Mental Health

Factors that may augment future development of SLE - includes Vitamin D levels, poor sleep, EBV reactivation & social determinants of health. Can you Prevent SLE? Dr. David Karp lecturing at UTSW @drdavidkarp @utswrheum https://t.co/e3TKATcxXB
Dr. John Cush @RheumNow( View Tweet )
Study of 286 RA pt finds comorbidity burden—particularly psychological comorbidity—was strongly associated with poorer HRQoL and greater management difficulty in RA. https://t.co/F90S55DaI6 https://t.co/4Hw1yTUgP5

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Dr. John Cush @RheumNow( View Tweet )
Longitudinal study of 1761 US military service pre- & post-deployment. The prevalence of fibromyalgia in Males/Females was 2.%/2% (sames as civilians) but post-deploy incr to 8%/11% (P < 0.001). PTSD incr from 21% /18% to 23%/26%. PTSD predeployment lead to a 3 fold risk of FM. https://t.co/XTjuhjx0zd
Dr. John Cush @RheumNow( View Tweet )
DARWIN study ADHD med use among children and adults in Europe (Belgium, Germany, Netherlands, Spain, UK) more than doubled betw 2010 to 2023. IN UK use went up 20X in females, 15X males. (Ed. note: ADHD meds-->poor sleep-->fibromyalgia-->MSK pains) https://t.co/KlvUF1vhhj https://t.co/yEWXwM0WBL

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Dr. John Cush @RheumNow( View Tweet )
What Is Restless Legs Syndrome? JAMA Patient Education handout. https://t.co/fCqArVxrSu https://t.co/WjFNWyr9Q2

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Dr. John Cush @RheumNow( View Tweet )
“We will remember not the words of our enemies, but the silence of our friends.” - Martin Luther King, Jr.

Dr. John Cush @RheumNow( View Tweet )

Review of Restless Legs Syndrome JAMA has published a full review of RLS - restless leg syndrome - a frequent, but often unrecognized, cause of poor sleep and the resultant hazards of insomnia. https://t.co/lPSMH3v7xS https://t.co/lbSfeNrfLz

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Dr. John Cush @RheumNow( View Tweet )
What Is Restless Legs Syndrome? JAMA Patient Education handout. https://t.co/fCqArVxrSu https://t.co/xjl0PTdgsu

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Dr. John Cush @RheumNow( View Tweet )

Comorbidity and Health Management: Tuesday Night Rheumatology Join panelists Vanessa Hill, NP-C, Lindsay Tom, PA-C, Barb Slusher, MSW, PA-C and Jack Cush, MD as they discuss comorbidity and health management in rheumatic disease. https://t.co/3KMgBW1Q4W https://t.co/4dVfKd7uy5

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Dr. John Cush @RheumNow( View Tweet )
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Obesity and Low Back Pain

EurekAlert!

A large patient population study finds weight gain,  increases risk for low back pain - the risk increased 7% for every BMI unit or 10 pounds over ideal weight. 

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APP Pearls “You must assess sleep and mood- without this, even if you control all inflammation, you will not control pain and fatigue!” - Christine Stamatos, NP, DNP, RN

Dr. John Cush @RheumNow( View Tweet )

APP QD Clinic: Difficult AxSpA Philip Mease, MD and Christy Vath, PA-C, Seattle discuss a difficult to treat axial spondyloarthritis (axSpA) case. This APP QD clinic is presented as part of RheumNow's "Mission: APP Partners in Care" campaign during the month of December. https://t.co/VY0O26l7XC
Dr. John Cush @RheumNow( View Tweet )
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 )
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Reefer Madness (12.12.2025)

Jack Cush, MD

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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Medical Cannabis for Pain Management

Jack Cush, MD

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

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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

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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

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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

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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

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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

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sheila @RHEUMarampa( View Tweet )

Recent Blogs

Choice Overload (and the Way Out)

Jack Cush, MD
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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
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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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Therapeutic Updates

The Impact of Obesity on Psoriatic Arthritis

Sponsored by Lilly Medical Affairs
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Obesity is common in PsA and may worsen disease activity and reduce treatment effectiveness through shared inflammatory pathways. Weight intervention may improve outcomes and support achievement of targets of disease control.
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