Mental Health

How Living With Childhood-Onset Lupus Impacts Mental Health Children, teens, and young adults with childhood-onset systemic lupus erythematosus (cSLE) require intense immunosuppressive treatments to prevent organ damage. Recently, the mental health burden for cSLE patients has https://t.co/JXkdYiAO9o
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Diagnosing Neuropsychiatric SLE (5.23.2025) Dr. Jack Cush reviews the news and journal reports from RheumNow - including views on the vagus nerve, NPSLE and CAR-T mania. https://t.co/PadauvfWWA https://t.co/4k4nfHSPg5

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teen under covers looking anxious

How Living With Childhood-Onset Lupus Impacts Mental Health

Kaveh Ardalan, MD

Children, teens, and young adults living with childhood-onset systemic lupus erythematosus (cSLE) require intense immunosuppressive treatments to prevent serious organ damage. By the mid-2010’s, multiple studies were published that showed high rates of depression, anxiety, and suicidal

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“Courage is what it takes to stand up and speak; courage is also what it takes to sit down and listen.” – Winston Churchill https://t.co/5YMQppiMSG
Dr. John Cush @RheumNow( View Tweet )
Unmet needs in #lupus are many 👇 Timely #diagnosis Morbidity - CV, metabolic, OP, mental health Premature mortality - CAD, active #SLE, infection Issues w pregnancy #steroid side effects ⬇️QoL With partnerships we can ✅ Pts HCPs researchers Pharma Gov’t #LUPUS2025 @RheumNow https://t.co/9T9rIrM1hV

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Janet Pope @Janetbirdope( View Tweet )
Impt predictors of #neuropsychiatric #SLE #LUPUS2025 @RheumNow No major predictors But if explanation of other conditions ex Past #cvA #ischemic events Doesn’t have to have ➡️Active systemic ##Lupus ➡️ ?ribosomalP +Abs described in #CNS lupus A real headache! https://t.co/iuWfB454EN

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Janet Pope @Janetbirdope( View Tweet )
‘It’s #Lupus, it’s all in your head!’ ➡️ Some patients with #SLE have heard this from others At #LUPUS2025 in a packed session on #CNS lupus #Dx is tricky 40% of #neuropsychiatric lupus have NEGATIVE #brain #MRI 👇r/o infarct/bleed Infection Rx #steroids @RheumNow https://t.co/yU1olg0uZU

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Janet Pope @Janetbirdope( View Tweet )
Steroids prevention of #congenital #heart #block in +Ro Mom #DM #HTN #wt⬆️ Fetus ?no diff #cardiomyopathy ?learning &behavioural changes Debate re screen #CHB Most CHB are kids w CHB as mom is unknown to be +Ro Angst w screening High titre Ro Impt @RheumNow #LUPUS2025

Janet Pope @Janetbirdope( View Tweet )

Assessing neuropsychiatric SLE by 3-T, 3D contrast-enhanced vessel wall imaging. 47 w/ NPSLE vs 42 without (just SLE) showed the NPSLE had 2 fold more 1ntracranial contrast-enhanced vessel wall imaging (CE-VWI) w/ AUC 0.78 for CE-VWLs, & sensitivity 60% , specificity 87%.

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QOL survey of on 5222 lupus pts (94% F; 56% both CLE/SLE; 40% w/ SLE. QOL concerns on social activities (60%), mental health (38%). CLE had increased therapeutic hesitancy and less likely to believe in the efficacy of biologics than SLE or both. https://t.co/BOUXUSmmcM https://t.co/62Z1aFsbbv

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National Inpatient Sample retrospective study of #RA pts using cannabis (n 42,415). Cannabis assoc w/ lower mortality (0.98% vs 2.71%; OR 0.50), depression (OR 0.47), chronic pain (OR 0.45), anxiety (OR 0.55); but more use of opioids (OR: 1.10), nicotine (OR: 1.35), & alcohol https://t.co/87SnCHVxkN
Dr. John Cush @RheumNow( View Tweet )
QOL survey of on 5222 lupus pts (94% F; 56% both CLE/SLE; 40% w/ SLE. QOL concerns on social activities (60%), mental health (38%). CLE had increased therapeutic hesitancy and less likely to believe in the efficacy of biologics than SLE or both. https://t.co/BOUXUSmmcM https://t.co/zrzEsDDqVn

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Dr. John Cush @RheumNow( View Tweet )
Telemedicine and Lupus https://t.co/RgfgnMGsZw https://t.co/uQEYLlrlB5

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Dr. John Cush @RheumNow( View Tweet )
Full read review of Neuropsychiatric SLE. NPSLE criteria includes 12 central & 7 peripheral findings (psych, cognitive, Sz, CVA/TIA, neuropathy, MS-like). NPSLE AutoAbs are many: Abs against APL, LAC, RP, NMDA, NMO/AQP4, EC, SBSN, UCH-L1, TP1, GAPDH, MAP2, U1RNP https://t.co/1m7SXMA68Z
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VitD_1.jpg

D-Lay Trial: High-Dose Vitamin D Retards Multiple Sclerosis

Jack Cush, MD

A randomized clinical trial with oral high-dose cholecalciferol ( vitamin D3) was shown to prevent or delay the onset of clinically isolated syndrome (CIS), typical for multiple sclerosis (MS).

Vitamin D plays an important role in immune

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Full read review of Neuropsychiatric SLE. NPSLE criteria includes 12 central & 7 peripheral findings (psych, cognitive, Sz, CVA/TIA, neuropathy, MS-like). NPSLE AutoAbs are many: Abs against APL, LAC, RP, NMDA, NMO/AQP4, EC, SBSN, UCH-L1, TP1, GAPDH, MAP2, U1RNP https://t.co/HvDX8wSuoB
Dr. John Cush @RheumNow( View Tweet )
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Rheumatology: Believe It or Not (4/25/2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Should we believe the reviews and metanalyses?

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Retrospective study of 334 children with non-organic amplified MSK pain syndr(AMPS) plus back pain. Pts w/ localized AMPS were more likely to have a (+) straight leg raising test (P 0.01) & diffuse AMPS more likely to have allodynia & incongruent affect (reporting pain, but still https://t.co/unbub6VK0t
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Systematic review shows PTSD is strongly assoc w/ an increased risk of developing SLE. 7 studies (5 prospect cohort) and 11614 SLE pts - 1,325 (11.4%) had comorbid PTSD, mostly females. All showed + association of PTSD & SLE, 3 showing 2fold incr risk of SLE. No genetic https://t.co/Xjya0QNznQ
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EMR Messaging Woes (4.11.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal reports and regulatory approvals from this past week on RheumNow.com

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MMWR: While PRE-overdose opioid prescribing is a risk marker for fatal overdose from opioids alone, stimulants alone, or both; PRE-overdose stimulant prescribing might not be a risk marker for fatal overdose attributable to stimulants. https://t.co/ReVbpligeT https://t.co/PnjeqaCySX

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Mindfulness and CBT improve chronic low back pain Behavioral interventions were associated with reduced pain and daily opioid use and improved function and quality of life for up to 12 months among adults with opioid-treated chronic low back pain, according to a new randomized https://t.co/e4jLNwNBy3
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12-month community trial 770 adults w/ opioid-treated chronic low back pain (CLBP). Found that opioid dosage decreased with both mindfulness-based therapy & cognitive behavioral therapy (CBT) at 6 & 12 mos.(noninferior) - Why dont we use these? https://t.co/9VhqJEHlhc https://t.co/GWnL66nbvY

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NIH Complimentary Medicine overview of Music Therapy - preliminary research suggests that music interventions may be helpful for anxiety, depression, pain control, dementia, multiple sclerosis, Parkinson’s disease, etc https://t.co/UGsfT7lITQ https://t.co/DrJm4JdEuY

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Transcranial_magnetic_stimulation

Repetitive Transcranial Magnetic Stimulation in Fibromyalgia

Jack Cush, MD

A randomized, sham-controlled trial has shown that repetitive transcranial magnetic stimulation (rTMS) reduced pain in fibromyalgia for up to 8 weeks; while analgesic effects waned, functional improvements remained during extended maintenance at week 16.

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Recent Blogs

Choice Overload (and the Way Out)

Jack Cush, MD
paint,choice,overload,color
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”. Read Post

Comorbidities in RA: Focus on Difficult-to-Treat Disease

Elena Nikiphorou, MD, PhD
Puzzle pieces
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’. Read Post
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