2 physicians. 35% projected growth over the next decade (vs 3% growth for MDs) https://t.co/7vkB5yeLNR
Dr. John Cush
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Univ Toronto lupus clinic study of 165 #SLE pts w/ Bx-proven LN (age 35.3 yrs; Dz dur 6.2 years). Half on antimalarial Rx. Being on HCQ did not alter Renal Bx outcomes (prolif GN, NIH AI, NIH CI, IFTA score. (But is known to improve renal outcomes) https://t.co/oQ0CgK7rXm https://t.co/cJMMVFmLcy
Dr. John Cush
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An important pitch and resource for training and careers at the NIH - National Institute of Arthritis and Musculoskeletal and Skin Diseases https://t.co/JhU1zbVunF https://t.co/uIf5U2dXoC
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From the Blog
The costs of GLP-1 agonists must come down in order to make these treatments available to the people who need them - including many people with rheumatologic diseases.
Podcasts
Don’t Hold the JAK (10.9.2026)
PsA Beyond the Joints: Rheum, Derm, and Gastro Perspectives-
Remission – Believe it or Not (10.2.2026)
The Four Pillars of Weight Loss Part 4
Therapeutic Updates
Clinical dilemmas in axSpA and PsA
Sponsored by UCB
Explore some of the challenges rheumatologists face in clinical practice, including expert perspectives from UCB's Annual International Immunology Summit.
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PsA Beyond the Joints: Rheum, Derm, and Gastro Perspectives
Sponsored by AbbVie Medical Affairs + Health Impact
Dr. Saakshi Khattri hosts dermatologist Dr. Ahmad Amin and gastroenterologist Dr. Joshua Steinberg to discuss multidisciplinary care in PsA and other immune-mediated inflammatory diseases. Learn how signals in the skin and gut may prompt the need for collaboration across specialties to support better patient outcomes that extend beyond the joints.
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Obesity – Inflammation – PsA
Sponsored by Lilly Medical Affairs
Learn about the inflammatory intersection between Psoriatic Arthritis and Obesity, and why adiposity is more than a comorbidity.
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Poster Hall
Sponsored by AbbVie Medical Affairs + Health Impact
