The disconnect between objective inflammatory response and PROs in AxSpA

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The assessment of disease activity in AxSpA involves the use of objective inflammatory response (OIR) and patient reported outcomes (PROs). In clinics, a combination of OIR and PROs are used to measure disease activity and response to treatment.

RA: MACE Events with Opioids vs. NSAIDs

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Addressing chronic pain often leads general practitioners and specialists to prescribe opioids. However, opioids (weak and strong) have not demonstrated efficacy in long-term pain management; their chronic use could even worsen pain in users. Opioids prescription is often perceived as being safer than NSAIDs prescription, especially in respect to MACE.

SLE: Variability in Racial Disparities in Pregnancy Outcomes

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Significant disparities exist in pregnancy outcomes in women with systemic lupus erythematosus (SLE), with previous cohorts identifying Black women as having a higher risk of maternal mortality compared to White women with SLE.

Why treatment of pre-RA isn't ready for prime time

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The ACR Great Debate was on "To treat or not to treat in pre-RA?". What is the clinician to do?

ACR 2022 Appraisal, Praise & Critique (11.18.2022)

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It was great to be back at an ACR annual meeting, this one in Philadelphia - Philly was great. A walking town, rich in culture, history and good places to meet and mingle. 

I loved the city, but not the convention center (not easy to navigate). 

ACR Best Abstracts - Day 3

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The last day was jammed with important reports and research including the late breaking abstracts. 

ACR Best Abstracts - Day 2

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Day two at ACR 2022 was full of great sessions on imaging, vasculitis, lupus, vasculitis, spondyloarthritis, COVID, pregnancy, microbiome, economics and more.

Here are the RheumNow faculty selections for #ACRbest abstracts today:

Does Evusheld shield people living with rheumatic diseases?

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While COVID vaccination and subsequent booster remain the cornerstone, pre-exposure prophylaxis such as Evusheld (tixagevimab and cilgavimab) has been approved by FDA in December 2021 and EMA in March 2022 for people immunocompromised either due to a medical condition or receiving treatment with immunosuppressants and may not mount an adequate immune response to COVID vaccination. How does this therapy fare in RMD patients?

SLE, Sex and STDs

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Once in a while, I find an abstract at the ACR meeting that can potentially save lives and be implemented in practice now.  

In Abstract #0939, Dr. J Patricia Dhar and colleagues shared data from a pilot study examining a new method to monitor cervical health in African American Women with Systemic Lupus Erythematosus (SLE) using a self-sampling brush to assess cervical cytology and human papilloma virus infection.

TNFi cycling in axSpA: Results from CorEVITAS Registy study

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Data presented at ACR22 shows that cycling through TNFi in axSpA patients with primary lack of efficacy with first line TNFi has limited additional benefit in controlling disease. 

Where are we with treating Pre-Rheumatoid Arthritis?

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The ability to prevent RA in individuals at risk is a holy grail in rheumatology. There is a long history dating back to the PROMPT trial of methotrexate and PRAIRIE trial of rituximab. Both otrials showed an effect, but it seemed more likely to be a delaying of RA than prevention or modulation. Framing it another way, there were better outcomes in pre-RA because we were actually treating RA as it emerged with a proven effective treatment. It is in this setting that three trials of ongoing studies in RA preventative therapy are presented at ACR.

Are MDA criteria created equal in PsA?

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Minimal Disease Activity criteria are used to evaluate PsA disease activity and response to treatment. Given that a patient only has to meet 5 of the 7 criteria, should the individual components be weighted equally? 

Are we really treating Psoriatic disease if we only address active disease domains and T2T?

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It’s widely accepted that Psoriatic disease has multi-system, multi-domain potential that can lead to life altering complications if left untreated or undertreated. Rheumatologists have shifted the way we discuss treatment options and disease state expectations with patients. Two #ACR22 abstracts stood out to me regarding the Psoriatic disease patient experience and will, ultimately, add to what I do in clinic. 

Updates on Reproductive Health in Women with SLE

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Is patient-administered cervical cancer screening an option for women with SLE? Should I prescribe estrogen containing contraceptives to SLE women with APL antibodies? What complications should I be aware of in pregnant women with SLE? Here are three abstracts that provide insight.

Proposed Cancer Screening for Inflammatory Myositis Patients

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Today's plenary session features a novel proposal on how and which patients with Idiopathic Inflammatory Myopathy (IIM) should be screened for cancer.  Abstract 0002 by Oldroyd et al, entitled "Cancer Screening Recommendations for Patients with Idiopathic Inflammatory Myopathy" took on this thorny practice issue. 

Survival and Mortality in RA: time to move away from “one-size fits all”?

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Patients with RA are known to have a higher mortality risk than the general population.

Anifrolumab shows long-term promise in patients with lupus

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Type I interferon (IFN) is a powerful immune activator that is present at high levels in the majority of patients with lupus, an autoimmune disease.

Long COVID and Rheumatic Disease

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The COVID-19 pandemic has had a significant impact worldwide particularly among those who are immunocompromised. Numerous studies have highlighted the increased risk of acute SARS-CoV-2 infection among patients with rheumatic diseases (RD).