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EULAR 2024 – Day 2 Report (A Difficult RA Day)

Jack Cush, MD Jun 13, 2024

Day 2 at EULAR 2024 was a big poster day for many with several good sessions and oral presentations on Preventing RA, new vasculitis therapies and a session devoted to the 50th anniversary of the Moll & Wright Criteria.

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Dual seropositivity and shared epitopes in RA: friends or foes?

Aurelie Najm, MD, PhD Jun 13, 2024

Dual seropositivity (rheumatoid factor and/or anti-citrullinated protein antibodies) as well as shared epitope are known to be associated with poor prognosis and structural damage in RA.

Oral presentation at #EULAR2024 about clustering #RA #ILD 🫁 @PhilippeDieude @jeffsparks @RaphaelBorie @bruno_crestani https://t.co/jz1unKIZmN

https://twitter.com/Juge_P_A/status/1801226270597915106/photo/1

I was allocated to bring down the warning, & I did apologise up front to both the EMA and Janet #EULAR2024. It's a tough gig regulating impactful medicines with risk-benefit, especially when our world is full of other medicines with risk-benefit trade-offs (like prednisolone). 2/ https://t.co/6YPhYHbhg8

So how do we get from slightly increased numbers of uncommon events in a single study (ORAL Surveillance)? Regulators think differently to us, which partly is the difficulty of a restrictive warning. So being the Aussie I am, I asked - does it pass the 'pub test'? 4/ #EULAR2024 https://t.co/Ih9H87wH22

What happens when RA patients only on csDMARDs want to stop their meds? in BIO-FLARE, only half flared within 6mo of stopping all csDMARDs suddenly. They’ve got a clinical predictive model. Many milder patients ask, and could benefit! #EULAR2024 POS0068 John Isaacs @RheumNow https://t.co/B7ZjP5Pj70

Risk of developing RA increased in antibody double-positive and single-positive compared to seronegative individuals. Highest risk in double-positive in first year. Single-positive increased risk of RA for up to five years after testing. In double-positive the risk remained… https://t.co/XLDHK4d4AE https://t.co/3Ek8knGExU

OP0201- clinical characteristics of pts failing ≥2 b/tsDMARDs D2T RA pts characterised by ⏰ Earlier disease ⏰ Later initiation of DMARD therapy Discontinuation of drugs mainly due to inefficacy regardless of number of drug lines or MOAs used #EULAR2024 @RheumNow

OP0140-When should we give #pneumococcal #vaccine to pts starting MTX? Study in RA:PCV13 vaccine given 1 month BEFORE starting MTX leads to higher immunological response at 1m, vs pts vaccinated simultaneously w MTX ⏩Vaccinate patients before starting MTX! @RheumNow #EULAR2024

When patients say their joints are swollen, what does it mean? Easy to dismiss it as a symptom, but this clinically suspect arthralgia cohort from Leiden shows: - some correlation with MRI/USS findings - predicts RA development still worthwhile! #EULAR2024 POS0609 @RheumNow https://t.co/dw2p5Eo26C

https://twitter.com/drdavidliew/status/1801220393036038147/photo/1

We’ve got better at treating RA over the last 20 years, and it’s genuinely saving lives. Something to be very proud of. Let’s not forget that! 5y mortality from DANBIO 🇩🇰 (still, we still have work to do in seropos RA in men!) #EULAR2024 OP0162 @RheumNow https://t.co/RfvABXhPvS

https://twitter.com/drdavidliew/status/1801183966709628934/photo/1

#EULAR2024 @RheumNow https://t.co/nXpDI52R2U

https://twitter.com/DrMiniDey/status/1801187162534052223/photo/1

OP0181- What are the best drugs to treat D2T RA? In this cohort of 185 pts, switching biologic or JAKi improved disease activity & was considered to be effective for patients with D2TRA, regardless of mode of action @RheumNow #EULAR2024

OP0165- incidence & risk factors of D2T RA in an early RA cohort Factors assoc with D2T RA: 🩸 Seropositivity 🦴 Erosions 📈 Disease activity 📊 D2T pts have higher steroid doses & more commonly develop iatrogenic-related #comorbidities, e.g. osteoporosis #EULAR24 @RheumNow

I’ve always thought new RA meds get prescribed to the most risky patients, and therefore you see more adverse events. Turns out it’s marginally true - maybe out to five years. Worth being careful of judging new meds too early! #EULAR2024 OP0114 @karolinskainst @RheumNow https://t.co/Q8dIHiIYQk

#EULARBest OP0156- validation & prevalence of D2T RA Data from @BrighamResearch BRASS In this cohort, the #EULAR definition of D2TRA correctly identified a subset of RA pts who have not achieved low disease activity despite multiple b/ts DMARD treatments #EULAR2024 @RheumNow

OP0137 is comparative analysis of clinical efficacy & drug retention of b/tsDMARDs >1/2 D2T RA pts starting JAKi, RTX, IL-6Ri, or TNFi, but ~1/3 w abatacept, achieved remission or low disease activity in 6m & maintained consistent drug retention for 2yrs @RheumNow #EULAR2024

Is it worthwhile delaying MTX start for a month in RA, to vaccinate effectively? VACIMRA (multicentre 🇫🇷) showed it marginally improves pneumococcal vaccine immunogenicity, persisting to 1y, no extra pred needed. I’ll admit, I’m still not game! #EULAR2024 OP0140 @RheumNow https://t.co/58qJxki8ov

How can we predict the 1/3 of palindromic rheumatism patients who will go on to develop persistent inflamm arthritis? Easy to use score derived from 15y data from @UniversityLeeds - can exclude the low-risk so they don’t need to be followed. #EULAR2024 OP0127 @RheumNow https://t.co/gB0FpUPOFC

OP0131 on occurrence & predictors of #DMARD treatment failure in #RA 8% of pts failed ≥3 b/tsDMARDs with ~4yrs to failure In pts starting first b/tsDMARD, up to 25% fail ≥2 b/tsDMARDs in 3yrs Risk of fulfilling EULAR D2T criterion 1 ➡️ 2.3% in first 5yrs @RheumNow #EULAR2024

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EULAR 2024 – Day 2 Report (A Difficult RA Day)

Dual seropositivity and shared epitopes in RA: friends or foes?

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