General Rheumatology

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Chronic Low Back Pain Disappointments in a Randomized Trial

Jack Cush, MD

Annals of Internal Medicine reports that patients with chronic low back pain (cLBP) may benefit from physical therapy (PT); but when that fails, other secondary measures (cognitive behavioral therapy (CBT) or mindfulness) may not be effective.

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Vitamin D in Rheumatic Disease - is it Good Enough?

Jack Cush, MD

Vitamin D deficiency or insufficiency of is highly prevalent and has been often associated with inflammatory rheumatic diseases, raising the question of whether inadequate vitamin D status contributes to immune dysregulation, incipient disease, increased disease activity, or poor skeletal
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“60-40-20” - Ed Keystone (rumor has it he was actually bidding on a copy of my textbook!)

Dr. John Cush @RheumNow( View Tweet )

In Still's disease, what is the primary life-threatening complication clinicians must monitor for? If you think you know the answer, prove it in this week's RheumIQ quiz at https://t.co/KVK8J2iaFQ https://t.co/O62ZpIciWW

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Dr. John Cush @RheumNow( View Tweet )
24 systemic amyloidosis pts (AA type 46%, AL 29%); 62% joint pain & AM stiff, axial 37.5%, macroglossia (4 pts, 17%), carpal tunnel (12%), proteinuria > 1 gm 50%, CKD 21%, Cardiac amyloid 29%. Amyloid was secondary to Rheum Dx in 11/24. Better survival w/ AA than AL (91% vs https://t.co/hwkpeav4MQ
Dr. John Cush @RheumNow( View Tweet )
Steroids Corticosteroids remain a cornerstone of rheumatologic therapy — rapidly effective but chronically dangerous, as their power to suppress inflammation through inhibition of prostaglandins, lipoxygenase, pro-inflammatory cytokines, and proteases comes at the cost of a https://t.co/PKdnFi1XSr
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Have a Rheumatology question or case for Jack Cush? Record it here, and we may feature it on an upcoming podcast. Tell us your name and where you practice rheumatology. https://t.co/yyGRvXx3lL https://t.co/MgPqpaFLOc

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Influential Rheumatoid Factors (5.8.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com

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Review of Toll-like Receptor Research A new review on TLRs systematically summarizes 40 years of discoveries in the TLR field, from the initial identification of Toll in Drosophila embryonic development to the current understanding of multilayered regulatory mechanisms that https://t.co/Rvy24nmuTj
Dr. John Cush @RheumNow( View Tweet )
Nurses - the calm through chaos Nurses are a unique breed. When they appear, it’s always a blessing. But who goes into nursing? What kind of person choose nursing over doctoring? https://t.co/smUWg06nVh https://t.co/swQYJ3NfZF

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Dr. John Cush @RheumNow( View Tweet )
Supposedly there's a shortage of Infectious Dz specialists & Fellowship applic are down. Survey of 380 Int. Med residents (41 prgs) shows ID interest signif assoc w/ exposure to ID in Yr 1 & 2, outpt clinics, ID- research. https://t.co/AUkiIvsuaV https://t.co/pOqkBhy93U

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Dr. John Cush @RheumNow( View Tweet )
A Patient’s Plea for a New Paradigm in Autoimmune Disease A current article in Nature Reviews Rheumatology has a patient boldly asking why we rheumatologists aren't more like her oncologists? https://t.co/fJMwR864HW https://t.co/a6CJPpo4yq

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Dr. John Cush @RheumNow( View Tweet )
American Nurses Assoc. response to Dept of Education’s Final Rule on Graduate Loans for nurses: "..profoundly dismayed by DoE exclusion of nursing from....“professional degree” programs... this ignores the voices of over 245,000 nurses and nurse advocates https://t.co/WEYdiO9x4n https://t.co/3wxOwDBHVg

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Dr. John Cush @RheumNow( View Tweet )
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A Review of Hydroxychloroquine Ocular Toxicity

Jack Cush, MD

While hydroxychloroquine (HCQ) is thought to be a very safe drug, its ocular risk profile is probably more serious than appreciated. A comprehensive review published in the Journal of Rheumatology discusses HCQ pharmacokinetics, mechanisms of retinal toxicity, risk stratification, and evidence-

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More Comorbidity in Difficult-to-Treat RA A systematic review demonstrated that smoking, obesity, fibromyalgia, and depression are significantly associated with difficult-to-treat rheumatoid arthritis (D2T-RA). https://t.co/guMm6mqJGr https://t.co/xiykw5tBlJ

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Dr. John Cush @RheumNow( View Tweet )
STEP Talk: Mitigating Surgical Risk with Dr. Susan Goodman Surgery is high stakes for rheum patients. Dr. Susan Goodman shares how to mitigate perioperative risk and optimize outcomes at #RheumNowLive 2026. Smart prep = better recovery. https://t.co/AM1N3SimiY #Rheumatology https://t.co/wk99ytXZKl

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Dr. John Cush @RheumNow( View Tweet )
Global trends in systemic sclerosis (SSc) mortality. Betw 2001-23, in 74 countries, 85,291 SSc deaths (79% females). While SSc-Crude mortality increased from 1.97 (2001) to 2.34 (2023), the age-standardized mortality decreased from 1.58 to 1.29. declining in Americas & Europe. https://t.co/lvHbF5HLPY
Dr. John Cush @RheumNow( View Tweet )
24 systemic amyloidosis pts (AA type 46%, AL 29%); 62% joint pain & AM stiff, axial 37.5%, macroglossia (4 pts, 17%), carpal tunnel (12%), proteinuria > 1 gm 50%, CKD 21%, Cardiac amyloid 29%. Amyloid was secondary to Rheum Dx in 11/24. Better survival w/ AA than AL (91% vs https://t.co/pAEqYJIKaw
Dr. John Cush @RheumNow( View Tweet )
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A Patient’s Plea for a New Paradigm in Autoimmune Disease

Jack Cush, MD

A current article in Nature Reviews Rheumatology has a patient boldly asking why we rheumatologists aren't more like her oncologists?

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Level, monitor, calculate, glucose, diabetes

Metabolic Syndrome Predicts Cardiovascular Outcomes in Inflammatory Arthritis

Jack Cush, MD

Chronic inflammatory arthritis (CIA) is associated with elevated cardiovascular risk. While metabolic syndrome (MetS) is prevalent, how much it contributes to adverse clinical outcomes is unclear.

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By @RheumattDoc #Psoriasis and nail changes #PsA #PsoriaticArthritis #enthesitis #dactylitis https://t.co/rxH2zrGBwC

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Dr Gurdeep S Dulay @gurdeep_dulay( View Tweet )
morbidity,covid,heart,lung,brain

More Comorbidity in Difficult to Treat RA

Jack Cush, MD

A systematic review demonstrated that smoking, obesity, fibromyalgia, and depression are significantly associated with difficult-to-treat rheumatoid arthritis (D2T-RA).

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RCT 120 mod-severe hip OA (KL 2-4) pts Rx w/ THA +rehab or exercise. @12 mos. THA had signif. better pain, function & HRQoL vs exercise program alone (WOMAC total -30.9 vs -3.7). (38% of exercise/conservative grp needed THA) https://t.co/6vvRAr6isf https://t.co/VOYgS3PPwr

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Dr. John Cush @RheumNow( View Tweet )
“Almost always, the creative dedicated minority has made the world better. “ -Martin Luther King, Jr.

Dr. John Cush @RheumNow( View Tweet )

Knee pain: JAMA review - 5% PCP visits knee pain - Knee OA ~654 million worldwide - Patellofemoral pain: <40 yrs & physically active; pain on squat - Meniscal tears in 12% adults (McMurray 61% sensitive; 84% specific; Joint line tender 83% sensitive; 83% specific) https://t.co/2fdpl464mb
Dr. John Cush @RheumNow( View Tweet )

Therapeutic Updates

5-Year Results of an IL-23 Inhibitor in Patients With PsA

AbbVie March 2026
Dr. Alvin Wells and Dr. Shikha Singla share their clinical perspectives on using an IL–23 inhibitor to manage patients with PsA throughout their treatment journey in the context of 5-year data from the KEEPsAKE trial program.
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Recent Blogs

Advanced Practice Rheum

Still's Disease and Fever

Jack Cush, MD
Stills apr video cover
Dr. Jack Cush reviews Still's disease and fevers.
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Autoantibodies Anonymous

Artie Kavanaugh, MD
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At first, it seemed similar to many other such sessions – a circle of folding chairs, a group of colleagues whose visages exuded understanding and acceptance – but this was special. I started the meeting…. “Hi, my name is Artie.”
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Advanced Practice Rheum

Difficult to Treat Rheumatoid Arthritis

Jack Cush, MD
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Dr. Cush addresses the management of difficult-to-treat rheumatoid arthritis (D2TRA).
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