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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Metabolic Bone Pearls
Betsy Kirchner, DNP, shares practical tips for managing metabolic bone disease, including the importance of VFA imaging to catch asymptomatic vertebral fractures and utilizing fracture liaison services to close care gaps. She highlights key pearls like the doubled fracture risk in RA patients,
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Partial vs Total Knee Replacement: Is One Superior?
Patients with osteoarthritis (OA) primarily affecting only one knee joint compartment did just as well with partial knee replacement (PKR) as with total arthroplasty after 10 years in a randomized trial -- and maybe a little https://t.co/KOZwedtnxo
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, anatomy, biomechanics, presentations, diagnostic evaluation,
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Study of 2280 dermatomyositis (DM) & polymyositis (PM) pts looked at short term (ST: <3 mos) vs long term (LT) steroid (GC) use. Vs ST, LT GC use assoc w/ higher risks of heart failure (adj OR 1.8), osteoporosis (1.9), all-cause & PM/DM-related admission (3.8) & higher costs https://t.co/Q9xt06yzew
Dr. John Cush @RheumNow( View Tweet )
Colchicine prevents total joint arthroplasty (TJA). Study of 31,478 colchicine initiators, followed 4.5 yrs. W/ an overall 12% lower risk of TJA (HR 0.88 95% CI 0.81 to 0.96), and a 23% lower risk of TJA in those with knee/hip OA (HR 0.77) https://t.co/1JsZd8K0sI
Dr. John Cush @RheumNow( View Tweet )
Vitamin D and Lupus Outcomes (11.21.2025)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.
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25-Hydroxyvitamin D levels and Lupus Outcomes
Lupus patients entering a prospective cohort study with low vitamin D levels faced doubled all-cause mortality risk and tripled risk for major cardiovascular events during follow-up averaging 6 years, researchers said. https://t.co/4nhACulIw0
Dr. John Cush @RheumNow( View Tweet )
Mesothelin as a biomarker and potential therapeutic target in rheumatoid arthritis? Mesothelin is elevated in RA & animal models & promothes osteoclast differentiation & bony destruction. Blocking mesothelin has the potential to reduce bone destruction. https://t.co/WRXG91AqmJ https://t.co/hMgddPXhxG
Links:
Dr. John Cush @RheumNow( View Tweet )
Bone Density in Ankylosing Spondylitis
At #ACR25, a retrospective study from China tackled this challenge using quantitative computed tomography (QCT), a more precise imaging modality that measures true volumetric bone density unaffected by cortical ossifications. https://t.co/1Z5cshkqjt
Dr. John Cush @RheumNow( View Tweet )
A 15-year-old girl has short stature and the hand finding shown . Labs show ↓Ca²⁺, ↑PO₄³⁻, ↑PTH.
What is the most likely diagnosis? https://t.co/afPUeaqfZT
Dr. Nikhil Agrawal @DrNikhilMD( View Tweet )
#2660 In >8000 women, serum urate rose sharply during the menopausal transition, then plateaued after menopause.
Hyperuricemia reached 4-5% post-menopause, up to 18% in obesity or low eGFR.
Healthy body weight & kidney function pre-menopause may decrease HU later @RheumNow #ACR25 https://t.co/v6ai3lgAd2
Mrinalini Dey @DrMiniDey( View Tweet )
What exercise best for steroid-induced osteoporosis? Does it have to be weight bearing?
Turns out anything helps - get out there and don’t let perfect be the enemy of good!
Laura Coates in the #ACR25 meeting review @RheumNow https://t.co/VGH2rz3dzb
David Liew @drdavidliew( View Tweet )
#1727
360k+ postmenopausal women w osteoporosis: >1/3 untreated patients were at v high fracture risk, yet few received recommended anabolic or antiresorptive therapy.
Even among treated women at very high risk, >50% were still on oral bisphosphonates
@RheumNow #ACR25 https://t.co/9S66tAU68P
Mrinalini Dey @DrMiniDey( View Tweet )
Why Brittle Bones Aren't Just a Woman's Problem
Osteoporosis is more common in women, prompting routine screenings for them at age 65. As a result, men might overlook getting a scan, which may not be suggested by an orthopedic specialist. However, about 20% of men over 50 will https://t.co/ggyse5ZDPV
Dr. John Cush @RheumNow( View Tweet )
Why Brittle Bones Aren't Just a Woman's Problem
MedPage Today
Ronald Klein was biking around his neighborhood in North Wales, Pennsylvania, in 2006 and tried to jump a curb. "But I was going too slow -- I didn't have enough momentum," he recalled. As the bike toppled, he thrust out his left arm to break the fall. It didn't seem like a serious accident, yet
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Osteoporosis Screening in High-Risk Men
A VA Health Systems study of older male veterans found benefits of a remote model of screening that significantly improved osteoporosis screening, treatment, and adherence compared with usual care, with high patient and clinician https://t.co/Kt3mJLahdq
Dr. John Cush @RheumNow( View Tweet )
NY Times on Osteoporosis in Men
The NY Times has addressed the problem of osteoporosis in men noting a need for increased awareness and screening. Takeaways:
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Osteoporosis Screening in High-Risk Men
A Veterans Affairs (VA) Health Systems study of older male veterans found benefits of a remote model of screening that significantly improved osteoporosis screening, treatment, and adherence compared with usual care, with high patient and clinician acceptance.
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Big Fat FDA Pink Slip (9.19.2025)
Dr. Jack Cush reviews the news and journal reports from this week on RheumNow.com. Today we cover GLP-1 agonists, acupuncture, what JAKs won’t do & an FDA Pink Slip.
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SLE and Osteoporosis
Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease that can present with a variety of signs and symptoms and organ involvement. Comorbidities further complicate the disease course that may lead to poor health-related quality of life and https://t.co/8ZmtLjzbqA
Dr. John Cush @RheumNow( View Tweet )
The overall prevalence of #osteoporosis in SLE is ~33-40% and is due to several factors with GC therapy being one of them.
Monitor DXA every 6-12 months (vs. 2 yrs for standard OP)
☝️Screen for GIOP
☝️Treat accordingly - once on GCs & esp w/long-term use
@RheumNow #APLAR25 https://t.co/E9FJDHrBUo
Links:
sheila @RHEUMarampa( View Tweet )
Key takeaways of trabecular bone screening:
📌Complements but doesnt replace BMD/FRAX in fracture risk assessment
📌Dont exclude any lumbar spine unless w/significant change like laminectomy
📌Can use in monitoring untreated pts since TBS declines
@RheumNow #APLAR25 https://t.co/bcN83IDDja
sheila @RHEUMarampa( View Tweet )
Remember! ☝️
Trabecular bone screening should not be routinely used in pre-menopausal women.
@RheumNow #APLAR25 #osteoporosis https://t.co/hGMExyDYUX
sheila @RHEUMarampa( View Tweet )
Japanese retrospective real world study shows antifibrotic use assoc w/ better survival in Pulm Fibrosis-ILD for 1st 3 yrs & improved survival in progressive pulm. fibrosis (PPF) “despite management” (PPF subset prev Rx non-antifibrotic therapy) https://t.co/caiIuhg7j8 https://t.co/N0ST73TMoR
Links:
Dr. John Cush @RheumNow( View Tweet )
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