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Low Dose Naltrexone for Fibromyalgia Pain - Use it or Lose it?
Medscape recently reviewed off-label use of low dose naltrexone (LDN) in fibromyalgia (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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Turkey Tryptophan (11.28.2025)
Dr. Jack Cush reviews the news and reports from this past week on RheumNow.com, including reports on FDA resurrections, FM seasonal worsening, and do you fight switch or swap biologics in PsA TNFi nonresponders?
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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.
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Chronic pain may dramatically raise your blood pressure
Science Daily
Widespread chronic pain may stealthily drive up blood pressure, partly through its ties to depression and inflammation.
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Low Dose Naltrexone for Fibromyalgia Pain - Use it or Lose it?
Medscape recently reviewed off-label use of low dose naltrexone (LDN) in fibromyalgia (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) https://t.co/RgRRHU9ZRo
Dr. John Cush RheumNow ( View Tweet)
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? https://t.co/lZ0NHX5Y56 https://t.co/JC04E3JUxB
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)
ICYMI: Inflammatory vs. Noninflammatory Pain
https://t.co/3nJ2NZYTQY https://t.co/7FuSYzkX2G
Dr. John Cush RheumNow ( View Tweet)
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?
https://t.co/cnxxwqwyTE https://t.co/82zugQnp2Y
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)
BASDAI scores elevated in Fibromyalgia - 58 FM pts were surveyed wtih FIQ, SSS, BASDAI. BASDAI was ≥ 4 points in 91.4% of FM (vs 13% controls (p < 0.001). BASDAI correlated w/ the FIQ (pain, fatigue, stiffness) & SSS scores (r = 0.88, p < 0.00). Could BASDAI be used in FM? https://t.co/M0tI8wjzh4
Dr. John Cush RheumNow ( View Tweet)
Obesity-inflammation axis in PsO & PsA: obesity is assoc w/ less remission& poorer drug responses; possibly from adipokines, biomechanical stress, gut dysbiosis, etc. Notably, weight loss can improve both psoriatic disease course and response to therapy. https://t.co/cZbeu0zfmR https://t.co/EoCTNKk265
Dr. John Cush RheumNow ( View Tweet)
BASDAI scores elevated in Fibromyalgia - 58 FM pts were surveyed wtih FIQ, SSS, BASDAI. BASDAI was ≥ 4 points in 91.4% of FM (vs 13% controls (p < 0.001). BASDAI correlated w/ the FIQ (pain, fatigue, stiffness) & SSS scores (r = 0.88, p < 0.00). Could BASDAI be used in FM? https://t.co/VF94ru0o3Q
Dr. John Cush RheumNow ( View Tweet)
JAMA review of Peripheral Neuropathy - affects ~ 1% of adults worldwide and may cause sensory, motor, and autonomic Sxs. Diabetes is the most common cause. 1st line Rxs include gabapentin, pregabalin, duloxetine, amitriptyline. (FOR AMA MEMBERS) https://t.co/sof15I1GpU https://t.co/PN0KMeUsGA
Dr. John Cush RheumNow ( View Tweet)
Retrospective analysis of 2614 FM pts in the Italian Fibromyalgia Registry underscores the seasonal changes in FM pain, w/ signif. differences in FM assessment tools WPI p=0.042 & FASmod p=0.037); these changes were only seen in female patients, not males https://t.co/LqXnTgGIMB https://t.co/ihw1yJqKLC
Dr. John Cush RheumNow ( View Tweet)
RETREAT study was a 12 wk RCT of Tai Chi in 178 knee OA pts Rx w/ online OA info vs same plus free web based tai chi video program. Tai Chi group had signif improved knee pain (−2.7 v -1.2); (−12 v −6.9) & achieved a minimal pain & function (73% v 47%); and Its free! https://t.co/WLzQ9YHrcu
Dr. John Cush RheumNow ( View Tweet)
Weight Loss as a Therapeutic Goal in PsA
PsA is a complex inflammatory disease often complicated by obesity, which not only worsens disease activity but also impairs treatment response. At #ACR25, 3 compelling studies spanning pharmacologic, lifestyle, and longitudinal https://t.co/Q6IFGn5zCI
Dr. John Cush RheumNow ( View Tweet)
What happens if you have #axSpA & concomitant #FM?
Pts with both have less TNFi retention,
-residual pain may lead to d/c Rx.
Need to determine if axSpA pt has #fibromyalgia as there may not be objective findings if no peripheral arthritis in axSpA.
#ACR25 @RheumNow abst#534
Janet Pope Janetbirdope ( View Tweet)
In a PsA cohort (n=1291), higher BMI was independently linked to lower odds of achieving MDA—especially in TNFi-treated patients. Impact was strongest in pain, skin, enthesitis, and PRO domains, not swollen joints. Each unit increase in BMI reduced MDA odds by 4–7%. Highlights https://t.co/TxO3HP51uk
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Abstract 2687: GLP-1 RA in PsA
In combined Toronto + NYU cohort, GLP-1 RA significantly associated with reduced:
- Weight, CRP, and pain scores
- Each 1% reduction in body weight associated w/ TJC, DAPSA, EQ-5D (QoL), LDL, Systolic BP
@RheumNow #ACR25 https://t.co/30lPDkALKs
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
