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Clinically suspect arthralgias: justified or artefact?
Some subjects in rheumatology seem to create contention the more they get explored, and one of those areas is a traditional crowd favourite for discussion at EULAR - clinically suspect arthralgias.
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EULAR 2023 – Day 3 Report
Day 3 was a sunny warm day in Milan at the 2023 EULAR Congress meeting. Here are a few of my favorite abstracts from today.
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EULAR 2023 – Day 2 Report
Day 2 at the international EULAR Congress meeting is always bigger and busier. There were sessions on JIA therapies, crystal arthritis, novel drugs for SLE and Sjogren's, early RA and preclinical RA interventions, IgG4 disease, osteoporosis and the growth and application of artificial intelligence in medicine and rheumatology.
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Important from @cappelliMD @jhrheumatology irAE cohort on predictors of DMARD requirement in ICI-inflammatory arthritis, and persistent ICI-IA post-ICI cessation.
The better we can predict these patients, the more we can get the right therapy early
POS0951 #EULAR2023 @RheumNow https://t.co/YGTRl71505
David Liew drdavidliew ( View Tweet)
The incidence of MACEs at 8 years is low in AS patients treated with NSAIDs. Study of 22929 patients, NSAIDs (SHR: 0.40 [0.32-0.49], p<0.001) and anti-TNFs (SHR: 0.61 [0.47-0.81], p<0.001) associated with a lower risk of MACE, Fakih O, Abst#POS0301, #EULAR2023 @RheumNow https://t.co/i5GZMcJwyO
Dr. Antoni Chan synovialjoints ( View Tweet)
meds for PsA at #EULAR2023 recommendations
bDMARD after csDMARD (no order proposed)
@RheumNow https://t.co/bHMG4A8nmP
Bella Mehta bella_mehta ( View Tweet)
How do we improve MTX adherence?
Biochemical measure of MTX adherence
37% of patients starting a biologic do not take their MTX (!)
Those who do respond better to first Biologic at 6 Mo than those who don’t
37% biologic responders = non adherent
POS0313 #EULAR23 @Rheumnow https://t.co/L1Mkqpg1Aj
Aurelie Najm AurelieRheumo ( View Tweet)
The key data for treating clinically suspect arthralgias (CSA):
TREAT-EARLIER (MTX)
ARIAA, APIPPRA (abatacept)
but what we need to do going forward:
stratify pts better for studies
predict individual risk better, to weight up risk-benefit of intervention
#EULAR2023 @RheumNow https://t.co/h3gNIyLxPY
David Liew drdavidliew ( View Tweet)
Tune it at 1pm EST for RheumNow's daily #EULAR23 recaps. You can find us live on Twitter, YouTube and LinkedIn. https://t.co/t531csjXo8
Dr. John Cush RheumNow ( View Tweet)
Study on folylPG synthétase (FPGS) activity and MTX-PG measured in sperm showed low bio active form of MTX-PG, low FPGS activity resulting in lower capacity to form MTX-PG, Perez-Garcia LF, Abst#OP0224 #EULAR2023 @RheumNow https://t.co/8sGQOBxn8r
Dr. Antoni Chan synovialjoints ( View Tweet)
Herpes Zoster vaccination in RA patients treated with Upadacitinib and MTX showed a satisfactory response,
slight reduction in response compared to general population in both antibody and cell mediated responses Winthrop K, Abst#OP0225 #EULAR2023 @RheumNow https://t.co/wxwbOYsn5K
Dr. Antoni Chan synovialjoints ( View Tweet)
To treat or not? Clinically suspect arthralgia does affect QoL including function. Both premises of treating with a DMARD are valid. OverRx v missing the very early window of opportunity @RheumNow #EULAR2023 @eular_org https://t.co/86CVZ2IjEf
Janet Pope Janetbirdope ( View Tweet)
For our rheum patients who have had cancer previously - the default can’t be to not have DMARDs.
@eular_org points to consider SLR:
no clear risk, across b/tsDMARDs
For too long these patients were unnecessarily asked to ride it out. No more please
POS1069 #EULAR2023 @RheumNow https://t.co/7m4Yh0h7rd
David Liew drdavidliew ( View Tweet)
Should immunosuppression be used to improve #PAH in #SSc added to PAH Rx (85%) Morbidity or mortality outcomes >700 pts - half had a DMARD after dx RheumNow #EULAR2023 OP0238 Targeted Rx improved esp RTX\TCZ findings V interesting results #GameChanger May change my Rx practice!
Janet Pope Janetbirdope ( View Tweet)
Retro French database study shows reassuring data.
Overall mortality after IRAEs =similar between pts receiving b/tsDMARDs vs. those who don't
70000+ pts treated w/ ICI, 7800+ IRAEs (most frequent colitis) & 330 treated w/ b/tsDMARDs, 10% Rheum IRAE
OP0270 @RheumNow #EULAR23 https://t.co/OFNaIU4kzt
Aurelie Najm AurelieRheumo ( View Tweet)
Malignancy in real world datasets:
do we see differences between DMARDs - particularly JAKi, with ORAL Surveillance in mind?
RABBIT German data (limited risk window):
Point estimates slightly up vs TNFi, esp in high CV risk pts
but magnitude not big
OP0218 #EULAR2023 @RheumNow https://t.co/Ou7TgWvf3b
David Liew drdavidliew ( View Tweet)
Men trying to conceive were prev told to avoid MTX. Another myth busted
Why? Spermatozoa lack the FPGS enzyme responsible for MTX-PG metabolism, the tiny amount of MTX-PG in sperm isn’t active. No quality issues!
OP0224 #EULAR2023 @RheumNow (& @ARD_BMJ https://t.co/SDdoNP12oR)
David Liew drdavidliew ( View Tweet)
Obesity in #AOSD – predicted the development of a chronic disease course and biologic DMARD failure, 139 pts with AOSD- 19% Obese (BMI>30) observational study. abst#AB1503 #EULAR2023 @rheumnow
Bella Mehta bella_mehta ( View Tweet)
ANSWER cohort
Retrospective study 6600+ bio/tsDMARDs ttmt courses, 20 yrs
✔️IL-6Ri is the lowest discontinued for lack of efficacy
✔️CTLA4-Ig is the lowest discontinued due to AEs
✔️Concomitant GC ⬆️30% drug discontinuation due to AEs
@Rheumnow #EULAR23 POS0051 https://t.co/8e6U5KHmX4
Aurelie Najm AurelieRheumo ( View Tweet)
