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How do we manage difficult discussions about pregnancy in RA?
Most rheumatologists know that it is important to get pregnancy planning right for women of childbearing age living with rheumatic diseases. That is easier said than done, though: the details are difficult, it is overwhelming for the patient, and the conversations are hard.
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Lovering et al. Synergestic effect of RA and CVD on dementia risk. 35% increased risk RA, 89% increased risk RA+CVD. Abstr#1628 #ACR23 @RheumNow https://t.co/Brj8XrG2o4
Richard Conway ( View Tweet)
#ClinicalPearl or #pathology pearl? Using synovial #biopsies to guide therapy in #RA #RCTs is a reality. But likely #fibrotic #phenotype won’t respond and #lympho_myeloid has more RA damage. #ACR23 session 13M140 #Precision #medicine #ACRbest @ACRheum @RheumNow https://t.co/DmI9dNpu8w
Janet Pope ( View Tweet)
@Dr_K presenting long COVID data from FORWARD RA.
These pts had some symtoms before COVID!- More comorbidites, depression patient reported scores, fibromyalgia but no different DMRD use.
PHQ8 and wodepread paid were the most important PROMs @RheumNow
#ACR23 https://t.co/JaWc4oDnaI
Bella Mehta bella_mehta ( View Tweet)
#Precision #Medicine in RA RCTs. Treat w right drug at right time?
Possible problems -sample variation on synovial #bx, some won’t respond ex fibrotic phenotype variable drug distribution/resistance. AI is helping to separate Pts #ACR23 @ACRheum @RheumNow 13M140 https://t.co/D7NxpM4YNw
Janet Pope ( View Tweet)
Michaud et al. RA patients with long COVID had more fibromyalgia pre-COVID (41% vs 13%), higher rates of pain, depression, and worse PROs pre-COVID. Authors suggest long COVID may partially reflect pre-existing illness Abstr#1629 #ACR23 #ACRbest @RheumNow https://t.co/mrcGWrSD6c https://t.co/YiGCbvBDtn
Richard Conway ( View Tweet)
Do you discuss HPV vax & cervical CA screening w/SLE & RA pts?
In this study, more women w/SLE discussed cervical CA screening w/their rheums(33.3% vs. 11.4% p<0.01) & more likely to have persistent abn paps on ffup
Similar HPV vax status for both grps
#ACR23 ABST1356 @RheumNow https://t.co/Vbu8hbZ1uh
sheila ( View Tweet)
Karpouzas et al. MTX reduces IHD in males but not females with RA. 4362 patients. 66% lower risk MACE and 55% lower risk any ischaemic CVE. Abstr#1627 #ACR23 @RheumNow https://t.co/MC4W0dinUv https://t.co/1hkBoawt4b
Richard Conway ( View Tweet)
RA males 81% increase MACE & 58% ischemic CVE
2 folds Males>Females in MTX non users
Makes MTX users reduction 66% & 55% risk MACE & ischemic CVE and no diff w/ females
MTX use not assoc w/ reduction MACE in females
@RheumNow #ACR23 ABST1627 https://t.co/qbAc2bWdcM
Aurelie Najm ( View Tweet)
SMART study in RA, splitting MTX
Split dosing better at wk 16 but ~similar at wk 24
Caveat: wonky design from wk16-wk24 makes it hard to interpret?
Surprsingly, adverse events ~similar but smallish sample
Mostly supports my practice of splitting?
@RheumNow #ACR23 #ACRBest https://t.co/g7s4EUHeCW
Mike Putman EBRheum ( View Tweet)
SMART study - MTX split into morning and evening once weekly vs all together. 253 patients. Split dosing better efficacy (DAS28 4.1 vs 4.5, p=0.03), more LFT elevation but less neutropenia. Abstr#1583 #ACR23 @RheumNow https://t.co/tkrds4uqQP
Richard Conway ( View Tweet)
Split dose oral MTX (15/10mg) versus single dose (25mg) in RA RCT 250pts
EULAR good resp
16wks 22 vs 10% (sig)
24wks 37 vs 28% (ns)
50% more addition of 2nd csDMARD in single dose
#ACRBest @RheumNow #ACR23
ABST1583
For more thoughts, have a read https://t.co/urA6X4rY0D 👇🏼
Aurelie Najm ( View Tweet)
SMART on MTX
Ab#1583 @RheumNow #ACR23
Single dose MTX 25 mg v Split dose (same day 15/10 mg). FA 5 mg 2x/wk. 16w can add csDMARD
Split 29% vs 22% - EULAR response improve - not signif. Better DAS28
Split: 35% added 2nd csDMARD vs. 54.5% in single dose
No stat diff in sAE
#ACRBest
Eric Dein ( View Tweet)
Should Methotrexate be prescribed as split dosing?
Multi-center, RCT of RA pts showed split dosing of 25mg MTX resulted in higher efficacy + reduced need for additional DMARDs, compared to single dose MTX
@RheumNow #ACR23 Abs#1583 https://t.co/zjjnzWUl5E
Robert B Chao, MD ( View Tweet)
What is frailty?
How does it affect RA outcomes?
Pop based cohort study
13000+ RA vs. 26000+ matched ctrl
Over 2x more frailty 5.6% vs 2.6%
OR frailty in RA 2.3
Adjusted for rurality, neighborhood income quartiles AND BL comorbidities index
@RheumNow #ACR23 ABST1275 https://t.co/ZkOpgHPSE0
Aurelie Najm ( View Tweet)
SMART study #ACR23 Plenary abs #1583: po split-dose MTX (vs single dose) once weekly in RA pts had ^^ efficacy & reduced need for add'l DMARDs. No major AE, but slight increase in frequency of persistent transaminitis in split-dose group. https://t.co/wHzjpSnfuA @rheumnow https://t.co/0hNTMGbt47
Dr. Rachel Tate ( View Tweet)
Large VA study of >1k RA-ILD pts
No difference in risk of respiratory hospitalization or death in RA-ILD pts using TNFi vs. nonTNFi/JAKi
Data does not support avoiding TNFi in RA-ILD
@RheumNow #ACR23 Abs#1582 https://t.co/LTNLXEIAPo
Robert B Chao, MD ( View Tweet)
Ab#1582 @RheumNow #ACR23
RA-ILD outcomes of TNFi v non-TNF b/tsDMARD
VA Data, propens match emulation study
No incr risk of death in TNFi vs non-TNFi
But are TNF safe?
- Don't support systematic avoidance. But are there specific pops - unsure. Don't answer if efficacy in RA-ILD https://t.co/AApEjZs4DM
Eric Dein ( View Tweet)
Important plenary session, RA-ILD outcomes in VA cohort study
No difference in death/hospitalization for TNF vs non-TNF treated patients. Jives w/my priors; I do NOT avoid TNF in RA-ILD
Encouraging if you (like me) prefer RA-active tx for RA-ILD 😉😆
@RheumNow #ACR23 #ACRBest https://t.co/TIDzMLOfs4
Mike Putman EBRheum ( View Tweet)
Non TNFi b/tsDMARDs vs TNFi in RA-ILD. New-User, Propensity Score Matched Study. 454 patients. No difference! resp-related hospitalisation aHR 1.22 [0.92, 1.60] No difference mortality. Abstr#1582 #ACR23 #ACRbest @RheumNow https://t.co/HzzVo9dJHi https://t.co/mZuHq4GShU
Richard Conway ( View Tweet)
