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New insights into Pre-RA: It ranges from asymptomatic individuals with ACPA positivity to those with symptomatic pre-clinical synovitis. Predicting who will develop RA is difficult, and there is a need for reliable biologic tools. Focusing on high-risk patients could https://t.co/SPOP7f0t7y
Dr. John Cush RheumNow ( View Tweet)
When every option fails, bold moves remain.
In 5 multi-resistant RA pts, TNFi + JAKi combo brought remission in most without major AEs.
Not standard, not risk-free, but in young, low-infection-risk pts, it may offer a path forward.
@RheumNow #ACR25 Abstract#2272
Jiha Lee JihaRheum ( View Tweet)
#ACR25 Abstr#LB01 After several smaller studies, a Multicentre, Phase 2b RCT of 152 #SLE pts in China. SRI-4 was met in IL-2 as s/c every other day for 12 wks, followed by weekly for another 12 wks vs PBO. Efficacy & T-regs expansion were dose dependent. On to Phase 3 @RheumNow https://t.co/L0rYr5D1R1
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Post hoc eval of relapses from MANDARA, MEPO vs BEN in EGPA
30% of pts had relapse, 81% of which were asthma +/- sinonasal disease
Remainder were mostly muscle involved, only a few mononeuritis
Mostly as expected; useful epi data for clinic
#ACR25 @RheumNow Abstr#1769 https://t.co/IKKolMZJlF
Links:
Mike Putman EBRheum ( View Tweet)
Gladman et al. PsA patients treated with guselkumab in DISCOVER-2. Male patients had more radiographic progression. Males exhibit stronger relationship between early joint response and lower subsequent rates radiographic progression. @RheumNow #ACR25 Abstr#2345 https://t.co/TSNwesvPzj
Richard Conway RichardPAConway ( View Tweet)
Mulcaire-Jones et al. Changes in PFTs over 1 year in early RA. Improved 31%, worsened 25%. No difference based on baseline disease activity, or MTX use. Those with baseline ILD were MORE likely to improve. ?due to effect of treatment @RheumNow #ACR25 Abstr#2235 https://t.co/bJeLYN9oN7
Richard Conway RichardPAConway ( View Tweet)
EGPA relapse in MANDARA including OLE
Majority of relapses are asthma / sinonasal in nature
Of non-airway:
- arthralgia/myalgia
- sensory peripheral neuropathy
@RheumNow #ACR25 Abst1769 https://t.co/cPjjzl4RWS
Links:
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
CAR T flex for myositis 💪 LB14: Ongoing Phase 1 CD19 CAR T in refractory myositis ✅ Well-tolerated (low-grade CRS, transient cytopenias) 📈 11/11 improved MMT-8 (median +22 Day 85, +27 Day 169) 🔹 10/11 off myositis therapy at follow-up @RheumNow #ACR25 https://t.co/btOsIcHe0f
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Punjadath et al. Predictors of progression palindromic rheumatism to RA. 30 patients. 47% progressed to RA. Total number of joints involved, RF, CRP predicted progression univariate. Only total joints significant in mutlivariate but underpowered. @RheumNow #ACR25 Abstr#2261 https://t.co/FtVKdGtEr9
Richard Conway RichardPAConway ( View Tweet)
Late Breaker: Phase 2 RCT of low dose IL2 in SLE
Dose dependent response in SRI4 over 12 weeks
& surprisingly high rates of LLDAS
Too early to know if useful, but worth evaluating in a phase 3
#ACR25 @RheumNow Abstr#LB01 https://t.co/oPOLG82nwi
Mike Putman EBRheum ( View Tweet)
Can fiber make methotrexate work better? (LB15)
In a placebo-controlled Superfibers RCT, inulin 12 g/day improved EULAR response & Th17/Treg ratio in RA among MTX users.
@RheumNow #ACR25 https://t.co/awMRNloNw5
Jiha Lee JihaRheum ( View Tweet)
Late breaking: secukinumab out-performs ustekinumab in PsA pt who have failed TNF therapy
RCT of 119 pt
57.1% response at wk 28 in SEC
27% response at wk 28 in UST
Numerically lower adverse events leading to d/c in SEC
@RheumNow #ACR25 #ACRBest Abst LB06 https://t.co/wDxtscP2ku
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Does fiber boost MTX efficacy?
LB15: Fiber + MTX led to
📉 Greater drop in DAS28 (–1.00 vs –0.34 placebo)
🧬 ↓ Th17 cells & Th17/Treg ratio
Some food for thought
@RheumNow #ACR25 https://t.co/VhLVP1nRy2
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Serrano-Combarro et al. Baricitinib in RA-ILD. Observational, 42 patients. Progressive ILD in 26%. More frequent in women. @RheumNow #ACR25 Abstr#2229 https://t.co/ZXfgxKoau7
Richard Conway RichardPAConway ( View Tweet)
Benson et al. Clinical features that predict CV risk in PsA. Median 3.53 year follow up. 56 CV events. 766 patients. Dactylitis emerged as key predictor in adjusted models. @RheumNow #ACR25 Abstr#2317 https://t.co/5O3G7vGYbq
Richard Conway RichardPAConway ( View Tweet)
Cutaneous vasculitis: who is most likely to have systemic disease?
430 pt w skin vasculitis examined in case-control
Associated with risk for systemic vasculitis/CTD:
- GI sx
- ulcerating/necrotic lesions
- constitutional sx
- hematuria
@RheumNow #ACR25 Abst 2525 https://t.co/lRjLKRYxDW
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
How great would it be to have a diagnostic RA-ILD Urine Dipstick?
Small cohort 14 RA-ILD vs. 64 RA no ILD
Urine ILDScore includes 2 proteins
SPOCK1 and PGRMC1
Independently asso with ILD w/ OR 6.19
Urine ILD score alone AUC 0.9
ILD urine score + clinical data AUC = 0.95
Needs https://t.co/7PqX8kdjKJ
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
To be continued (or discontinued?): Abstract 2360: Compared to TNFi, IL-17i & JAKi users had 🔹 Higher odds of med switching <180 days 🔹 Shorter time to discontinuation @RheumNow #ACR25 #axSpA https://t.co/IOHaFSJqHn
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Interesting study evaluating the "CALLY" index (serum albumin × lymphocyte count / CRP / 10,000) for predicing mortality in AAV
I typically dislike these because (1) they are often cumbersome to calculate & (2) they often perform poorly
This one piqued my interest; pretty https://t.co/ziroQOH5Cq
Mike Putman EBRheum ( View Tweet)
Meta-analysis of 3 RCTs (n=1990) shows IL-17i offers comparable joint response but superior skin clearance vs adalimumab in biologic-naive PsA. IL-17i also had fewer discontinuations due to adverse events. Supports sequencing of biologics through different mechanisms of action in https://t.co/SJgFUMxWVb
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
