Reefer Madness (12.12.2025)
Dr. Jack Cush reviews the news, journal and regulatory reports from this past week on RheumNow.com. B cell drugs in SLE and ITP, biomarkers in GCA & PSS and great videos by APPs.
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QD Clinic: Weakness with Fibromyalgia
ack Cush, MD and Leilani Law, APN, Dallas, TX, discuss a case about weakness with fibromyalgia and how to best treat the complaints she presents with. This APP QD clinic is presented as part of RheumNow's "Mission: APP Partners in Care" https://t.co/OHeTdemtra
Dr. John Cush @RheumNow( View Tweet )
Medical Cannabis for Pain Management
Recent research and publications have underscored the use, efficacy, safety and limitations to the use of cannabis for arthritis and pain patients.
Chronic pain affects more than one in five American adults, yet practitioners are limited in treatment alternatives. Even if we exclude the
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2018 NHANES population survey of 28,040 individuals, 4168 (14.32%) identified with sleep disorders, and 1589 (4.28%) had #RA. Thus, sleep disorders were significantly associated with increased odds of RA (OR = 1.76, 95% CI: 1.46–2.13, P < 0.001). https://t.co/9O2MsLvwVe https://t.co/cBsm8Jt8Ks
Dr. John Cush @RheumNow( View Tweet )
Study of 489,569 UK Biobank participants (40 to 69yrs) betw 2006–2010 showed incident RA in 5404. Having self reported eating disorders (anorexia nervosa, bulimia, etc) was associated with a higher risk of developing RA (ad HR 1.76; 1.12–2.76), moreso in men (HR 5.09). https://t.co/GPV3YoE3kt
Dr. John Cush @RheumNow( View Tweet )
Sleep Apnea in Psoriatic Arthritis – A Wake Up Call
Fatigue is one of the most disabling symptoms in psoriatic arthritis (PsA), yet its causes are often underexplored. At #ACR25, Abstract #0549, a possible hidden contributor was studied: obstructive sleep apnea (OSA). In a https://t.co/E3cy1Uss73
Dr. John Cush @RheumNow( View Tweet )
Higashida-Konishi et al. RA. Insomnia and fatigue in >80%, depression in 13%. RA disease activity is associated with depression, fatigue, and insomnia. @RheumNow #ACR25 Abstr#2254 https://t.co/7SibPW6BBw
Richard Conway @RichardPAConway( View Tweet )
Stress Raises the Risk of Psoriasis
New longitudinal research reveals that severe stress caused by changes in family structure like divorce or separation experienced during the first year of life may triple the risk of developing psoriasis later in life. https://t.co/TSXoQKjRPN
Dr. John Cush @RheumNow( View Tweet )
Abstract 1421: PsA and 'Brain Fog'
Pts w/ #PsA who did not achieve Minimal Disease Activity (MDA) had higher odds of subjective cognitive decline vs those with MDA
🔹 Fatigue, and to a lesser extent depression/anxiety, ↓ this associated risk
@RheumNow #ACR25 https://t.co/RohwKJZDzp
Links:
Akhil Sood MD, MS @AkhilSoodMD( View Tweet )
Mac Gearailt et al. Depression in axSpA. Depression in 10%. Associated higher disease activity, worse functional status, and increased peripheral manifestations. @RheumNow #ACR25 Abstr#1409 https://t.co/8pnoQiaiQr
Richard Conway @RichardPAConway( View Tweet )
I wouldn't sleep on this. 😴💤
Abstract 1413: In a PsA cohort, restless leg syndrome was linked to:
🔹 ↑ disease activity (polyarthritis, swollen joints, DAPSA)
🔹 Worse physical function (↑ HAQ)
🔹 Fatigue, anxiety, depression, & poorer sleep quality
@RheumNow #ACR25
Akhil Sood MD, MS @AkhilSoodMD( View Tweet )
Kuzkina et al. Efficacy of IL-6i with olokizumab on depression in RA. There appear to be some benefit but anti-depressants still needed. Group 1 is olokizumab alone, other 2 groups have anti-depressants also. @RheumNow #ACR25 Abstr#1323 https://t.co/h2ExYQgKTL
Richard Conway @RichardPAConway( View Tweet )
X-sectional study by Dr Toledano et al showed that 20% (46/230) PsA pts had restless leg syndrome (RDS).
Pts w/ RDS:
- Polyarthritis
⬆️ Swollen jts
⬆️ Fatigue, anxiety, depression
⬆️ Dse activity
Poor sleep quality
Polyarthritis & Pso: assocd w/ RDS
#ACR25 @RheumNow Abs1413 https://t.co/8Ds3TgLjs1
sheila @RHEUMarampa( View Tweet )
#1639
In 2 lupus cohorts (n=619), 1 in 4 had mismatch between self-reported & measured physical function.
Higher BMI, disease activity & depression linked to underreporting ability ➡️ self-report ≠ performance! Important for SLE care & research. @RheumNow #ACR25 https://t.co/kMlChreJPh
Mrinalini Dey @DrMiniDey( View Tweet )
The axSpA Registry of Ireland (ASRI): 10% reported depression, w/ higher prev in older cohorts.
Pts w/ depression had ⬆️peripheral involvement, ⬆️dse activity & poor functional status
💡Consider the impact of non-inflamm factors in dse burden
#ACR25 @RheumNow Abs1409 https://t.co/yDfHA24M6e
sheila @RHEUMarampa( View Tweet )
A randomized trial of app-based behavioral (acceptance and commitment) therapy (ACT) showed reduced pain interference and affective distress in axial SpA compared to standard of care. Acceptance was moderate, but impact was meaningful. Abstract 1461 @RheumNow #ACR25 https://t.co/sF5Ldtc61R
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
High prevalence of sleep related symptoms in PsA pts!
-Snoring 53%
-Morning fatigue 68%
-Obstructive Sleep Apnea in 50%
14% mild 19% moderate 17% severe
Estimated prevalence 36%
No correlation between OSA and PsA disease activity or comorbidities
But small cohort! https://t.co/VKe7qcHIRm
Aurelie Najm @AurelieRheumo( View Tweet )
#0793 In #SLE, abusive trauma was linked to 58% higher risk of medication non-adherence; resilience buffered this effect. Patients with trauma cited motivational, not access-related, barriers. Trauma-informed & resilience-focused care may improve adherence. @RheumNow #ACR25
Mrinalini Dey @DrMiniDey( View Tweet )
Do you believe that patients w #rheumatic #diseases flare if #extreme #weather?
Even 90 days after extreme weather events flares occur - loss of power, heat’ med storage = ++stressful events
Is it early flare from weather & then ++stress
@RheumNow @ACRrheum #ACR25 abst#0164 https://t.co/pGPwOKrKU7
Janet Pope @Janetbirdope( View Tweet )
In a novel Geri-Rheum clinic, cognitive screening revealed 35% impairment among adults >55 yrs.
Common deficits: visuospatial, attention & recall.
Early geriatric screening = earlier intervention.
A model for age-friendly rheum care in action.
@RheumNow #ACR25 Abstract #0226 https://t.co/lIAcrZvL4H
Jiha Lee @JihaRheum( View Tweet )
Come to our first #HealthLiteracy poster of #ACR25!
#0190
Cluster analysis >900 people with IA
Lowest health literacy cluster assoc w:
4× ⬆️anxiety/depression
2× ⬆️disease activity, vs highest HL
Higher HL assoc w older age & ⬆️comorbidities but fewer mental health Sx
@RheumNow https://t.co/iIRXaOl4qZ
Links:
Mrinalini Dey @DrMiniDey( View Tweet )
Clinical and Genetic Effects of Neuropsychiatric Lupus
The clinical features and genetic abnormalities of neuropsychiatric systemic lupus erythematosus shows that NPSLE often means more severe lupus and more organ involvement beyond the central nervous system. https://t.co/7Ujo6Kaf1N
Dr. John Cush @RheumNow( View Tweet )
JAMA Pediatrics study of 1,473 young US adult, finds 1/4 use cannabis or alcohol for sleep (18% cannabis; 7% EtOH), even though these may interfere with quality or ability to stay asleep. In those using cannabis in the last yr, 41 reported using cannabis to sleep. https://t.co/fdW6bdDM3I
Dr. John Cush @RheumNow( View Tweet )
2019 National Health Survey of 87,678, 21% had chronic back pain (cLBP). cLBP had more Multimorbidity 62.1%, worse activity limitation. depression, and cardiovascular disease https://t.co/LFdWr0s6tg https://t.co/R5cZSWySUK
Links:
Dr. John Cush @RheumNow( View Tweet )
Data from 2019 National Health Survey on 87,678 ppl -- 21.6% had chronic back pain. Chronic LBP assoc w/ multimorbidity in 62% (esp. CV dz, arthritis, & depression) https://t.co/LFdWr0s6tg https://t.co/Enj162VYJl
Links:
Dr. John Cush @RheumNow( View Tweet )
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