Several abstracts have studied the mechanism of action of JAK inhibitors (JAKi) in various diseases. JAKi alter many other mediators affected by the JAK STAT pathway. For instance, T cell signature in blood that is proliferative was associated with a response in RA.
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Since the millennium, we have seen an expansion in the number of advanced treatments both biologic and targeted synthetic disease modifying anti-rheumatic drugs for rheumatoid arthritis. The challenge remains on how best to characterise the subtypes of RA in order to choose the best drug to ensure optimal outcome for patients.
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Research work from the Accelerating Medicines Partnership (AMP: RA/SLE) Network, was published in Nature and more specifically characterizes RA synovium into several cell-type abundance phenotypes (CTAPs). Could CTAPs known disease features or more effective future therapies?
David Liew
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Colchicine - what a fascinating medicine.
From a rheum point of view, interesting to see it play out for secondary prevention coronary artery disease, lot of patients. Great we can share our collective clinical confidence with it with cardiology
#ACR23 @US_FDA session @RheumNow https://t.co/Q7zLtyby8l
Eric Dein
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Are Long-term NSAIDs safe in AS?
Ab#0528 #ACR23 @RheumNow
19,775 AS pts vs 59,325 controls.
Incidence of 16.9, 13.8 per 1,000 person-yrs, respectively
Long-term use of NSAIDs increased risk of CVD in non-AS control (aHR 1.64), but did NOT in AS pts (aHR 1.06)
Eric Dein
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Ab#498 Does DMARD for PsO and PsA decrease MACE?
#ACR23 @RheumNow
Retrospective database Israeli study.
PsO, PsA on MTX or bDMARD: lower MACE compared to health matched controled (HR 0.45-0.68, p<0.001)
Pts on topical Rx had marginally Increased MACE (HR 1.14, p <0.001) https://t.co/0uRgjzYbFp
Robert B Chao, MD
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Systemic anti-inflammatory treatments for PsO and PsA including methotrexate and biologics provided cardioprotective effects
Potential cardiovascular benefits of IL-17i and IL-12/23i compared to TNFi
@RheumNow #ACR23 Abs#0498 https://t.co/Np7PSNvFd6
Dr. Antoni Chan
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Difficult to treat D2T-axSpA (failure > 3 biologics), affects one in five patients exposed to b/tsDMARDs in this national registry. D2T is more common in women, presence of peripheral involvement, psoriasis, depression, Fakih O Abst#0514 #ACR23 @RheumNow https://t.co/OoymZzzQST https://t.co/EpTqS1C61A
Yet another (mostly) reassuring report about lymphoma and DMARDS
The skin cancer signal in the CIRT trial was weird; would be worth looking into that in observational studies as well @NamrataRheum
#ACR23 Abst0438 @RheumNow https://t.co/Beg8UUe2mn
David Liew
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It seems so simple. We should be able to use proteomics to better pick winners when it comes to b/tsDMARDs in RA.
Why is it hard? I guess:
- theory ≠ practice
- too many other factors
- it's too easy not to
Yet I hope/believe, one day we'll do better.
#ACR23 ABST0427 @RheumNow https://t.co/5VBVp3KOJN
David Liew
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If you're >65 years old & have new RA, you start a DMARD, right? At worst, sometime in the first year?
US Medicare data 2008-17
n=33,373
only 30% have a DMARD on file
(of which bDMARD <10%)
>5% on PNL alone
Do we hate old people with RA?😔
@JihaRheum #ACR23 ABST0433 @RheumNow https://t.co/1CUXAh3fi0
Meral K. El Ramahi, MD
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Year in Review by Dr. P Seo
NORD-STAR trial:
⭐️Abatacept or Certolizumab >> Tociluzumab > triple therapy in tx of 812 early RA patients based on clinical & radiographic results
➡️tx-naive, all got MTX
➡️mod-sev dz activity
➡️randomized to 48 wks therapy
#ACR23 @RheumNow https://t.co/vy2uYuyOse
Interesting question... but feels like some time related bias or perhaps confounding?
Seems implausible that MTX & biologic would be protective for PsO & harmful for PsA
@RheumNow #ACR23 Abstr 0498 https://t.co/pSRoLHRTAm
David Liew
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NAFLD a real issue in RA
Does DMARD choice matter?
National Taiwanese data
newly dx RA n=41791
HCQ reduced NAFLD risk: adjHR 0.75
(other RF: obesity, NSAIDs, even low-dose PNL; but not DM, MTX)
Can HCQ improve liver health in RA?
Authors: ?adiponectin
#ACR23 ABST0396 @RheumNow https://t.co/9VMJpImFKs
Join us tonight at 6pm PT/ 9pm ET for our daily #ACR23 recap. https://t.co/0RDwTdzhwS
Dr. Rachel Tate
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#ACR23 Abs #0505 found use of IL-17 inhibitors and oral DMARD alone were associated with a decreased likelihood of achieving MDA in PsA. Small sample size, but interesting finding nonetheless. https://t.co/CAZGykwxRT @rheumnow https://t.co/8ptF8aTIFu
Did you know about Tubulointerstitial nephritis uveitis (TINU) syndrome? Usually younger pts; uveitis may not be concurrent with the TIN. Risks: NSAID/abx, infx, genetics. Nice systematic review of this entity (link below). #boardquestion @rheumnow #ACR23 https://t.co/HDqLDHyGM6
FAST trial, MMF vs MTX at the Review Course today
Overall a big win for MTX, powered for noninferiority (bc people loved MMF) but looks like MTX won the day w/10% difference in outcomes
Take home: MTX FTW per usual
@RheumNow #ACR23 #ReviewCourse https://t.co/lY1V6S7X3d
OA and Syncope
OA patient on NSAIDs presents with a peptic ulcer and GI Bleed.
https://t.co/ezMbqgAB0Q https://t.co/iutdfUAPv2
David Liew
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I never tire of hearing this story.
Biologic DMARDs revolutionized rheumatology & changed millions of lives.
How did we get TNFi?
Sharp translational insights & courage++
After 4w, RA gone, up/down stairs like a miracle.
Sir Ravinder 'Tiny' Maini #ACR23 Global Summit @RheumNow https://t.co/Je1cz3cWG5


