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#ACRbest Abstracts – Day 2

Jack Cush, MD

Our reporters have been prolific in finding the hot abstracts, those that were most attended or those that are getting the most buzz on social media.  Here are RheumNow's #ACRbest abstract reports from Monday, November 13, 2023 at #ACR23, covering The Great Debate, SGLPT2 inhibitors in SLE, the SMART Study of MTX, TMP/SMX Prophylaxis, RA-ILD & TNF Inhibitors, cancer research and more. 

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Methotrexate: shall we split up?

Aurelie Najm, MD, PhD

Methotrexate is widely used in rheumatic diseases yet poses common tolerance issues, especially for the oral form; and bioavailability is known to be limited for doses over 15mg. In the SMART study, Prasad et al. present the first RCT comparing either single dose (25 mg) or split-dose (10 mg morning, 15 mg evening, same day) once weekly MTX for 24 weeks.

Mike Putman Tweet
EBRheum
Large observational study of TNF use among patients with RA & cancer Overall encouraging, no negative impact on survival I'm kind of a TNF-truther on this; I don't think they cause ANY increased risk of malignancy @RheumNow #ACR23 Abstr 1675 https://t.co/KRVlIFxhl8
Robert B Chao, MD Tweet
Does TNFi use in pts with RA and early breast cancer affect survival? TNFi did not affect overall survival or breast cancer specific survival compared to cDMARDs Steroids did increase mortality @RheumNow #ACR23 Abs#1675
Dr. Antoni Chan Tweet
No significant difference in overall survival in early stage breast cancer (BC) patients treated with TNFi (alone -/+ cDMARDs, in 1st year of BC) and cDMARDs in RA. Those on glucocorticoids had worse survival. Suarez-Almazor M, Abst#1675 #ACR23 @RheumNow https://t.co/lnZx3OpuN5
Aurelie Najm Tweet
Insights into pathogenesis venous & arterial thrombosis in RA + JAKi Significant dysregulation of clotting pathways in myeloid & increased clot formation in context of microbial challenge (TLR4) Observed across all JAKI, but selective JAK3i @RheumNow #ACR23 ABST1676 https://t.co/nboy0znfAW
David Liew Tweet
drdavidliew
Hand movement video: more promising than photos as a computer vision concept for remote monitoring of RA disease activity. Of course: validation, training, clinical evaluation all must happen before it is ready for your clinic https://t.co/HyN6ElKF0F #ACR23 ABST1293 @RheumNow https://t.co/DltI9HFiFE
Aurelie Najm Tweet
Fatigue 😴 in RA & synovial biology In DAS LDA pts Fatigue asso w/ -female sex -synovial lymphocytic inflammation In DAS moderate DA: -female sex -synovial lining layer -Anxiety Limitations: arthroplasty tissue, small sample size, no Immunohisto @RheumNow #ACR23 ABST1630 https://t.co/4vhzvdPgyd
Richard Conway Tweet
Fisher et al. In high disease activity, fatigue associates anxiety and synovial lining hyperplasia, 1.57[1.01,2.5]; p=0.047) In LDA, fatigue associates chronic lymphocytic synovial inflammation, 1.92[1.09,3.57]; p=0.024) Abstr#1630 #ACR23 @RheumNow https://t.co/Gev6pU3srq https://t.co/Ys8etP36ir
David Liew Tweet
drdavidliew
Do we miss RA activity in obese pts? Pre-clinical trial entry MSK USS: similar DAS28 but lower SJC/US scores in obese Is it because, in obese RA patients: we underdetect on exam? we undertreat? higher risk, so lower penetrance of severe dx endotypes? #ACR23 ABST1287 @RheumNow https://t.co/3FFPdBJOpz
Bella Mehta Tweet
bella_mehta
Multimorbidity in #RA - VARA registry data- looking at 61 different biomarkers and 44 comorbidities Chronic pain in 44% Specific biomarkers seen in different morbidities @rheumnow #ACR23 session#13M148 https://t.co/l6FU1ELKD3
Aurelie Najm Tweet
Peyton et al.: 4 multimorbidity patterns in RA -Mental health and subst abuse -Metabolic -CV -Chronic pain All associated with different sets of biomarkers. Some are very specific of one profile while others are widespread across profiles. @RheumNow #ACR23 ABST1631 https://t.co/VqCrLI3oyy
Dr. Antoni Chan Tweet
In PS-matched study, no significant difference in respiratory hospitalisation or death between RA-ILD patients on non-TNFi/JAKi vs. TNFi. This finding does not support systematic avoidance of TNFi in RA-ILD, England B Abst#1582 #ACR23 #ACRBest @RheumNow https://t.co/1zVjMWNZZS https://t.co/d8TRIvGaIe
TheDaoIndex Tweet
KDAO2011
Abst#1583 SMART study: Split dose qwk MTX (10 mg QAM, 15 mg QPM) may have better efficacy compared to 25 mg single dose qwk MTX. RCT 253 RA patients: split dose had better DAS score, less likely to add other DMARDS, but slight⬆️in LFTs. #Plenary #ACR23 @rheumnow #ACRbest
TheDaoIndex Tweet
KDAO2011
It's OK to use TNFi in RA-ILD! VA study 1000+ pts using Target Trial Emulation framework: TNFi vs nonTNFi biologics/JAKi followed for 3 years. NO differences in respiratory hospitalizations or deaths or all cause mortality. abst#1582 #ACR23 #ACRbest @rheumnow https://t.co/aI2SmMrLPE
Bella Mehta Tweet
bella_mehta
Factors predicting fatigue in RA differ by disease activity. Synovial lining hyperplasia and synovial lymphocytic inflammation on histology were key factors. @rheumnow #ACR23 session 13M148 https://t.co/yPBZX2Rxft
Aurelie Najm Tweet
RA-ILD: the study that exonerates TNFi ? TNFi vs. other BioDMARDs/JAK do not increase risk of death or hospitalization over 1 and 3 yrs follow up. No subgroups stand out VHA cohort, 50% smokers No info on ILD patterns or disease trajectory ABST1582 @RheumNow #ACR23 https://t.co/frv16oRLqv
Richard Conway Tweet
Lovering et al. Synergestic effect of RA and CVD on dementia risk. 35% increased risk RA, 89% increased risk RA+CVD. Abstr#1628 #ACR23 @RheumNow https://t.co/Brj8XrG2o4
Janet Pope Tweet
#ClinicalPearl or #pathology pearl? Using synovial #biopsies to guide therapy in #RA #RCTs is a reality. But likely #fibrotic #phenotype won’t respond and #lympho_myeloid has more RA damage. #ACR23 session 13M140 #Precision #medicine #ACRbest ⁦@ACRheum⁩ ⁦@RheumNow⁩ https://t.co/DmI9dNpu8w
Bella Mehta Tweet
bella_mehta
@Dr_K presenting long COVID data from FORWARD RA. These pts had some symtoms before COVID!- More comorbidites, depression patient reported scores, fibromyalgia but no different DMRD use. PHQ8 and wodepread paid were the most important PROMs @RheumNow #ACR23 https://t.co/JaWc4oDnaI
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