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#ACR23 Abstr#1634 Promising therapy for two #Sjogren groups: 1 (high ESSDAI & ESSPRI) & 2 (low ESSDAI, high ESSPRI). Phase 2 RCT of Iscalimab (anti-CD40ab) showed more ISC-treated pts met the primary endpoint (ESSDAI and ESSPRI changes at WK24) vs PBO. Going to Phase 3 @RheumNow https://t.co/3bN3IS1zCO
Md Yuzaiful Md Yusof ( View Tweet)
Dr. AMendel et al:TMP-SMX prophylaxis assoc w⬇️serious infexns in RTX treated GPA pts; BL (aHR 0.5;95%CI 0.3-0.8) & time-varying exposure (aHR 0.5; 95%CI 0.3-0.9)
A good thing to consider but weigh benefits/harms w/TMP-SMX prophy. More studies req'd?
#ACR23 ABST1584 @RheumNow https://t.co/dfsfpcQu2A
sheila ( View Tweet)
TMP-SMX in AAV with RTX. 919 patients. Only given to 31% (40% on steroid>20mg), what!? TMP-SMX aHR 0.5 for serious infection, aHR 0.7 for minor infection. PJP 13 vs 0. Abstr#1584 #ACR23 @RheumNow https://t.co/4YQELIC82F https://t.co/U5l5KzSkB5
Richard Conway ( View Tweet)
TMP-SMX PPx in GPA
A#1584 @RheumNow #ACR23
919 pt analyzed
TMP-SMX ass w/ decr serious ifn (HR 0.5), less outpt ifns (0.9)
Rates for AEs attrib to TMP-SMX per 100 py: 29.6, wo TMP-SMX: 13.4
13 PJP, all in non-TMP-SMX pts
Should we use Bactrim to prevent ifn beside PJP? GC effects
Eric Dein ( View Tweet)
#ACR23 Abstr#1584 Data N=919 pts with GPA vasculitis treated with rituximab showed Septrin prophylaxis (+/- 28days of RTX) reduced serious & any infection. PJP=1.4% not on septrin. Question remains re: how long for in those receiving repeat cycles & steroid confounding @RheumNow https://t.co/81f8hbMids
Md Yuzaiful Md Yusof ( View Tweet)
#ACR23 Abs #1032 identified six major themes of diverse patient experiences. Studying patient experiences is critical for understanding mechanisms of health disparity, targeting interventions and, ultimately, improving quality of care. https://t.co/Fd2m4yzlHp @rheumnow https://t.co/EhIIF9cquQ
Dr. Rachel Tate ( View Tweet)
OA and Microbiome!
Ab#1581 @RheumNow #ACR23
Microbiome transplantation of mouse models - benefit if before or soon after OA induction (meniscal destabilization)
⭐️OA is inflammatory dis of innate immune sys, not "wear-and-tear" and gut biome may be a 🔑 https://t.co/eA8unUBnpC
Eric Dein ( View Tweet)
How does Dr. Robert Spiera manage GCA?
1) Tx with steroids alone, taper by 6 months
2) Do not chase ESR/CRP
3) Pay attention to steroid complications
4) Low threshold to use IL-6i
Similar plan for PMR
Taper steroids by month 4
@RheumNow #ACR23 https://t.co/KSwyfjobFY
Robert B Chao, MD ( View Tweet)
Still uncomfortable with IL-6i in GCA or PMR especially given the pt population and potential AE?
Be on the look out for NEW biologics!
Mavrilimumab
Secukinumab
and MORE!
@RheumNow #ACR23 https://t.co/gdcDIcvffa
Robert B Chao, MD ( View Tweet)
More vitamin D during pregnancy is better, right?
Hopkins Lupus cohort, vit D levels & adverse pregnancy outcomes
Actually, there's a sweet spot
(too high just as unfavourable as too low)
Maybe popping vit D pills isn't always limitless
@jhrheumatology #ACR23 ABST1364 @RheumNow https://t.co/TVPCqP3dq9
David Liew drdavidliew ( View Tweet)
Pregnancy Updates That Will Change The Way I Practice
Dr. Rachel Tate ( @uptotate) shares two abstracts related to autoimmune patients and pregnancy risks, and her take home practice updates. #ACR23
https://t.co/X85lkKpcea https://t.co/djDujw810T
Dr. John Cush RheumNow ( View Tweet)
The great debate: Dr. Robert Spiera on why advanced therapies should not be used first-line in GCA and PMR 👇
#ACR23 @Rheumnow https://t.co/O7jtpfkoRw
sheila ( View Tweet)
Plants For Joints continuation data poster was meant to be this am #ACR23 - but withdrawn.
Makes me sad!
Intervention: plant-based diet, exercise, stress Rx for 16w
Abstract reports 1y follow-up:
sustained DAS improvement, despite BMI reductions rebounding
Enticing
@RheumNow https://t.co/4adYf5BTtt
David Liew drdavidliew ( View Tweet)
The Great Debate #ACR23 - and it’s a cracker.
Is early steroid-sparing therapy justified in GCA/PMR? I don’t know, but Rob Spiera and @philseo will battle it out to tell us.
(and ably moderated by the always eloquent @SattuiSEMD)
I’ll put some highlights here ⬇️🧵
@RheumNow https://t.co/ASpuglyENv
David Liew drdavidliew ( View Tweet)
So firstly the no case, and Rob Spiera takes up the case, dictated by the electronic coin toss.
No-one disagrees that we need steroid-sparing options, or that IL-6Ri work in PMR and GCA. But it’s the strategy questions which remain in play:
#ACR23 @RheumNow https://t.co/I2QDU7l6DE
David Liew drdavidliew ( View Tweet)
ACR#23 Abs #1023: IgG4-RD males > likely (vs females) to have multi-organ & serological activity w/ ^ immunoglobulin concentrations. Interestingly, lower lipase levels observed in males are consistent with greater degrees of pancreatic damage. https://t.co/4hUGmzTQqX @rheumnow https://t.co/kcy5dL62Pn
Dr. Rachel Tate ( View Tweet)
Great work @sharoncowley01 https://t.co/llUF6REOFR https://t.co/Ej8fQlTNH0
Barry O'Shea ( View Tweet)
⭐️Real world data on use of #avacopan presented by @zach_wallace_md
#vasculitis
Important observations to inform the practice and management of #AAV https://t.co/gtZORcnt9t
KenWarringtonMD MdWarrington ( View Tweet)
Fantastic presentation by @sharoncowley01 🚀
~1/5 patients with PMR have US evidence of Vasculitis at time of diagnosis without clinical signs of GCA
⬆️role of US in these patients https://t.co/wSs3IB8SU7 https://t.co/mAhFDVJJ8T
Caoilfhionn Connolly ( View Tweet)
#ACR23
Scleroderma renal Crisis (SRC)
May precede skin involvement also.
RISK FACTORS
• Early diffuse skin disease
- 2-3 years from SSc onset, median 8 months
• Anti-RNA polymerase III (60%)
• Use of corticosteroids
- >15 mg/d or low doses for longer time https://t.co/RSIxEXLdX7
Aditya Burje AdityaBurje ( View Tweet)
