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Booking regular clinic visits for controlled RA pts - can we be more efficient?
12m RCT
Self-monitoring app, supported self-initiated care
only one scheduled follow-up visit
controlled RA pts
DAS28/pt satisfaction same
visits/y: 1.7 vs 3.0
@reade_020 #ACR21 ABST0830 @RheumNow https://t.co/600XTKo9GM
David Liew drdavidliew ( View Tweet)
Risks for RA:
- chromosome 6 has HLA risk genes encoding HLA-I and -II
- HLA-DRB1 *04:01 and *04:04 stonrgly assc w/ RA in white Americans/Europeans
- the Shared epitope increase risk for RA & severe disease; high assc with ACPA+
Protective➡️HLA-DRB1*13:01 @rheumnow #ACR21 2/2
TheDaoIndex KDAO2011 ( View Tweet)
Chances for RA if a family member has RA?
Dr. B Masri reviews familial studies:
👉person w/1st degree relative w/ RA has 2-4 X risk
👉Multigen study standard incidence ratios: 3.02 child, 4.64 siblings, 9.31 in multiplex family, 6.48 twins, 1.17 in spouses #ACR21 @rheumnow 1/
TheDaoIndex KDAO2011 ( View Tweet)
Dr. Ranjeny Thomas on preventing RA:
👉60% genetics/immunopathogenesis (noncontrollable factors)
👉40% lifestyle modifications: healthy diet, healthy weight, avoiding tobacco, reduce occupational exposure, improve exercise/sleep, decrease stress.
#ACR21 @rheumnow 1/2 https://t.co/eoh3kcekR8
TheDaoIndex KDAO2011 ( View Tweet)
Dr. R Thomas: current studies on prevention of RA:
👉oral DMARDS (MTX, HCQ)
👉biologics (RTX, abatacept)
👉 studies regulating T cells to restore tolerance
👉biomarkers of tolerant state & look at people who don't develop RA
👉 imaging as window of subclin dz. #ACR21 @rheumnow https://t.co/5bsu5459az
TheDaoIndex KDAO2011 ( View Tweet)
#ACR21 Abs#0818: Starting biologics in moderate vs severe RA activity:
▶️ Moderate disease activity: more likely to reach LDA, remission
▶️ Severe disease: greater overall improvements, but less likely to reach remission
https://t.co/9jBtN9wUGF @Rheumnow
Links:
Eric Dein ericdeinmd ( View Tweet)
So it's day 2 at #ACR21, and you know what that means - it's ORAL Surveillance day!
This is the figure everyone will be talking about, leading up to details in the plenary.
Why are the other bars higher than the pink bars?
ABST0831
plenty of @RheumNow coverage coming on this https://t.co/B80cSmhNV7
David Liew drdavidliew ( View Tweet)
Abst#0788 #ACR21. Forgot to measure vitamin D?
▶️ Red cell distribution width (RDW) inversely correlates w vit D 25(OH) levels prior to MTX
⭐️ RDW ⬆️ after starting MTX, no longer correlates
https://t.co/b5EPDmGE18 @Rheumnow https://t.co/cNN14ErOmF
Links:
Eric Dein ericdeinmd ( View Tweet)
ORAL Surveillance
In mod-severe RA pts >50yo, with CV RF & no hx malignancy, patient-years of exposure required for one event (vs TNFi):
MACE
tofa 5mg bid: 567
tofa 10mg bid: 319
malignancy
tofa 5mg bid: 276
tofa 10mg bid: 275
#ACR21 ABST0831 @RheumNow https://t.co/9vyXPTMFzj
David Liew drdavidliew ( View Tweet)
#ACR21 Abst#0793. Japanese multicenter US cohort (KUDOS) study, looked at difficult to treat (D2T) RA pts
▶️ 1/5 pts are D2T (fail 2+ b/tsDMARD, mod disease or GCs)
⭐️ Contributors of good outcomes: IL-6i (OR 9.6), concomitant MTX (OR 7.1)
@Rheumnow https://t.co/9YSa4ebQlR
Links:
Eric Dein ericdeinmd ( View Tweet)
Greater #comorbidity burden is assoc. w/ worse improvement and disease activity in 1st yr of treatment in ERA @earlyarthritis.
Comorbidities esp affect SJC and patient and physician global assessments.
#ACR21 Abs#0798 @RheumNow
https://t.co/02BRqYp9Yk
Mrinalini Dey DrMiniDey ( View Tweet)
#ACR21 Abst#0801 Early remission at 6 mos is a predictor of long-term remission in patients w new onset RA
▶️ DAS28-CRP, SDAI, CDAI at 6mo predicted remission at 60 months
https://t.co/vWy7EmseZp @Rheumnow https://t.co/HWJSjvFY8d
Links:
Eric Dein ericdeinmd ( View Tweet)
How can we better identify patients with #RA-ILD using #EHRs?
Abs#0561: previously validated algorithms have clinical & research utility when applied to EHRs, esp when well-integrated with key info such as CT chest reports
#ACR21 @RheumNow
https://t.co/OU8BdwqHpc
Mrinalini Dey DrMiniDey ( View Tweet)
ADACTA & MONARCH both showed IL6i monoRx > TNFi monoRx for RA in DBRCTs.
What about in real-world data?
Looking at CorEvitas, less so
LDA: aOR 0.99
MCID in CDAI: 1.06
Even without MTX, both great drug classes for RA
Equally so?
#ACR21 ABST0834 @RheumNow https://t.co/6wvzVrXTW6 https://t.co/fYEktJhZuV
David Liew drdavidliew ( View Tweet)
#ACR21 A#0563 - Is FRAX score applicable for RA? 10 yr Olmsted County epi study: Yes
▶️ 76 osteoporotic fxs in RA pts, FRAX predicted 67 fx (SIR 1.13, not signif)
▶️ 21 observed hip fx, FRAX predicted 23.3 (SIR 0.9)
⭐️ No differences by ages/sex
https://t.co/vWy7EmseZp @Rheumnow https://t.co/8BlzgQYqaV
Links:
Eric Dein ericdeinmd ( View Tweet)
Guidance on self-efficacy (SE) in IA were published this yr- what factors influence this?
👉PROMs & treatment response determine long-term SE
👉This may help identify pts benefitting most from interventions to improve SE
Abs#0795 #ACR21 @RheumNow
https://t.co/dx28WgxNsE https://t.co/7uN6XctnQb
Mrinalini Dey DrMiniDey ( View Tweet)
#ACR21 Abst#0786. Fibroscan screening for liver injury in pts on MTX:
▶️No significant correlation between cumulative MTX dose and liver stiffness by fibroscan, even at high dose MTX.
⭐️Age, sex, waist circumference, BMI are risks
@Rheumnow https://t.co/IhcNr9fhEh https://t.co/c7TUoGrNZ7
Links:
Eric Dein ericdeinmd ( View Tweet)
It was a pleasure to speak to Dr Bryant England about #multimorbidity in #rheumatoidarthritis with a focus on abstract #1924, to be presented at the #Epidemiology & #PublicHealth abstract session on Tuesday #ACR21: https://t.co/qHws6B3fFf
Watch @RheumNow: https://t.co/OKM7WxIEpR
Mrinalini Dey DrMiniDey ( View Tweet)
It was a pleasure to speak to Dr Bryant England about #multimorbidity in #rheumatoidarthritis with a focus on abstract #1924, to be presented at the #Epidemiology & #PublicHealth abstract session on Tuesday #ACR21: https://t.co/qHws6B3fFf
Watch @RheumNow: https://t.co/OKM7WxIEpR
Mrinalini Dey DrMiniDey ( View Tweet)
#ACR21 Abst#0285
Calculated 10-yr CV risk ↑ w/in 1st yr of new RA dx in 53 Dutch pts:
➤43% had intermediate (I) or high (H) morbidity risk
➤76% had I or H mortality risk
◘ avg 57yo, 74%♀, 72% HTN, & 57% HLD
*️⃣ Early CV risk assessment critical at RA diagnosis!
@Rheumnow
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)