Fibromyalgia/Pain

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Low Dose Naltrexone for Fibromyalgia Pain - Use it or Lose it?

Jack Cush, MD

Medscape recently reviewed off-label use of low dose naltrexone (LDN) in fibromyalgia (FM) and found it is deemed effective by some clinicians and patients, but 1) there is no FDA indication for LDN use in FM and 2) the data supporting its use is limited.

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Turkey Tryptophan (11.28.2025) Dr. Jack Cush reviews the news and reports from this past week on RheumNow, including reports on FDA resurrections, FM seasonal worsening, and do you fight switch or swap biologics in PsA TNFi nonresponders? https://t.co/cnxxwqwyTE https://t.co/82zugQnp2Y

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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, https://t.co/u4w3b915my
Dr. John Cush @RheumNow( View Tweet )
BASDAI scores elevated in Fibromyalgia - 58 FM pts were surveyed wtih FIQ, SSS, BASDAI. BASDAI was ≥ 4 points in 91.4% of FM (vs 13% controls (p < 0.001). BASDAI correlated w/ the FIQ (pain, fatigue, stiffness) & SSS scores (r = 0.88, p < 0.00). Could BASDAI be used in FM? https://t.co/M0tI8wjzh4
Dr. John Cush @RheumNow( View Tweet )
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Turkey Tryptophan (11.28.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and reports from this past week on RheumNow.com, including reports on FDA resurrections, FM seasonal worsening, and do you fight switch or swap biologics in PsA TNFi nonresponders?

Read Article
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Coccyx and Sacrococcygeal Joint Disorders

Jack Cush, MD

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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Obesity-inflammation axis in PsO & PsA: obesity is assoc w/ less remission& poorer drug responses; possibly from adipokines, biomechanical stress, gut dysbiosis, etc. Notably, weight loss can improve both psoriatic disease course and response to therapy. https://t.co/cZbeu0zfmR https://t.co/EoCTNKk265

Links:

Dr. John Cush @RheumNow( View Tweet )
BASDAI scores elevated in Fibromyalgia - 58 FM pts were surveyed wtih FIQ, SSS, BASDAI. BASDAI was ≥ 4 points in 91.4% of FM (vs 13% controls (p < 0.001). BASDAI correlated w/ the FIQ (pain, fatigue, stiffness) & SSS scores (r = 0.88, p < 0.00). Could BASDAI be used in FM? https://t.co/VF94ru0o3Q
Dr. John Cush @RheumNow( View Tweet )
JAMA review of Peripheral Neuropathy - affects ~ 1% of adults worldwide and may cause sensory, motor, and autonomic Sxs. Diabetes is the most common cause. 1st line Rxs include gabapentin, pregabalin, duloxetine, amitriptyline. (FOR AMA MEMBERS) https://t.co/sof15I1GpU https://t.co/PN0KMeUsGA

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Dr. John Cush @RheumNow( View Tweet )
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Chronic pain may dramatically raise your blood pressure

Science Daily

Widespread chronic pain may stealthily drive up blood pressure, partly through its ties to depression and inflammation.

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Retrospective analysis of 2614 FM pts in the Italian Fibromyalgia Registry underscores the seasonal changes in FM pain, w/ signif. differences in FM assessment tools WPI p=0.042 & FASmod p=0.037); these changes were only seen in female patients, not males https://t.co/LqXnTgGIMB https://t.co/ihw1yJqKLC

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Dr. John Cush @RheumNow( View Tweet )
RETREAT study was a 12 wk RCT of Tai Chi in 178 knee OA pts Rx w/ online OA info vs same plus free web based tai chi video program. Tai Chi group had signif improved knee pain (−2.7 v -1.2); (−12 v −6.9) & achieved a minimal pain & function (73% v 47%); and Its free! https://t.co/WLzQ9YHrcu
Dr. John Cush @RheumNow( View Tweet )
Weight Loss as a Therapeutic Goal in PsA PsA is a complex inflammatory disease often complicated by obesity, which not only worsens disease activity but also impairs treatment response. At #ACR25, 3 compelling studies spanning pharmacologic, lifestyle, and longitudinal https://t.co/Q6IFGn5zCI
Dr. John Cush @RheumNow( View Tweet )
What happens if you have #axSpA & concomitant #FM? Pts with both have less TNFi retention, -residual pain may lead to d/c Rx. Need to determine if axSpA pt has #fibromyalgia as there may not be objective findings if no peripheral arthritis in axSpA. #ACR25 @RheumNow abst#534

Janet Pope @Janetbirdope( View Tweet )

In a PsA cohort (n=1291), higher BMI was independently linked to lower odds of achieving MDA—especially in TNFi-treated patients. Impact was strongest in pain, skin, enthesitis, and PRO domains, not swollen joints. Each unit increase in BMI reduced MDA odds by 4–7%. Highlights https://t.co/TxO3HP51uk

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Antoni Chan MD (Prof) @synovialjoints( View Tweet )
Abstract 2687: GLP-1 RA in PsA In combined Toronto + NYU cohort, GLP-1 RA significantly associated with reduced: - Weight, CRP, and pain scores - Each 1% reduction in body weight associated w/ TJC, DAPSA, EQ-5D (QoL), LDL, Systolic BP @RheumNow #ACR25 https://t.co/30lPDkALKs

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Akhil Sood MD, MS @AkhilSoodMD( View Tweet )
#ACR25 Clinical Preview by Prof Coates for use now: GLP-1 agonist & Diet Abstr#813 GIP/GLP-1 improved MSK pain Abstr#849 GLP-1 reduced risk of #MACE in PsA Abstr#2690 RCT = the degree of weight loss regardless specific dietary strategy determined benefit in PsA @RheumNow https://t.co/4jB0fFHosC

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Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
Disease activity associated with symtomatic knee OA and increased with increased KL grades Abst#2625 #ACR25 @RheumNow https://t.co/uCrdnVXk0J

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Bella Mehta @bella_mehta( View Tweet )
Perhaps it was my ignorance, but a FDA-approved therapy for fibromyalgia was not on my 2025 bingo card. We’re not exactly overwhelmed with proven options for FM, the unmet need is so great, so the more, the better. #ACR25 FDA session @RheumNow https://t.co/wwWijl3IyW

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David Liew @drdavidliew( View Tweet )
Hindosh et al. Semaglutide associated with reduced synovitis, joint pain and swelling, in RA. @RheumNow #ACR25 Abstr#2286 https://t.co/6Xs4um5l32

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Richard Conway @RichardPAConway( View Tweet )
Gender differences in p/axSpA in Turkiye from ASAS-PerSpA: Males - early onset IBP (<45yrs); sacroiliitis on CR, HLA-B27+ (vs. females) Females - peripheral dse, enthesitis, Pso, dactylitis; ⬆️dse activity, FM (vs. males) Individualize & optimize tx. #ACR25 @RheumNow Abs2322 https://t.co/vcisNguJLB

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sheila @RHEUMarampa( View Tweet )
“I never thought I’d live to old age with MCTD, now I plan for it.” This patient’s journey highlights the power of evolving therapies, resilience, and lifestyle adaptation to age well with chronic autoimmune disease. Patient perspectives abstract #PP04 @rheumnow #ACR25

Jiha Lee @JihaRheum( View Tweet )

GLP-1 in Knee Osteoarthritis https://t.co/SxyVEAK1CZ @bella_mehta Discusses role of GLP1 in OA and possible mechanisms of effectiveness ? weight reduction ? or doses it have anti-inflammatory -anti-fibrotic role ? @RheumNow #ACR25

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Nouf Al hemmadi @NoufAhmedAlham2( View Tweet )

A largely understudied area: Impact of peri-menopause in PsA Toronto Cohort 473pts, HRT 1.5% Peri menopause = increase DAPSA, TJC, SJC, FACIT-fatigue, HAQ compared to pre- and post-menopause No association w/ BMI, but with fatigue Less impact when education level increases https://t.co/bSuGxZCbGn

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Aurelie Najm @AurelieRheumo( View Tweet )
Functional MRI studies have been out there for a while, but mechanisms and significance underlying fMRI findings are unclear fMRI study in 38 active PsA pts w/ significant fatigue Altered functional connectivity between posterior insula to cerebellum & superior frontal gyrus https://t.co/3s9CJUg2uN

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Aurelie Najm @AurelieRheumo( View Tweet )

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