Self-Directed Cognitive Behavioral Therapy for Chronic Pain
Is self-directed cognitive behavioral therapy (CBT) when augmented with asynchronous, personalized feedback for chronic pain (CBT-CP) superior to clinician-delivered CBT-CP?
U Maryland study found that 5-minutes of proximal intercessory prayer (PIP) — in-person prayer offered by a trained volunteer — significantly reduced pain and anxiety in primary care patients compared to a music control group. 180 pain pts (pain >4/10) w/ > 2 pt reductions at 2 & https://t.co/k4JiQvyC31
Dr. John Cush @RheumNow( View Tweet )
Retrospective study of 116 BL KOA (Kellgren–Lawrence I–II) pts rx w/ three PRP injx (n 58) or NSAIDs +/- IAhyaluronic acid (n 58). After 5 yrs there was no signif. difference in VAS, WOMAC, and SF-36, with both groups worsening. https://t.co/KDSMTvEl59 https://t.co/lgHOsppIU3
Dr. John Cush @RheumNow( View Tweet )
JAMA Review on Low Back Pain
A comprehensive JAMA review synthesizes current evidence on the epidemiology, pathophysiology, clinical evaluation, and treatment of nonspecific low back pain (nsLBP), drawing on 108 publications identified from a PubMed search (2005–2026) and the https://t.co/liEitQ2ACf
Dr. John Cush @RheumNow( View Tweet )
JAMA Review on Low Back Pain
A comprehensive JAMA review synthesizes current evidence on the epidemiology, pathophysiology, clinical evaluation, and treatment of nonspecific low back pain, drawing on 108 publications identified from a PubMed search (2005–2026) and the most recent guidelines from the WHO, ACP, and NICE.
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Genicular artery embolization (GAE) in knee OA? Multiple open label studies & metanalyses suggest a clear pain benefit; BUT 3 sham-controlled RCTs have not demonstrated a statistically significant benefit over placebo. GAE is not addressed by ACR or EULAR guidelines. https://t.co/amIN6kzY74
Dr. John Cush @RheumNow( View Tweet )
EULAR 2026: Updated Recommendations for Vaccination in Patients with Autoimmune Inflammatory Rheumatic Diseases
This update includes new pandemic era evidence, recombinant zoster vaccine data, and new perspectives on vaccination in patients taking novel immunosuppressants. Five overarching principles and 10 vaccine recommendations follow.
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MTX: SC vs Oral? Metanalysis of 9 RCTs, 974 RA pts. Compared w/ oral, SC MTX signif. incr odds of ACR20 (RR=1.15), ACR50 (RR=1.14) & reduced GI adverse events (RR=0.58), diarrhea (RR=0.42): BUT no difference in ACR70, DAS28-ESR, bioavailability AUC, or other AE https://t.co/tQeQz7H7do
Dr. John Cush @RheumNow( View Tweet )
EULAR 2026 Rheumatology RoundUp
It’s time for Rheumatology RoundUp from EULAR 2026 from London, UK. Drs. Artie Kavanaugh and Jack Cush review their choice presentations from the meeting, offering their perspectives on impact and applicability.
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Understanding Comorbidities in RMD
People with rheumatic and musculoskeletal diseases (RMD) are at risk of a number of comorbidities, from cardiovascular diseases to cognitive impairment and fractures. EIULAR 2026 showcased new data and ideas around various comorbidities and https://t.co/twr0EiMp9f
Dr. John Cush @RheumNow( View Tweet )
#OP0159 #EULAR2026
Multimodal study in D2T RA identified altered brain connectivity patterns linked to pain, psychological features & peripheral transcriptomics. Supports neuroimmune component in D2T RA & need for personalised approaches beyond inflammation control. @RheumNow https://t.co/qMQbkiMCwX
Mrinalini Dey @DrMiniDey( View Tweet )
Does #RA accelerate age-related functional decline in older adults? STAR study (n=421, age 55-85): RA with worse HAQ, grip strength, but aging's effect on function similar in RA vs controls. Geriatric syndromes like sarcopenia may matter more than RA @RheumNow #EULAR2026 POS0360
Jiha Lee @JihaRheum( View Tweet )
Do GLP-1 agonists achieve meaningful weight loss in patients with RMDs?
RISE registry
Retrospective
N=60,206
Tirzepatide: lost 8%
Semaglutide: list 6%
At 12 months
PsA had the highest usage
OP0112 #EULAR2026 @RheumNow https://t.co/P3CTgiwqCr
Nelly ZIADE 🍀 @Nellziade( View Tweet )
Machine learning identifies a “vulnerable” phenotype in older RA patients n=275
-51% “vulnerable”
-Worse grip strength, gait speed & SARC-F
-Higher disability (HAQ 1.56 vs 0.64)
-More fatigue, poorer QoL
-Higher DAS28 despite greater biologic exposure
Suggests we should assess https://t.co/bv1FbTxGKR
Aurelie Najm @AurelieRheumo( View Tweet )
Failure to achieve early remission RA asso w/ non-inflammatory pain
NORD-STAR 526 early RA pts)
no remission at 24 wks increased risk of 48wk
• unacceptable pain (OR ~6)
• refractory pain (OR ~6)
• fibromyalgic RA (OR ~16)
Signal strongest w/ very early remission wk8 https://t.co/H8iyhIrsJw
Aurelie Najm @AurelieRheumo( View Tweet )
What does remission really mean to patients with #PsA? The RemiPPsA international qualitative study asked 123 patients across 11 countries. Pain-free + ability to resume daily life topped the list, not just composite scores. #EULAR2026 @RheumNow, POS0294 https://t.co/mEGpkewuTX
Jiha Lee @JihaRheum( View Tweet )
Day 3 EULAR Report
Day 3 was an interesting mix of posters, oral presentations, and review sessions on many practical subjects like osteoarthritis, large vessel vasculitis, systemic sclerosis, and pregnancy. Here are a few of my recommended abstracts from Friday at EULAR 2026.
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What does remission look like for people living with PsA?
Much more than the absence of swollen joints
Absence of pain
Skin management
Ability to resume daily activities
Sustained over time
A definition not always reflected in our disease activity scores
#POS0294 #EULAR2026 https://t.co/VCnMGAOVYm
Links:
Aurelie Najm @AurelieRheumo( View Tweet )
PET-derived parameters in #PsA correlated with DAPSA, CRP and patient pain. Angiogenesis imaging may be a complementary biomarker of overall disease burden Abstr#OP068 #EULAR2026 #Imaging
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
#EULAR2026 OP0220 How can we improve physical function of #SLE patients? Cross-sectional study of 2 US cohorts: poor physical function was associated with Fatigue, depression, learned helplessness and perceived stress. We should focus on improving fatigue & wellbeing @RheumNow https://t.co/vAFqYyuzgN
Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
🔮 Can polygenic risk scores predict PsA timing in psoriasis?
Another GWAS study (n=703) says YES!
70-SNP model achieves AUC 0.843 for predicting PsA onset <10 vs >10 years
#POS0088 #EULAR2026 @RheumNow https://t.co/wI4Jy8Yu2A
Nelly ZIADE 🍀 @Nellziade( View Tweet )
@RheumNow HOT #Obesity session (7)
📢A call for action
Current RMD treatments ignore obesity:
They all target immune response but miss the metabolic-inflammatory loop
Breaking that cycle may be the missing piece
Obesity must be part of every rheumatology plan
#EULAR2026 @rheumnow
Nelly ZIADE 🍀 @Nellziade( View Tweet )
Treatment for #lupus #brain #fog?!
#small #RCT of Memantine a N-methyl-D-aspartate receptor (NDAR) antagonist used in #Alzheimers
SLE-more permeability in #brain #SLE -antiDNA cross reacting w NDAR
#memantine N=19 v #PBO N=25 showed more improvemt
#EULAR2026 @RheumNow POS701 https://t.co/qvHOy9oDS7
Janet Pope @Janetbirdope( View Tweet )
ClearMEMory: Ph2 RCT evaluating memantine for tx of cognitive impairment in SLE using RBANS as outcome measure
MEM grp had sig. higher change in RBANS TIScore upto wk 12 vs. PBO, esp. immediate memory index score
Potential adjunct tx for NPSLE?
AbsPOS0701 @RheumNow #EULAR2026 https://t.co/UffdVPRu6s
sheila @RHEUMarampa( View Tweet )
D2T RA shows a linked brain–psychology–immune signature
Cohort D2T RA vs non-D2T RA vs HC
91% D2T RA
Higher catastrophizing
Higher pain sensitivity
More emotion-focused coping strategies
“Chronic pain-like” profile
Associated with higher CNS related gene expression NRG1 https://t.co/nkQco73vqI
Aurelie Najm @AurelieRheumo( View Tweet )
Recent Blogs
Dr. Cush provides a systematic approach to evaluating musculoskeletal and rheumatic complaints in clinical practice.
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I have been investigating the mechanisms of antinuclear antibody (ANA) expression in SLE since 1978. In this pursuit, I have followed the advice of my first division chief, Dr. Ralph Snyderman, a great academician. Ralph told me to identify a research focus and make it mine. I think I have done reasonably well in my mission so you can imagine my surprise (and excitement) when, for the Lupus 2025 meeting in Toronto, I was asked to conduct a Meet the Professor session on the Type 1 & 2 model for SLE.
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Podcasts
ACR 2025 Daily Podcasts Day3c-
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ACR 2025 Daily Podcasts Day2c
