Influential Rheumatoid Factors (5.8.2026)
Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com
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Nurses - the calm through chaos
Nurses are a unique breed. When they appear, it’s always a blessing. But who goes into nursing? What kind of person choose nursing over doctoring?
https://t.co/smUWg06nVh https://t.co/swQYJ3NfZF
Dr. John Cush @RheumNow( View Tweet )
More Comorbidity in Difficult-to-Treat RA
A systematic review demonstrated that smoking, obesity, fibromyalgia, and depression are significantly associated with difficult-to-treat rheumatoid arthritis (D2T-RA).
https://t.co/guMm6mqJGr https://t.co/xiykw5tBlJ
Dr. John Cush @RheumNow( View Tweet )
Do patients with chronic pain have double the rates of smoking compared to those without pain? Take this week's RheumIQ quiz to find out.
https://t.co/rmB55KC7Zh https://t.co/ms3G9uBMd5
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Dr. John Cush @RheumNow( View Tweet )
NHIS 10yr survey of 195,600 Americans shows Chronic pain assoc w/ double rates of smoking & vaping. Smoking decr over time, but always higher in chronic pain pts (17.7% 2014, 13.1% in 2023) than w/o pain (12.5% 2014, 7.5% 2023). E-cigs incr over time, more w/ chronic pain https://t.co/iW7IDwHyJa
Dr. John Cush @RheumNow( View Tweet )
UK Our Future Health study of 1,563,155 finds affective Dz (depression, bipolar, anxiety) signific higher (p<0.001)in autoimmune pts vs gen. pop. (29% vs 18%) - dx by PHQ-9, GAD-7. (OR 1.86), even after adjustments income and pain, etc. https://t.co/HoKBeAZxbS https://t.co/NtJhaf7WCo
Dr. John Cush @RheumNow( View Tweet )
Top Four and More (4.10.2026)
Dr. Jack Cush reviews the news and journal reports from RheumNow.com this week - including his top four favorite subjects.
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UK Our Future Health study of 1,563,155 finds affective Dz (depression, bipolar, anxiety) signific higher (p<0.001)in autoimmune pts vs gen. pop. (29% vs 18%) - dx by PHQ-9, GAD-7. (OR 1.86), even after adjustments income and pain, etc. https://t.co/HoKBeAZxbS https://t.co/LnC4lqqgq7
Dr. John Cush @RheumNow( View Tweet )
1/3 of American adults have poor sleep. New survey from Amer. Academy Sleep Medicine shows 45% of pts never discuss sleep issues with their doctors; only 15% discussed it with a sleep specialist. https://t.co/uvlHjpuVs8 https://t.co/fDOtp9rxOn
Dr. John Cush @RheumNow( View Tweet )
What's it like to have RA? MARY: "I can manage the pain, the exhaustion, and side effects of the meds. The hard part is grief. I grieve for me, the adventurer that decided what she wanted and boldly went after it, no matter what. I trusted myself to handle whatever came. Now https://t.co/GakWIy2XCt
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What's it like to have #RA? RICHARD: "There were days that I couldn’t mask the pain or hide the limp..So I tried to deny and hide the disease. I would always go up and down stairs when no one was looking. I got up extra early so no one could see me walk like an old man to the https://t.co/krHn4yoRYd
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What's it like to have #RA? PATTY "To find patients or doctors who can talk intelligently about RA is a welcomed relief. However, I prefer that those around me not know about me and my RA. I hope they don’t notice the changes in my hands or shoes or that I cannot wear my usual https://t.co/OQbXJrcyPp
Dr. John Cush @RheumNow( View Tweet )
After hours EHR catchup has been coined "Pajama time" by residents & physicians & contributes to burnout. Survey 9,731 YR 2 Family Med residents- spend 3+ hrs/d after wk on ambulatory EHRs. Pajama time assoc w/ less knowledge, professional satisfaction, more burnout. https://t.co/QSR7VM2T7u
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Portugese multicentre retrospective of 748 adults with JIA (age 28 yrs; Dz duration 21 yrs). Oligoarticular JIA was the most common subtype (29.9%). HTN (9%), psychiatric dz (8%), & osteoporosis (5%) were most prevalent comorbidities. bDMARD use reduced risk of psych Dz https://t.co/xCrTDxirlj
Dr. John Cush @RheumNow( View Tweet )
Psychiatrists have the highest Medicare opt-out rate (8% vs 1.2% MDs vs <3% Rheum), leading to a critical shortage of psychiatrists and more antipsychotic management to APRNs and PAs over the last decade. APPs Handle 40% of Antipsychotic Scripts https://t.co/wWnFcnXpRa https://t.co/WSQBEzvxgK
Dr. John Cush @RheumNow( View Tweet )
TENS Efficacy in Fibromyalgia
A randomized clinical trial of transcutaneous electrical nerve stimulation (TENS) in fibromyalgia showed meaningful improvement in pain for 6 months when combined with physical therapy (PT).
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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/xbOKeZj5cm
Dr. John Cush @RheumNow( View Tweet )
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
Dr. John Cush @RheumNow( View Tweet )
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
Dr. John Cush @RheumNow( View Tweet )
You can change what comes to your attention. We can change the external and internal focus by being mindful of the triggers and amplifiers we consume. If you’re not happy with what your attention is bringing you, you can change it. - Seth Godin https://t.co/QsUxTmjX1U
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Dr. John Cush @RheumNow( View Tweet )
Poor sleep increases risk of #RA. English Longitudinal Study of Ageing. RA risk was signif. higher in those with moderate sleep quality (SQ) (HR 1.23) or poor SQ (HR 1.50), cmpared to good SQ. Partly mediated by depression https://t.co/kTbCUHeIGi https://t.co/6CD5tsKDdA
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Dr. John Cush @RheumNow( View Tweet )
Most inhibition of inflammation is via the brain. More GLP1 and GIP1 receptors are in the brain, more than the gut. @RWCSmtg #RWCS26 https://t.co/CNzUqteBLg
Dr. John Cush @RheumNow( View Tweet )
Study of 90 adolescents (46 w. Juvenile fibromyalgia (JFM) & 44 controls) finds that JFM pts have greater sensitivity to non-painful sensory stimuli, such as sounds and bright lights; such hypersensitivity is closely related to the severity of the disease and brain function https://t.co/KGqzRK6e4a
Dr. John Cush @RheumNow( View Tweet )
Factors that may augment future development of SLE - includes Vitamin D levels, poor sleep, EBV reactivation & social determinants of health. Can you Prevent SLE? Dr. David Karp lecturing at UTSW @drdavidkarp @utswrheum https://t.co/2J1JBjeXKU
Dr. John Cush @RheumNow( View Tweet )
Factors that may augment future development of SLE - includes Vitamin D levels, poor sleep, EBV reactivation & social determinants of health. Can you Prevent SLE? Dr. David Karp lecturing at UTSW @drdavidkarp @utswrheum https://t.co/e3TKATcxXB
Dr. John Cush @RheumNow( View Tweet )
Recent Blogs
I recently overheard a very good practicing rheumatologist complain, “why do I need yet another drug for psoriatic arthritis? I have more treatment choices than I have actual PsA patients who need a new or better drug”.
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The presence of comorbidities naturally complicates treatment choice, patient adherence to medication and patient outcomes, increasing also the risk of making RA ‘difficult-to-treat’.
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With the increasing development and use of new biologics and oral targeted therapies to treat RA and other immune mediated inflammatory diseases, an awareness of infection risk and prevention has become of increasing interest as well. While our patients may be susceptible to many different types of infections depending on immunosuppressive regimen, age and co-morbidities, I’ll highlight a few of the “usual suspects”.
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