All News
An update on JAK inhibitors and cardiovascular risks
In the last 2 years, there has been more caution and vigilance with the use of JAK inhibitors in the treatment of rheumatoid arthritis due to the risk of CV events, including MACE and VTE. The ORAL surveillance study, a post-approval safety study conducted in RA patients aged ≥50 years with ≥1 CV risk factor, has resulted in increased caution and greater emphasis on assessment of MACE and VTE risks in patients starting JAK inhibitors.
Read Article
ILD in RA and PsA
Interstitial lung disease (ILD) is a severe extra articular manifestation of RA, with limited treatment strategies and poor prognosis.
Read Article
How much MTX do we need with adalimumab in RA? Can blood concentrations help?
MTX RBC polygluts:
- don’t seem to match to efficacy
- do seem match to safety, a bit
(no ADAb data here)
*One day* we’ll get better at what MTX dose is needed with TNFi #EULAR2023 OP0128 @RheumNow https://t.co/OGM3hxr4fG
David Liew drdavidliew ( View Tweet)
#EULAR2023 #OP0007 What are the recent trends of autoimmune disease (AID)? A database study (22m) in UK showed:
- 1 in 10 people had AID in the last 20yrs
- socioeconomic, seasonal & regional disparities cd influence pathogenesis
- CTD (SLE,pSS,SSc) tended to co-occur @RheumNow https://t.co/3DDPR2K5NC
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
A highlight at #EULAR2023 AI in predicting RA from MRI scans of hands and feet in patients with early onset arthritis or clinically suspect arthralgia. From 1,974 people, 651 went on to develop RA. The accuracies were close to expert level prediction, Li Y, Abst#OP0002 @RheumNow https://t.co/MP8yn18PWI
Dr. Antoni Chan synovialjoints ( View Tweet)
Beydon et al., french registry study 255000+ RA patients 2010-2020
Increase ⬆️ overall malignancy by 20% vs. general pop
⬆️lung 40%, ENT 40%, cervix 80%, prostate 8%, melanoma 37%
Pancreatic cancer 10% less frequent in ♂
Breast 9% & Uterine body 23% less frequent in ♀
Aurelie Najm AurelieRheumo ( View Tweet)
So can computers beat humans in predicting RA from pre-RA arthralgia MRIs?
No, for now… but unsupervised they pick up the same culpable features we look for: bone marrow edema & tenosynovitis. Sometimes it’s nice when the machines tell us we’re right
#EULAR2023 OP0002 @RheumNow https://t.co/71Zo2JyC8d
David Liew drdavidliew ( View Tweet)
I swear it is muscle, Doctor!
GLORIA trial substudy
Pred 5 mg/day 2 years in RA pts >65yo:
Weight gain 1kg vs. PBO, no increase or redistribution of fat mass but augmentation in lean mass 💪
Probably explained by better disease control (although NS in study, small sample size)
Aurelie Najm AurelieRheumo ( View Tweet)
EULAR PtoC management of targeted therapies in pts w/ IA & Hx cancer
1) If remission, initiate targeted therapy w/out delay
2) Prefer anti-cytokine bDMARDs if Hx solid cancer
3) B cell depleting therapy if Hx lymphoma
4) Use JAK inhibitors and abatacept with caution 🛑 https://t.co/cKhQVZwGh1
Aurelie Najm AurelieRheumo ( View Tweet)
Prediction of RA early arthritis & clinically suspect arthralgia pts w/ AI analysis of MRIs scans:
✔️Feasible
✔️Accurate AUC 0.683 EA group AUC 0.727 CSA group
✔️Peformance = human experts
✚ Could identify new imaging biomarkers
https://t.co/sVXw9A8NqZ OP0002 #EULAR23 @Rheumnow https://t.co/oq5RJApm9U
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Provan et al. large scandinavian registry study: 🫁ILD risk in RA & PsA initiating b/tsDMARDs
HR ILD RA=10
HR ILD PsA=5
No increase risk w/ MTX and b/tsDMARDs but RA HR ILD 1.7 RTX vs. ETA: confounding by indication?
https://t.co/CF1ysNkQxU OP0006 #EULAR23 @Rheumnow https://t.co/DgDE1uFeUs
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Autoimmune disease diagnoses slowly on the rise, despite reduced smoking - but that’s now 10% of the population, & many patients have more than one. Most are lifelong.
Surely this needs more investment??
CPRD data from the UK #EULAR2023 OP0007 @RheumNow https://t.co/7NGF5YaE9z https://t.co/m6SaibqmEq
David Liew drdavidliew ( View Tweet)
Scandinavian RA registry study shows reassuring data on CV risk in RA🫀
Acute Coronary Syndrom incidence rates are similar in RA pts achieving remission & general pop & is similar whether RA pts reach remission using MTX or TNFi.
https://t.co/wBDZtaTVba
OP0038 #EULAR23 @Rheumnow https://t.co/JLdbYF49xF
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Data from combined big Scandinavian population registries looking at both RA and PsA, ILD development, & MTX exposure
Here’s the ILD risk for methotrexate.
Can we stop this MTX misinformation? No more besmirching a really useful drug for our patients #EULAR2023 OP0006 @RheumNow https://t.co/7swqAYchDC
David Liew drdavidliew ( View Tweet)
Interstitial lung disease in RA and PSA in b/tsDMARD treated patients with MTX - there is no increased risk of developing ILD above the background risk of RA and PsA vs general population Sella Aarrestad Provan Abst#OP0006 @RheumNow https://t.co/yJsrmraeZ5
Dr. Antoni Chan synovialjoints ( View Tweet)
Comorbidities and metabolic burden in PsA:
-Occur EARLY
-Early PsA pts > multiple comorbidities & > CV morbidity vs. age-matched early RA pts
Independent of BMI & obesity
Time to address these as part of dis pathogenesis in PsA
https://t.co/qOiGHn2eZT OP0066 #EULAR23 @Rheumnow https://t.co/lK7MbeMybO
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
New benefit/risk outlook 👀 on ORAL surveillance
2 subgrps:
🟢RA w/ no previous Hx of atherosclerotic CV dis = TOFA at least as good as TNFi
AND risk of MACE is comparable 🛑RA w/ HxASCVD = efficacy TOFA = TNFi AND > risk of MACE
https://t.co/VOxNQSoyY4 OP0043 #EULAR23 @Rheumnow https://t.co/m98eSMG03U
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Leiden arthritis clinic:
1000+ pts w/ RA & high BMI associated w/ < MRI-detected osteitis at dis onset but NOT synovitis
RA w/ overweight/obesity 25% < MRI-detected erosive progression at 2 yrs
More marked in ACPA+ pts
Is leptin the missing link? 🤓
OP0039 #EULAR23 @Rheumnow https://t.co/RRSV9VlRtn
Aurelie Najm AurelieRheumo ( View Tweet)
Biosimilar vs originator: as switches loom in the US, once again it’s really hard to say we see any differences in drug survival for our RA patients
These data from forced switching in BC, Canada are just like the others - biosimilars are business as usual. POS0567 #EULAR2023 https://t.co/Ebl1hTM4qE
David Liew drdavidliew ( View Tweet)
Ongoing work to #classify #inflammatory #arthritis in Pts using #check #point #inhibitors. A 1st step to study the etiology of immune changes from these life prolonging medications #EULAR2023 @RheumNow https://t.co/Bv1q8IphqF
Janet Pope Janetbirdope ( View Tweet)
