General Rheumatology

Low Dose Naltrexone for Fibromyalgia Pain - Use it or Lose it? 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) https://t.co/RgRRHU9ZRo
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JAMA Case Challenge - Painful Hand Swelling With Finger Contractures 56-yoF w/ BL hand contractures, 15 mos BL hand pain/swelling/stiffness. No or partial relief w/ ibuprofen, 30 mg prednisone, MTX 10-20 mg/wk. All labs were normal. Whats the Dx? https://t.co/lZ0NHX5Y56 https://t.co/JC04E3JUxB

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Legislative Issues Affecting APPs Major interstate “compacts” allow for cross state licensing for physicians. However, compacts for Advanced Practice Registered Nurse (APRN) are fewer and currently on hold - thereby limiting healthcare manpower and patient care. https://t.co/cgzgGXIWka
Dr. John Cush @RheumNow( View Tweet )
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The Essential Role of Physician Assistants in Rheumatology

Daric A. Mueller, PA-C

Ready to bring a PA into your rheumatology practice? This blog post breaks down the key facts you need to know about PA training, scope of practice, and the recent changes to the profession's title.

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RheumNow Live 2026 Where the data meets the dialogue. Join leading rheumatologists, researchers, and innovators at RheumNow Live 2026 — the meeting redefining rheumatology education. ➡️https://t.co/zYYC2350tE https://t.co/I7YxpEcBG6

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"Act as if what you do makes a difference. It does." – William James

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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/zrGDwULms5
Dr. John Cush @RheumNow( View Tweet )
PROSPERO metanalysis of 22 studies & 2208 JIA associated uveitis (JIAU) showed severe visual impairment in 16.6% at ~18 yrs. Most frequent: Cataract (44.3%), followed by glaucoma, synechiae, band keratopathy and hypotony. Biologics were protective https://t.co/6OoupX64NE https://t.co/7bp0JtRken

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High Cost of Cancelling Knee Replacement Surgery Thousands of NHS knee replacement operations are cancelled at short notice every year, many for avoidable reasons, according to a new study published December 1st. This costs the NHS millions of pounds and increases waiting times https://t.co/USWAPC0k6N
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ICYMI: Inflammatory vs. Noninflammatory Pain https://t.co/3nJ2NZYTQY https://t.co/7FuSYzkX2G

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Hiring, Onboarding and Training APPs Watch our kickoff webinar for this month's Mission: APP — Partners in Care campaign. Our panel of rheumatologists and experienced advanced practice providers share insights into hiring, onboarding, training, compensation, and more. https://t.co/stgTQM9soW
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APPs in the News (12.5.2025)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from RheumNow.com, including info on scleroderma, dermatomyositis and malignancy, rheumatologist and APP salary concerns.

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RheumNow Live 2026 Where the data meets the dialogue. Join leading rheumatologists, researchers, and innovators at RheumNow Live 2026 — the meeting redefining rheumatology education. ➡️https://t.co/zYYC2350tE https://t.co/4Vz7swwqFJ

Links:

Dr. John Cush @RheumNow( View Tweet )
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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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Consensus Definitions on Difficult to Treat PsA A substantial number of patients with PsA, have difficult, persistent and hard-to-treat disease. A GRAPPA task force has developed a consensus terminology for two distinct states: Complex-to-manage PsA (C2M-PsA) https://t.co/po1psn9GNm
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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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WHO recommendations on GLP-1 agonists: 1) conditional recommendation - GLP-1 drugs can be used for for long-term obesity treatment by adults, except pregnant women; 2) GLP-1a use should be paired with a healthy diet and physical activity. Access to these drugs is a problem. https://t.co/jMa7rbJPby
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Changing Loan Limits for Advance Practice Providers

Jack Cush, MD

The "One Big Beautiful Bill" (OBBB), or H.R. 1, was signed into law in July, calls for significant changes in the funding of healthcare education.  This bill that lowers cap limits on education loans applies to graduate (APRN, PA) programs. It was driven by the need to lower the US

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U Colorado compared 10K Traditional Rheum consults (TC) to 670 eConsults. 75% eConsults completed without F2F eval & 73% w/in 3 days. eConsults referred to F2F had better 180d completion rates (36% vs 19% TC, p< 0.001). Dx & Rx rates were similar. Most eConsults came from PCPs. https://t.co/fE6yLMcm25
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 )
10 yr European retrospective study of haemophagocytic lymphohistiocytosis found 3345 deaths due HLH from 29 countries. Crude mortality rate = 5.3 per 10million PYs (range: 1.1-11.3). From 2011 to 2021, increasing from 3.9 to 6.6/10millPYs, varying by country, sex, age. https://t.co/58gCQ72saF
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Legislative Issues Affecting APPs

Jack Cush, MD

Here's a summary of legislative issues in three key areas: APRN compact and interstate licensing hold up; scope of practice; and, reimbursement hassles.

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PROSPERO metanalysis of 22 studies & 2208 JIA associated uveitis (JIAU) showed severe visual impairment in 16.6% at ~18 yrs. Most frequent: Cataract (44.3%), followed by glaucoma, synechiae, band keratopathy and hypotony. Biologics were protective https://t.co/6OoupX64NE https://t.co/4GFnugdvod

Links:

Dr. John Cush @RheumNow( View Tweet )
A&R USA adult rheum workforce study showed in 2019, there were 5,667 rheumatologists & 379 APPs. Betw 2009 - 2020, rheumatologist #s increased 23%, while #APP #s increased 141%. There was a signif increase in female rheumatologists & APPs over time https://t.co/Y5ZSwPLsNe https://t.co/RzDxbN7irL

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Congratulations to Professor Stuart Ralston (Versus Arthritis Professor of Rheumatology) from the University of Edinburgh. He has been honored with the RSE Sir James Black Medal by The Royal Society of Edinburgh for his research research & dedication to medical education https://t.co/vCm4Mkp6u7
Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

The War Rheum

Kathryn H. Dao, M.D.
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The effects on rheumatologists and their patients living in Ukraine largely have been unseen by the world. At ACR Convergence 2024, I met Dr. Marta Dzhus who practices at St. Michael's Clinical Hospital in Kyiv; she shared her story with me about the humanitarian crisis in rheumatologic care in Ukraine because of the ongoing war. Here is an excerpt of our conversation. Read Post

Overlap Syndrome with ILD

Jack Cush, MD
Cush RheumThought ILD

How would you manage a patient with Overlap (anti-synthetase) syndrome, ILD, polyarthritis and myositis?

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