Moral Distress (3.27.2026)

Jack Cush, MD

Mar 27, 2026 9:42 am

Dr. Jack Cush reviews the journal reports and news from RheumNow.com. This week we discuss moral distress, FM in PsA, Lyme Vax is back & hidden but tangible benefits of the MDHAQ.

JAMA survey study of 5741 physicians found mean moral distress score (0-10, >4 High) =3.29, w/ 39% having high level of moral distress; more than US workers. Burnout, intent to leave (ITL), or reduce work hours (ITR) was higher for each 1-point incr in moral distress score https://t.co/dslwMztjV7
Economic analysis of ESR & CRP testing (are they same or different?). Compared to doing either ESR OR CRP, they found the ESR + CRP testing was cost-effective strategy, reducing misdiagnoses, followup costs and overall healthcare costs. https://t.co/UU15bxuPKP
Real-world safety of tofacitinib vs biologics in 48,167 #PsA pts Rx w/ TOFA (3,166); TNFi (27K); IL-17Ai (20K); risankizumab (4,381); ustekinumab (4,499). Crude IRs/100 PY were 1.78-2.53 for serious infxn, 0.27–0.61 MI/stroke, 0.17–0.42 VTE, & 0.74–1.06 cancer. TOFA had signif https://t.co/Z5wZTGc5gB
Retrospective TriNetX Network cohort study of adult PsA (N 123,031) pts, propensity- matched to non-PsA controls. PsA had signif higher CV morbidity: MACE (HR 1.74); mortality (HR 1.95); CHF (HR 1.96), MI (HR 1.71), & CVA (HR 1.49). bDMARDs reduced MACE (HR 0.95) & mortality (HR https://t.co/bHrq9KpwBM
Prevalence of fibromyalgia in PsA = 18%. FM-PsA pts have higher scores Dz activity scores from FM, rather than inflammation. Fibromyalgia is assoc w/ worse disease outcomes, including failure to achieve low disease activity state and poorer response to therapy. https://t.co/utQRXPmpDs
phase 3 VALOR trial of 6-valent OspA-based Lyme dz vaccine (LB6V) vs placebo; 4 doses given @ Mos 0, 2, 5-9, & 12 mos later. LB6V reduced Lyme Dz risk by 73.2% @28d after 4th dose. But it was only 15.8% effective (falling short of prespecified 20%) because of fewer than expected https://t.co/TcX0GV05gY
Disease activity defined in adult-onset Still's dz. Criteria developed using Italian cohort 187 & 41 from CONSIDER (canakinumab) trial. Active AOSD based on 5 criteria: fever, plus 1: skin rash, arthritis, pt global>2 cm, CRP > 10 mg/L; or any 3 without fever (AUC 0.93, 0.85, 0.88) https://buff.ly/7RYKmQD
Rush University MDHAQ surveys done on 1,337 pts (excluding primary FM), identified 30% w/ anxiety, 24% depression, 25% fibromyalgia, & 44% w any 3 of these. In this 44%, HIGHER pain (7 vs 4) and RAPID3 (17 vs 8.2) vs those without FM, anxiety, or depression (p< 0.001). https://t.co/GzZ0LZKPPR
A retrospective cohort study of 195 renal Bx from 135 Lupus Nephritis pts, Mod-Severe interstitial fibrosis and tubular atrophy (IFTA) strongly assoc w/non-renal response & ESRD progression (HR 8.9) (also w/ age, SLE duration, prior LN flares, higher chronicity index) https://t.co/3JGLi5R5Fs
Predictors of Response in Lupus A systematic review suggests that traditional measures (serologies and disease activity) are superior to biomarkers in predicting response to biologics in systemic lupus erythematosus (SLE) patients. https://t.co/7YuYpoDctR
Incident RA is assoc w/ considerable work loss. 3850 RA pts compared to 4422 same-sex siblings (2006-2020). Work loss began 13 mos before RA Dx & peaked the year after, less in last 10 yrs. Work loss highly skewed; small proportion contributed the most work loss days. https://t.co/splolrEDpe
Prednisone use in Alberta primary care 546 #RA pts - 40% of PCP RA Rx w/ 1 or more prednisone Rx. 41% Rx w/ both Pred + DMARD, w/ 44% on Pred median 124 day before DMARD. 66% continued Pred >1 yr after DMARD initiation. https://t.co/wrxQRP2TWN
RA pt on 7.5 mg/d Prednisone need hip replacement. What do you advise re: pred dose before TKR?
EULAR 2025 Update for Behçet’s syndrome EULAR has updated its recommendations for the management of Behçet’s syndrome, the last being published in 2018. The current update carries no recommendations from the previous version: seven recommendations have content modifications, https://t.co/QcjVUqlyMU