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ICYMI: What to do about pre-clinical RA?
RheumNow Live’s 2023 conference led with this year’s hot topic of rheumatoid arthritis, especially what to do regarding pre-clinical RA.
Dr. Kevin Deane started the discussion by mapping out a very complex course of RA, beginning with a person’s genetic and environmental risk factors. What are Dr. Deane’s recommendations for management of pre-RA patients?
National Population Insights (4.28.2023)
Dr. Jack Cush reviews the news and journal reports and addresses 3 viewer case questions.
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Did you miss Tuesday Night Rheumatology this week?
This webinar features highlights from:
Preclinical RA – To Treat or Not To Treat
Year of the JAKi
Fibroblast/Stromal Cells
https://t.co/yVQLtG6fEe https://t.co/WMXcKdqwdP
Links:
Dr. John Cush RheumNow ( View Tweet)
Another NHANES survey of US adults shows increased prevalence of RA for those exposed to high levels of polycyclic aromatic hydrocarbons (PAH)(OR: 1.8; p=0.02). 90% of the smoking effect on RA risk is mediated by PAH https://t.co/N93MbKspRM https://t.co/uqH75vOZrA
Links:
Dr. John Cush RheumNow ( View Tweet)
Have a Rheumatology question or case for Jack Cush? Record it here and we'll feature it on an upcoming podcast. Tell us your name and where you practice rheumatology.
https://t.co/0mC7PxF0DU https://t.co/klbnwjcPbM
Links:
Dr. John Cush RheumNow ( View Tweet)
Study of 481 incident RA:
- no risk of RA w/ tea, alcohol & sugar-soft drinks
- Incr RA risk seen w/ coffee [≥4 vs ≤1cup, HR=1.24;p=0.04] & diet drinks [HR=1.66;never-smokers]
- Reduced RA risk w/ mod EtOH (ever-smokers;HR=0.63) & wine (seropos RA) https://t.co/gPZkTl9rid https://t.co/khYEZYFotl
Links:
Dr. John Cush RheumNow ( View Tweet)
Downs Syndrome (1/700) & autoimmune mechanisms - Downs has a 4-6 fold higher risk of JIA, type 1 diabetes, autoimmune thyroid disease and coeliac disease. https://t.co/wVUDRCS96I https://t.co/RosPAkRnPA
Dr. John Cush RheumNow ( View Tweet)
DDW 2023 study claims microscopic colitis (MC) pts had a 2fold higher risk of #RA. 11,293 MC pts matched 1:5 w/ population controls. With 8 yrs of F/U, RA was found in 1.1% of MC vs 0.6% controls (adj HR 1.92 (95% CI = 1.56-2.34). https://t.co/R5faYDoaAq https://t.co/qiaOMgOyLR
Links:
Dr. John Cush RheumNow ( View Tweet)
Stop RA trail:
Plaquenil didn’t prevent RA in patient with pre clinical RA. Kevin Deane #RNL2023 @RheumNow https://t.co/gO9QKbAues https://t.co/gEpuBvDpj5
Links:
Dr. John Cush RheumNow ( View Tweet)
#RNL2023 @RheumNow
There are a lot of RA Rx on market now - do we need more?
Dr. Brenner: YES
Stromal targets like LIF/LIFR, Notch3, cadherin-11 offer upstream benefits for our difficult to treat RA patients that don't respond to tradition cs/bDMARDs https://t.co/Og1vvbTRO9 https://t.co/WyqPH0lgkd
Links:
Dr. John Cush RheumNow ( View Tweet)
JAKinib safety takeaways
- avoid in older population 65 yo, malignancy, CV risk, VTE risk
- appropriate in younger pts without VTE/CVD risk factors
#RNL2023 @RheumNow https://t.co/mFvvqJ9Jbp https://t.co/A76tR2S1Rb
Links:
Dr. John Cush RheumNow ( View Tweet)
#RNL2023 @RheumNow
Dr. Stanley Cohen: possible adverse effects of JAKi
-Herpes zoster, other infections
-Malignancy
-Occasional cytopenias
-LFTs (with DMARDs)
-Incr Cr or CPK
-Acne
-Incr lipids
-GI perf
-VTE
Which do you counsel with your patients? https://t.co/zncCw3jlK7 https://t.co/AHhDyxaumM
Links:
Dr. John Cush RheumNow ( View Tweet)
Dr. Stanley Cohen on JAKinibs:
Very concise and informative timeline on the multiple JAKinibs approved for multiple conditions
@RheumNow #RNL2023 https://t.co/ulLh2HikUt https://t.co/0kR8CNZvsV
Links:
Dr. John Cush RheumNow ( View Tweet)
How do you prevent RA in at-risk patient?
Smoking cessation! Healthy weight and exercise! Diet! Periodontal health! 🚭🏋️🥕🦷
Education follow-up!
Not robustly proven to prevent/delay RA, but may be more important than early DMARD intervention! Kevin Deane, MD
#RNL2023
Dr. John Cush RheumNow ( View Tweet)
STOP-RA study on HCQ preventing RA...
HCQ did NOT prevent RA development in pre-RA pts
@RheumNow #RNL2023 https://t.co/uZRqAxWyyo https://t.co/02qUN4Hhrc
Links:
Dr. John Cush RheumNow ( View Tweet)
QD Clinic - Audience RA Questions from RNL23
Audience Questions & Answers from RNL23 on Rheumatoid Arthritis
https://t.co/vh1Tzstbwl https://t.co/IUXfAlzPoE
Links:
Dr. John Cush RheumNow ( View Tweet)
UK's MHRA has followed EMA final ruling regarding new Safety recs & JAK inhibitors:
- RE: tofacitinib, abrocitinib, baricitinib, upadacitinib & filgotinib use in chr inflammatory Dz.
- avoid JAKi if no suitable alternative: age >=65, smokers, CV/CA Hx https://t.co/Y1vZPHPEPN https://t.co/odovKWebFV
Links:
Dr. John Cush RheumNow ( View Tweet)
Join us this Tuesday for our the start of our May Tuesday Night Rheumatology focusing on Rheumatoid Arthritis: Revolutionary Advances in Therapy
https://t.co/TbNYaGJ3sk https://t.co/DiJwjvUX1d
Links:
Dr. John Cush RheumNow ( View Tweet)
A Danish national registry study compared RA pts taking JAKi (n 875) and bDMARDs (n 4247). They found similar rates of subsequent cancers (14.4 vs 12.9/ per 1000 PYRS); with a nonsignificant risk (HR1.41; CI 0.76, 2.37) https://t.co/wfrlAcij8x https://t.co/OvqKrHw5Wu
Links:
Dr. John Cush RheumNow ( View Tweet)
Analysis of 14,958 RA pts in Japans National Database of Rheumatic Diseases (NinJa) shows women had higher DAS28-ESR values than males, despite no obvious difference in other indices or disease activity categories. https://t.co/PYsTGnejOF https://t.co/AqOiiZm3uI
Links:
Dr. John Cush RheumNow ( View Tweet)
