One of the most common questions I receive in my vasculitis clinic is one of the most difficult to answer: “When can we stop rituximab?” While we know everyone needs therapy for at least one year and have reasonably good data for 18 months, whether folks should continue after that remains an open question. That is why I was especially excited to see a post hoc analysis of RITAZAREM, which followed patients for up to 48 months from enrollment
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Read ArticleACR Convergence was off to a big start with the year in review, posters and plenary sessions. Here are a few of my favorite presentations from todays Plenary I session at ACR Convergence. Two of five plenary abstracts were about weight loss, one was about artificial intelligence, and two offered new mechanistic insights with therapeutic implications.
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Dr. John Cush
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Early tocilizumab leads to less hospitalization in #GCA. TriNetX study of 127 GCA Rx (w/in 3 mos Dx) w/ TCZ+GC vs GC alone (127). Early TCZ had 36% less hosp in 12 mos (19.7 vs 30.7%) but no diff in vascular events. Abstract #166 #ACR26 https://t.co/a9WfEMQ8wg https://t.co/ors9EBYb6T
Dr. John Cush
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GCA with normal CRP? French study of GCA > 50 yrs, dx w/ temp artery Bx 67% or imaging (US, PET) + nl Baseline CRP <10 mg/L. 74 pts (age 73 yrs) 84% filled 2022 Dx criteria. Low CRP pt had less fever, fatigue, wt loss, PMR Sxs & more ischemic Sxs and strokes. They were more https://t.co/olL8Vf93DW
Dr. John Cush
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TARA study from China - Ph2 H2H Girocitinib (JAK1/TYK2i) vs Tofacitinib in active RA refractory to bDMARDS. 459 pts, ACR50 @wk 24 Giro 73% vs Tofa 49% (p<0.0001), also superior at ACR20, ACR70, DAS remission, CDAI<10. H.Zoster 3%. Abst#LB21 #ACR26 https://t.co/JZLjQx4vSa https://t.co/51gaIOKTWf
Dr. John Cush
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RheumNow’s expanded coverage of the #ACR26 Annual Meeting is sponsored by UCB
All coverage content is independently selected by RheumNow and its faculty
Dr. John Cush
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RheumNow’s expanded coverage of the #ACR26 annual meeting is sponsored by Eli Lilly and Company.
All coverage content is selected by RheumNow and its faculty.
David Liew
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Are clinical scenarios into AI chatbots useful?
(both specialized eg OpenEvidence or generalist eg ChatGPT):
performance will vary (platform but also model, effort)
prompt structure critical
users (patients & clinicians) need to know real limitations
ABST0869 #ACR26 @RheumNow https://t.co/vPNvJlSXZY
Janet Pope
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Who will progress in
#SSc-ILD?
+Scl70
Male
African American
#smoker
Worsening #mRSS
#aspiration
CRP, KL6?
60 SSc-ILD v 19 SSc no ILD
FVC%pred related to baseline
#KL6 & #ICAM-1
But NOT predicted worsening
But small study
Better markers needed
#ACR26 0037 @RheumNow @ACRheum https://t.co/mvpL17Mdjr
Janet Pope
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Impt pathway for #fibrosis & #inflammation?
FIbrosis in #sarcoidosis mediated thru
#TL1A
Myeloid cells —granulomas
TL1A effects
TNF
IL1beta
IL6
IL17
Drugs could be effective
Some already in #IBD
Ex
#Tulisokibart
#Duvakitug
#Afimkibart
🤷
#O019 #ACR26 @RheumNow @ACRheum https://t.co/GPKwEqWFkh
Janet Pope
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Short #telomeres are associated w #IPF
Cool study from #UCSF @ACRheum #ACR26 showed
#senescence
In #PPF & #SARD-ILD
-epithelial remodeling w #DNA damage
Same theme leading to ILD—#fibrosis
?Rx pathway for repair
#0025 @RheumNow https://t.co/8wjtYgBXNF
Dr. John Cush
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RheumNow’s expanded coverage of the #ACR26 annual meeting is sponsored by UCB.
All coverage content is independently selected by RheumNow and its faculty.
Janet Pope
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I used to think #SSc #scleroderma pts w #SjD #Sjogren’s did better as more
Mild ‘#CREST’
Nope 👎
#CSRG study N>1000 pts
showed #SjD had
=#mRSS
But
⬆️#GI #gut issues
⬆️ #ILD ? From +#Ro
⬇️worse #QoL
#0231 #ACR26 @ACRheum @RheumNow https://t.co/A4zxpc24XN
Janet Pope
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Rx of calcinosis in #SSc is ‘hard’
Small RCT of BID topical #sodium #metabiosulfite v #PBO
neg #trial but a trend to some imaging improvement at 4 mo
Tough trial to do
?need:
Larger, longer study
Higher dose?
Try sodium #thiosulfate instead
#0226
#ACR26 @ACRheum @RheumNow https://t.co/CyA1k4rnNr
Janet Pope
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#dcSSc active
Early allogenic #CAR-T -initial dosing had #mRSS drop of 16pts (L Chung)
Well tolerated
in vivo #CAR-T #CD19 N=3 SSc + for #skin & #lung 🫁 from China
+ in SLE NEJM just published
closer to scalable Rx vs autologous!
#ACR26 @RheumNow @ACRheum
#0223, 0225
Janet Pope
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Use deep B cell depletion in #diffuse #scleroderma if #rituximab fails?
🤞
Small case series from France showed #obinutuzimab seemed to be well tolerated and reduced #skin #score #mRSS post #RTX which was d/c for loss of effect or infusion rx’n
Need RCT
@RheumNow #0222 #ACR26 https://t.co/iEv2T4XcYS
David Liew
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There's a LOT of talk about CAR-T safety in autoimmune disease, and whether it's worth the payoff.
In amongst all the moving parts, it's not so simple.
here's my breakdown of what zola-cel has taught us so far @RheumNow #ACR26
https://t.co/mGZmOsoE8o
Mrinalini Dey
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Ultra-processed food & RA: In 108,886 participants, highest vs lowest intake was associated with incident RA (HR 2.58), but the association lost significance after nutrient adjustment. Findings support a potential role of dietary quality in RA development @Rheumnow #0949 #ACR26
Mrinalini Dey
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In 64 RA patients randomized to ITIS or Mediterranean diets, both groups improved over 3 months, with distinct microbiome/metabolomic response patterns. Different dietary interventions achieve clinical benefit through complementary biological mechanisms. #0948 @Rheumnow #ACR26 https://t.co/Ls1awH3pgE
Mike Putman
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Low-dose naltrexone fails again :(
LoDoNaVasc blinded crossover RCT of 60 pts with remission/very low vasculitis activity. No difference in PROMIS physical or mental health
Supports results from @TheLancetRheum in fibromyalgia
Sadly, this does not seem to work
@RheumNow https://t.co/S2XRSyGvIZ

Poster Hall