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Opening Day Report
The opening of ACR2 Convergence was a hit for all who signed up and viewed in. The day included the presidential address by outgoing president Dr. David Karp (UT Southwestern) and a keynote talk and interview with Dr. Seema Yasmin (Stanford).
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Towards better assessment and management of multimorbidity
Appropriate assessment and management of comorbidities and multimorbidity in patients with RA is vital for overall health and well-being of the patient, as well as to encourage treatment adherence, and address social, psychological and quality of life factors.
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Pre-clinical RA: starting off the wrong foot
Patients with clinically suspect arthralgia can represent a challenge for clinicians, in a sense that there are not yet reliable markers to predict evolution to clinical RA nor enough evidence to support routine prescription of conventional synthetic DMARDS or biologic treatments in this setting.
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#ACR21 Abst#0182
Does tenderness in non-swollen joints of PsA or RA pts portend inflammation & radiographic damage?
⭐️NO, except in early PsA!
➡️Abnormal PDUS associated w/ radiographic progression vs tenderness otherwise
#ACRBest @Rheumnow @uptoTate
https://t.co/iB1E0SL45e https://t.co/3Q30LeCMH4
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR21 Abst#0271
➡️Patients 40-75 yo w/ RA dx in the prior 5 yrs have ⬆️ prevalence of subclinical athero vs age-matched controls.
→ Should we consider obtaining a carotid US at time of RA dx & monitor per risk status to help optimize CV risk? @Rheumnow
https://t.co/3PpHIRk984 https://t.co/ChRTU7zACk
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Blurred line indeed, one could argue that a patient with ACPA+, arthralgia and sub-clinical inflammation detected on MRI is already transitioning toward early RA and fall into the category of patients we should treat anyway. https://t.co/Y1JceOijK0
Aurelie Najm AurelieRheumo ( View Tweet)
Exciting day at #ACR21
I wrote an article discussing COVID 19 in #RheumatoidArthritis discussing the following abstracts
0097 by Hasseli
1445 by @NamrataRheum
L04 by @rheum_cat & @rheum_covid
@rheumnow #COVID19 #RA #JAK #Rituximab
https://t.co/g32ZYHBjQY
Akhil Sood MD AkhilSoodMD ( View Tweet)
Blurred line btwn RA, preRA & RA prevention which makes interpretation of RCTs problematic. I’ve learned that if pt has RA not meeting criteria, some Rx ⬇️chance of RA over time-MTX, now #Abatacept but was it RA anyway AND what happens when you stop Rx? #ACR21 @RheumNow abst#0505 https://t.co/HwivsITvCQ
Janet Pope Janetbirdope ( View Tweet)
#ACR21 #Abstr0437 OK, so RTX affects #COVID vaccine but some pts need RTX. Factors predicting response to vaccine:
RA vs AAV/IIM
Higher IgG
Longer time-to-RTX
Lower RTX courses Number.
Prediction Calculator is developed but need ext. validation #RheumNow https://t.co/iXSaGQ76hS https://t.co/WQAV3GRPBz
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Abst # 0494
Dowell & colleagues showed that in RA patients using RISE registry
- disease activity correlated with burden of comorbidities
- this was linked to areas of low SES (ADI > 80) who received primarily Medicaid Coverage
https://t.co/xkdVnieHB2 #ACR21 @RheumNow https://t.co/jyZbV64qVz
Akhil Sood MD AkhilSoodMD ( View Tweet)
Insurance type, not race or distance to care, assoc'd w/ RA dz activity & burden. We need ^ rheums to care for socially deprived, rural, high comorbidity, Medicaid-covered RA pts w/ enhanced reimbursement & access to tx. Abs 0494 #ACR21 #RheumNow @RheumNow https://t.co/0es0i24gkS https://t.co/pBvhFR2DqE
Dr. Rachel Tate uptoTate ( View Tweet)
Active RA w/ large joint swelling & co-existent CVD & diabetes associated with ⬆️risk of #AlzheimersDisease & related #dementia in RA pts.
👉~1300 patients
👉Among CVD conditions, #stroke & #CHF assoc w/ the risk of #dementia
#ACR21 Abs#0284 @RheumNow
https://t.co/N3x2ZtBFGe https://t.co/kFyf3A0gha
Mrinalini Dey DrMiniDey ( View Tweet)
Abs0266 #acr21 @RheumNow study of impact of pandemic on pts w/SLE (67%), RA (19%), & pSS (8%): 63%reported a flare since the pandemic & 16% had COVID-19. 19% reported no changes to their care.76% reported a change in their mood& emotional health. Was your pts experience similar?
Olga Petryna DrPetryna ( View Tweet)
#ACR21 Abst#0284
My 56 yo ♀RA pt expressed concern for developing dementia last wk. This study helps recognize her RF beyond aging:
➡️ Large joint swelling (HR 2.2)
➡️ CVD (HR 2.4): stroke (HR 3.2) + chronic HF (HR 1.8)
➡️ DM (HR 1.6)
#ACRBest @Rheumnow
https://t.co/wsZnaLwSmD
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Provocative study in pre-RA. SC Abatacept in patients with pre-clinical RA can:
-improvement MRI inflammation
-⬇️evolution to clinical RA at 6 months
-No new safety signal
Yes, but we need longer term follow-up and an estimation of NNT.
#OP0505 @Rheumnow #ACR2021 https://t.co/2P1Yk3IyeR
Aurelie Najm AurelieRheumo ( View Tweet)
Do RA autoantibodies incr the risk of MACE?
In study of ~2000 pts, ⬆️ concentrations of RA-related autoantibodies assoc. w/ MACE and/or CVD-mortality.
Autoantibodies may therefore directly contribute to excess CVD risk in RA...
Abs#0269 #ACR21 @RheumNow
https://t.co/ju3YCRonJt https://t.co/UcOMsYxVMP
Mrinalini Dey DrMiniDey ( View Tweet)
Abs 0463 #ACR21 @RheumNow
Park & colleagues compared treatment persistence across abatacept, TNFi, and JAKi in dual seropositive RA patients using Medicare database
- Users of abatacept were more persistent to index time of 12 months and showed longer time to discontinuation https://t.co/0huE7zZjLq
Akhil Sood MD AkhilSoodMD ( View Tweet)
Pre clinical RA: don't miss the feet 🦶🏼! Among 577 patients
with clinically suspect arthralgia undergoing MRI:
-23% intermetatarsal bursitis > ACPA + 56% vs. 19%
-higher risk or RA HR 3.3.
Would we find the same results w/ US?
#OP0468 @RheumNow #ACR2021 https://t.co/VkzUu93qGq https://t.co/GGw7UgdPVR
Aurelie Najm AurelieRheumo ( View Tweet)
Accdg to this study by Dr. B VanDijk et al, intermetatarsal bursitis (IMB) was seen in 23% of clin suspect arthralgia(CSA) pts; predicted clinical arthritis in ACPA+; ⬆ frequent w/ synovitis & tenosynovitis
Addtl tool for early RA dx?
@RheumNow #ACR21 abs0468 #ACRBest https://t.co/bcUuy8bHLJ
sheila RHEUMarampa ( View Tweet)
#ACR21 Abst#0455 ARIAA Study: Abatacept for subclinical arthritis
⭐️ ACPA + arthralgia + MRI inflammation 🔥
⭐️ ⬇️ MRI inflam (primary) and ⬇️ progression to arthritis (secondary)
▶️ Many patients likely early RA, would still rec starting MTX 1st
https://t.co/4aREvqlpUI @Rheumnow https://t.co/vqRgsd75Il
Links:
Eric Dein ericdeinmd ( View Tweet)