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Day 1 Report from ACR21
The first full day of Abstracts and Presentations from ACR Convergence, was full of highly engaging sessions, quality posters and unique presentations. To hear more about the best of the best, I would encourage you to look at our Day 1 Recap Video and Day 1 ACR Best Abstracts. Here are a few of my favorites from the first day.
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In pts w/o RF, liver bx prev suggestd if lifetime cumulative MTX dose was 1-1.5g, then 3.5-4g.
All pts in centre offered Fibroscan
liver stifness associations:
- age, BMI
- not cumulative MTX dose
maybe survival bias, but what we're doing now is fine!
#ACR21 ABST0786 @RheumNow https://t.co/I6IhS3jhmC
David Liew drdavidliew ( View Tweet)
Does concomitant SJS affect tx effectiveness in RA?
Abst#0839 suggest yes!
➡️RA+SjS have an inferior response to TNFi than RA patients w/o SjS
BUT, RA/SJS pts w/ longer RA dz duration & ↑ DAS28 + HAQ-scores.
What's your clinical experience with this?
#ACR21 @Rheumnow https://t.co/TIc3raMOSJ
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Abst#0572: In US veterans w/ RA followed for 17 yrs, several cytokines+chemokines
⭐️Associated w/ ↑ risk of incident MACE independent of typical CVD RF & RA activity
&
⭐️Predicted MACE even if in LDA/remission
WOW! We need to do better @ CVD risk strat!
#ACRBest @RheumNow https://t.co/J74rRa9EQE
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
⭐️2 polyunsaturated fatty acid lipid mediator profiles are significantly associated w/ incident inflammatory arthritis in ACPA+ pts
➡️If validated, this would be of great utility in determining which pts w/ pre-clinical sero+ should be treated!
Abst#0590 at #ACR21 @RheumNow https://t.co/KGEwiY6G2Q
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Abstr 0983 mRNA SARS-CoV-2 Vaccine in RA Patients
Rubbert-Roth and colleagues found:
- RA patients developed anti-S1 antibodies slower and lower compared to controls
- Reduced titers among Abatacept & JAKi users
#ACR21 @RheumNow https://t.co/sXW8d53O8m
Akhil Sood MD AkhilSoodMD ( View Tweet)
Post-Hoc of ASCORE trial:
➡️RA w/ mod-high dz on SQ ABAtacept as 1st line tx w/ better retention vs receiving it as 2nd line tx independent of b/l duration of dz
➤Do you use ABA as 1st line treatment for RA, when/if insurance allows? Comment below!
Abst#0816 #ACR21 @RheumNow https://t.co/TRJga4OfiW
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
NORD-STAR Trial: outcomes in tx-naïve, early RA pts after 48w of csDMARDs+GC vs bDMARD (ABAtacept, CerToliZumab, or ToCiluZumab)+MTX
➡️ Superior CDAI remission rates w/ ABA+MTX & CZP+MTX but not TCZ+MTX vs csDMARD+GC
➡️Imaging progression low in all
Abst#0825 #ACR21 @RheumNow https://t.co/QaFIF4WNEG
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
⭐️RA pts w/ high adipokines (fat-secreted proteins) have lower rates of LDA + remission independent of b/l dz activity & BMI
⭐️↑ adipokines esp adiponectin, then more likely to need b/tsDMARD
➡️Adipokines may be prognostic biomarkers 4 refractory dz.
Abst#0789 #ACR21 @RheumNow https://t.co/AFT22TzTFp
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Abst 0981
Interesting study by Singer & colleagues examining economical and clinical burden of herpes zoster in patients with RA
- RA + HZ --> higher odds health resource utilization
- RA + HZ --> higher costs $$$
#ACR21 @RheumNow https://t.co/6Oc7ymbKHQ
Akhil Sood MD AkhilSoodMD ( View Tweet)
TOFA Post hoc analysis on 2000pts:
⬆️ Paraoxonase PON1 activity associated w/
⬇ risk of malignancies (not NMSC) in RA pts treated w/ TOFA, Adj on RA duration, age, and smoking.
A promising biomarker! #Abst980 @RheumNow #ACR21 https://t.co/fOILnAyDN9
Aurelie Najm AurelieRheumo ( View Tweet)
#Abs0588 Effectiveness of TNFi vs non-TNFis in obese patients with #rheumatic disease @MilenaGianfran:
👉🏼>16000pts @ACRheum RISE
👉🏼Abatacept➡️larger decreases in CDAI in obese pts
👉🏼Tocilizumab➡️larger decreases in CDAI in non-obese pts
@RheumNow #ACR21
https://t.co/bL5xnG1iNh
Mrinalini Dey DrMiniDey ( View Tweet)
B cell repertoire: the new 🔮?
An algorithm associating baseline CDAI to BCR sequencing outcomes w/
✨Isotypes frequency
✨Somatic Hypermutations
predicts MTX 12mo response w/ 78% sens & spe
#Abstr982 #ACR21 @RheumNow
https://t.co/SZaip6xUaO https://t.co/fbWq34gtzc
Aurelie Najm AurelieRheumo ( View Tweet)
Had the pleasure of interviewing @MyasoedovaElena from Mayo Clinic on Cognitive Function and RA
#ACR21 @RheumNow
https://t.co/SuXeMhUvk0
Akhil Sood MD AkhilSoodMD ( View Tweet)
My video take on this from yesterday for @RheumNow:
'11 Ways to Stay Away From RA' #ACR21
https://t.co/ELZaL1A20i https://t.co/bynPNibk3q
David Liew drdavidliew ( View Tweet)
My video take on this from yesterday for @RheumNow:
'11 Ways to Stay Away From RA' #ACR21
https://t.co/ELZaL1A20i https://t.co/bynPNibk3q
David Liew drdavidliew ( View Tweet)
#ACR21 Abst#0588. TNF vs non-TNFi in obese RA pts
⭐️TNFi use ⬆️ disease activity vs ABA in obese pts
⭐️TNFi use ⬆️ activity vs TCZ in non-obese pts
⭐️No diff w RTX, Tofa
▶️Further research needed: Wt-based dosing? SC vs IV?
https://t.co/K8WycPTgxW @Rheumnow #ACRBest
Links:
Eric Dein ericdeinmd ( View Tweet)
ORAL Surveillance MACE conclusions:
So this is fair: tofacitinib acts as a CV risk factor, there are many others, we need to address CV risk in RA pts.
Nevertheless, in terms of MI risk, tofa vs TNFi, if I had one CV risk factor, I know what I'd do.
#ACR21 ABST0958 @RheumNow https://t.co/4Z79XtTzl9
David Liew drdavidliew ( View Tweet)
For what it's worth, I'm struck by my conversation last week with one RA patient in clinic with stents.
3y ago post-MTX/HCQ had asked for a JAKi first line, immaculate RA response.
Listened, no blinking, okay thanks doctor - I'm happy where I am. Next question.
#ACR21 @RheumNow
David Liew drdavidliew ( View Tweet)
“For many patients, it doesn’t matter if there’s an increased risk, because they don’t want to go to the alternative” - Christina Charles-Schoeman, presenting ORAL Surveillance MACE data in the #ACR21 plenary
Discussions with pts needed, these data justify that need.
@RheumNow
David Liew drdavidliew ( View Tweet)