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#ClinicalPearl Update on @eular #rheumatoid #arthritis guidelines. Reassuringly not much of an update. Very reasonable discussion of #JAKi safety. @RheumNow Day 1 of #EULAR202 T2T, shared decision making, limit #glucocorticoids to shortest time. Change MOA or not, after failure.
Janet Pope Janetbirdope ( View Tweet)
The amazing @SuAnnYeoh1 oral presentation showing terminally differentiated T effector memory re-expressing CD45RA are associated persistent disease activity in TNF non-responders (but not other bDMARDs) ?role in driving disease @RheumNow #EULAR2022 OP0011 https://t.co/OFradjuGvo https://t.co/flpFmcvixO
Links:
Richard Conway RichardPAConway ( View Tweet)
178,000 cells from knee synovium studied to eval diff in RA vs PsA transcriptomes. With RA:
👉synov Tcells ⬆️TGFB1 express'n
👉⬆️FAP+ THY1+ synovial fibroblasts
👉receptor ligand network➡️synovial T cell & macrophage synergy
👉IL-1b & TGFb synergy #EULAR2022 OP0067 @rheumnow https://t.co/0uaFyqZqBg
TheDaoIndex KDAO2011 ( View Tweet)
#Plenary OP0066. Consider Whipple Dz in pts inflammatory rheum dz Screen with PCR saliva/stool samples, confirm with duodenal bx or PCR on joint fluid. pts on doxycycline and HCQ can lead to rapid remission. @rheumnow https://t.co/VcGp8pr3dT
TheDaoIndex KDAO2011 ( View Tweet)
NORD-STAR substudy looking at anticoagulant effects. Important as RA assoc. ⬆️DVT/PE. DMARDs improve haemostatic imbalance, with bDMARDs stronger effect than csDMARD (may relate to better disease control with this) @RheumNow #EULAR2022 OP0059 https://t.co/TKwAZMOZjY https://t.co/IazrfD7z7k
Links:
Richard Conway RichardPAConway ( View Tweet)
Pedersen et al report 6-fold mortality⬆️over 10 years in RA patients with co-existent depression. Even stronger effect in younger patients (<55) @RheumNow #EULAR2022 OP0067 https://t.co/vYYTmTnstQ https://t.co/xKgMu7zaOA
Links:
Richard Conway RichardPAConway ( View Tweet)
NORD-STAR TRIAL drug does better in ttmt naive eRA? 48wks
CDAI remission ▶️ w/ ABA and CERTO PEG vs. MTX+ GCs while TCZ not stat ▶️.
Is the difference clinically sufficient to recommend these in first intention over MTX ? not convinced 🧐
OP0058 #EULAR22
@rheumnow
Aurelie Najm AurelieRheumo ( View Tweet)
Screen for depression in RA patients!
From the #DANBIO registry of 11,000 pts, they found
6X ⬆️mortality in pts w/#RA and #depression . The mortality curve separates early. #Plenary OP0067 @rheumnow #EULAR2022 https://t.co/qfjyejGVzQ
TheDaoIndex KDAO2011 ( View Tweet)
#EULAR2022 POS0241 shows JAKi ⬇️ pain catastrophization/central sensitization in RA patient via CSI (Central Sensitization Inventory) and (PCS) Pain Catastrophizing Scale.
No decrease of articular inflammation on ultrasound with JAKi shown, but study had just 22 pts
@RheumNow
Eric Dein ericdeinmd ( View Tweet)
#EULAR2022 OP0066
French retrospective obs study 2019-2021 with 73 cases of Whipples disease treated for rheum disease
▶️M/F ratio 3, middle aged
▶️1/2 met RA criteria
▶️Peripheral jts, 1/3 had axial involvement
▶️Rx: HCQ, Doxi - 80% cured, DMARD stopped in >90% cases
@RheumNow https://t.co/t7zlDrPfJB
Eric Dein ericdeinmd ( View Tweet)
NORD-STAR results. Biologic + MTX combo seemed better than slightly strange "conventional"(ACT) group of MTX + oral steroids or triple therapy + IA injections @RheumNow #EULAR2022 OP0058 https://t.co/tOfTlcplFR https://t.co/CvtvuVn5Xj
Links:
Richard Conway RichardPAConway ( View Tweet)
#EULAR2022 POS0235: Filgotinib Safety in RA for Median 2.2 years:
▶️No new safety concerns from 2020 report with shorter f/u
▶️Adverse events stable, or decreased, from early studies
@Rheumnow https://t.co/DO15Tqim4n
Eric Dein ericdeinmd ( View Tweet)
@Rheumnow #EULAR2022 POS0240
▶️ In 2021, 73.6% of Belgian RA patients staring a JAKi, started a 2nd generation JAKi (UPA, FIL).
Predictors for 1st generation usage (BAR, TOFA): older age, prior DMARD therapies.
What would you start as a first JAKi?
Eric Dein ericdeinmd ( View Tweet)
Household Cleaning is dirty business at least if you have #rheumatoid #arthritis as silica exposure from laundry and cleaning products were associated with RA ILD. #EULAR opening day. #ClinicalPearl #EULAR2022 @RheumNow #OP0006 https://t.co/OJQMy9Fe9m
Janet Pope Janetbirdope ( View Tweet)
ACR21: conditionally recommends against steroids with starting csDMARD
#EULAR2022 recommends with rapid GC dose reduction and discontinuation
Which is better recommendation?
@RheumNow
Eric Dein ericdeinmd ( View Tweet)
#EULAR2022 RA updated reccs w/ minor changes: start MTX+GC, reduce GC rapidly, JAKi are recc only for pts w/o risk factors for CV or malignant dz (not sure I agree with this last one if the JAKi is the best drug for the pt and there are little options avail) @rheumnow https://t.co/CXyyCi6LVI
TheDaoIndex KDAO2011 ( View Tweet)
After the #EULAR2022 Recommendations session, it begs the question - Do we follow it?
In Germany, the answer is sometimes
Early bDMARD or JAKi is more frequent in recent years. 1/3 of patients did not receive recommended treatment escalation after 1st csDMARD
POS0234 @Rheumnow https://t.co/0DaP5b7Htc
Eric Dein ericdeinmd ( View Tweet)
EULAR 2022 Featured Industry Abstracts
Below is a collection of several EULAR 2022 abstracts highlighted in recent press releases from companies sponsoring major clinical trials. You can search the EULAR site for these abstract and others here.
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Immune Checkpoint Inhibitor Associated Arthritis
Immune checkpoint inhibitors (ICIs) have dramatically improved outcomes in numerous cancers but have been hampered by a growing spectrum of immune-related adverse events (irAEs). Rheumatic complaints may be less frequent than other irAEs associated with ICI in cancer patients.
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Bridge Prednisone Use Fails to Improve Outcomes
A one year, X-ray outcome trial has shown that the initial use of prednisone (high or low dose) in newly treated active early rheumatoid arthritis (RA) did not improve radiographic outcomes.
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