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Methotrexate and hepatic fibrosis: we must be doing something right
Methotrexate may be a rheumatologist’s best friend, but a key part of counselling any patient about its use has always been the risk of hepatotoxicity.
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ACR21 Best Abstracts - Day 2
The RheumNow faculty reporters have been scouring and reporting on the best abstracts from the ACR. Here is a sampling of their choice abstract presentations reported during ACR 2020 Day 2 (#ACRbest).
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Day 1 Report from ACR21
The first full day of Abstracts and Presentations from ACR Convergence, was full of highly engaging sessions, quality posters and unique presentations. To hear more about the best of the best, I would encourage you to look at our Day 1 Recap Video and Day 1 ACR Best Abstracts. Here are a few of my favorites from the first day.
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What predicts response to MTX in RA?
👉🏼DAS28-ESR
👉🏼RA duration
👉🏼Pt global assessment
👉🏼Swollen joint count
Abs#1227 #ACR21 @RheumNow
https://t.co/s942zvFiZ1
Mrinalini Dey DrMiniDey ( View Tweet)
#ACR21 #Abstr1420 A study checking #COVID vaccine response in 90 #lupus pts and 20 HC:
⬇️Titres of Abs in SLE vs controls
💠Factors of poor response: On any DMARDs exc HCQ only (OR 15) and normal dsDNA
📢Important to pause DMARDs in stable SLE @RheumNow https://t.co/USovFkiCRb https://t.co/bn5CC0xRS9
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Fautrel describes a series of 13 #AOSD (Stills) pts with Pulmonary arterial HTN (cath confirmed) - seen exclusively with women, 85% and all were on DMARDs - 31% MTX, 69% IL-1i, all on steroids- 5 deaths, 3 yr Survival 74% (same as PAH) #ACR21 Abstract 1100 https://t.co/qR21MdYG3A https://t.co/WN38ifgtT6
Links:
Dr. John Cush RheumNow ( View Tweet)
#ACR21 Abs#1224. ⬇️ CD39 expression on B cell predicts occurrence of anti-drug Ab in RA on RTX
⭐️13/23 pts on RTX became ADAb+. No diff in concomitant MTX usage
⭐️Baseline CD73 similar, but lower CD39 predictive of ADAb
https://t.co/QzbAmXtTmZ @Rheumnow https://t.co/CLtEev69YD
Links:
Eric Dein ericdeinmd ( View Tweet)
Atypical patterns of HCQ retinopathy:
- outside the central macula
- missed by standard central macula screening
- 41x more likely in Asians!
Lesson: screening with extramacular SD-OCT for Asian HCQ pts is so, so important. 41x over.
@MGHrheumatology #ACR21 ABST0989 @RheumNow https://t.co/0w7ALHJDSW
David Liew drdavidliew ( View Tweet)
Another exciting day at #ACR21 and covering for @RheumNow
Also presented my poster (Abstr 0587) DMARD Use in Medicare Patients with #RheumatoidArthritis and Risk of Long-Term Opioid Use
- DMARD users showed lower odds of long term opioid use compared to non-DMARD users https://t.co/2XZgYY8ORg
Akhil Sood MD AkhilSoodMD ( View Tweet)
Stopping/reducing hydroxychloroquine (HCQ) in SLE associated with increased flares, especially for those in low disease activity or in remission. Super helpful data to share with pts wanting to reduce/dc HCQ.
#ACR21 Abst#0959 Plenary Session II @RheumNow https://t.co/i7jPDN2sgZ
Pedro Castillo _Castillo_Pedro ( View Tweet)
How concerned should we be for #hydroxychloroquine retinopathy. >4000 pts prospectively followed. 1/2 w RA & 15% w #SLE. New risks Asian with pericentral pattern and overall. Length of time on use and ⬆️wt based dose per day & CKD all risks. Abst#0989 #ACR21 #ACRBest @RheumNow https://t.co/XTfdQpVC7H
Janet Pope Janetbirdope ( View Tweet)
In pts w/o RF, liver bx prev suggestd if lifetime cumulative MTX dose was 1-1.5g, then 3.5-4g.
All pts in centre offered Fibroscan
liver stifness associations:
- age, BMI
- not cumulative MTX dose
maybe survival bias, but what we're doing now is fine!
#ACR21 ABST0786 @RheumNow https://t.co/I6IhS3jhmC
David Liew drdavidliew ( View Tweet)
Very interesting talks by Dr. Kim and Dr. Hyrich on DMARDs and Cancer risks
#ACR21 @RheumNow https://t.co/Dl5WPo7mmj
Akhil Sood MD AkhilSoodMD ( View Tweet)
NORD-STAR Trial: outcomes in tx-naïve, early RA pts after 48w of csDMARDs+GC vs bDMARD (ABAtacept, CerToliZumab, or ToCiluZumab)+MTX
➡️ Superior CDAI remission rates w/ ABA+MTX & CZP+MTX but not TCZ+MTX vs csDMARD+GC
➡️Imaging progression low in all
Abst#0825 #ACR21 @RheumNow https://t.co/QaFIF4WNEG
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR21 #Abstr0871 📢Argument against HCQ<5mg/kg dose from cardiac perspective in #lupus. A retrospective study N=296 pts, 13% developed CV events.⬇️28% in risk of heart failure, arrhythmia/cardiac death per mg/kg of HCQ in non-smokers @RheumNow #ACRBest https://t.co/6ssd2159R1 https://t.co/tllPWLnFFj
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
B cell repertoire: the new 🔮?
An algorithm associating baseline CDAI to BCR sequencing outcomes w/
✨Isotypes frequency
✨Somatic Hypermutations
predicts MTX 12mo response w/ 78% sens & spe
#Abstr982 #ACR21 @RheumNow
https://t.co/SZaip6xUaO https://t.co/fbWq34gtzc
Aurelie Najm AurelieRheumo ( View Tweet)
PsA impacts many aspects of life. PRO such as VAS pain
and HAQ, are commonly assessed. The FACIT-Fatigue scale, ranked the highest by
patients. Personalized discussion is vital in assessment and shared decision making @RheumNow #ACR21 Abst#0751 https://t.co/gRfYK4sHc6 https://t.co/f5xjUnXsGQ
Dr. Antoni Chan synovialjoints ( View Tweet)
Can patient with low dx activity SLE stop HCQ, or at least try and reduce the dose?
Not if you want to avoid flares.
If there are safer subgroups to try it in, we haven't found them yet
(in fact higher dx activity➡️less risk ?other Rx)
SLICC inception #ACR21 ABST0959 @RheumNow https://t.co/NS2V4dEGHv
David Liew drdavidliew ( View Tweet)
Do you order EKGs in everyone starting HCQ? Do you avoid HCQ in patients with heart failure? Will these abstracts impact your practice? Click on link to read more....#ACR21 @rheumnow #HCQ https://t.co/fvUZAvNWa8
TheDaoIndex KDAO2011 ( View Tweet)
CARRA STOP-JIA 400pts, Obs study w/ 3 treatments plans :
-Step up
-Early combination
-Biologic first
Which one do you think works best?
I'd say none: overall 40-60% not achieving CDI off steroids at 24 months.
Results: 42% for SU, 52% EC, and 44% BF #Abtr0960 #ACR21 @RheumNow
Aurelie Najm AurelieRheumo ( View Tweet)
