Troubles with ‘Gut Feelings’ (10.16.2026) Save

Dr. Jack Cush reviews this week's news from RheumNow.com, including: placebo trumps controversial therapies, the dynamics of disease activity, fuse the big toe, and patients don’t appreciate being told “its all in your head”!

1. Single center study of Probiotics in #PsA showed no benefit. 66 moderately active PsA pts (PASDAS>3.2) on stable Tx: Rx probiotic vs PBO x 12 wks. 56 pts analyzed, PASDAS <3 responders: 43% probiotic vs 65% PBO (P 0.167), w/ no change in gut permeability markers or stool https://t.co/g6icpjuQOU
2. ? value of FamHx in Rheum evals? My bias is that few Dz are heritable - #Ank Spondylitis, #gout, DIP Osteoarthritis! But literature says there's high heritability for SLE, RA, systemic sclerosis, Sjögren's, & autoimmune endocrinopathies. WHAT do you think? https://t.co/WGyQqpY1qX
3. UK survey study of 6607 autoimmune dz pts (91% female) saw females had longer Dx delays, more HCP visits, & signif more often told their Dz attributed to psychiatric (43% vs 33%: OR 1.56) or psychosomatic causes (34% vs 21%; OR 1.87). Females had slightly more misdiagnoses (48% https://t.co/tGhiWCSPy9
4. 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
5. 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
6. 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
7. 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
8. 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
9. 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
10. 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
11. 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
12. Can DMARD Doses Be Safely Reduced for RA Patients? Close to 90% of patients with rheumatoid arthritis (RA) well controlled on targeted therapies were able to take 50% dosage reductions without experiencing worsened disease activity in a randomized trial, South Korean https://t.co/GGPOBhVhJe
13. Not all Low Dz Activity RA pts do the same. COREVITAS study of 6,856 RA pts w/ baseline CDAI 0-10. Comparing very low LDA (2.8-6: ~19.6%) vs high LDA >6-10 (31%); latter were twice as likely to have CDAI moderate Dz activity (10-22) at 1 and 2 years https://t.co/mmc1wzJXWY
14. In early RA, initial b/tsDMARDs are better than MTX. Metanalysis of 29 RCTs (13387 pts), Vs MTX alone, initial b/tsDMARDs + MTX signif incr DAS28 remission 2 6 mos (RR 1.62) & 12 mos (RR 1.54). Benefits greater w/ higher baseline Dz, seropositivity https://t.co/exwVOc08xR
15. Should You Use Low Dose Naltrexone?
16. Surgery for 1st MTP Osteoarthritis
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