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Medication adherence is a problem
Much has been written about tapering medications in rheumatic diseases, often due to high costs of medications, a desire to avoid side effects and patient preference to take less medications (especially if they have side effects).
This is countered by something we all know: medications not taken don’t work, and those that are frequently missed may not provide optimal outcomes for the majority of patients.
Potential new treatment for Sjogren's
Is there finally something new on the horizon in Sjogren’s syndrome?
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Wiebe et al. Steroids <=5mg/day not associated negative effect on BMD. Of course steroid-related increase in fracture risk is not fully captured by BMD effect @RheumNow #ACR22 Abstr#1318 https://t.co/Ond5gzopRa https://t.co/HX2AUyQmsf
Richard Conway RichardPAConway ( View Tweet)
Singh @NamrataRheum et al. 27,421 RA patients, 8225 on b/tsDMARD. b/tsDMARDs did not increase risk of lymphoma. IR 1.68/1000PY (95% CI 1.5-1.9) on csDMARD vs IR 1.73/1000PY (95%CI 1.4-2.1) on b/tsDMARD. @RheumNow #ACR22 Abstr#1210 https://t.co/3Uvz3mvsGM https://t.co/6k3Vqb21KF
Richard Conway RichardPAConway ( View Tweet)
Table by @CuoghiE on how long to wait off #teratogenic meds before trying to conceive: note 2 years fr leflunomide unless a cholestyramine washout is done #ReproductiveRheum #ACR22 @rheumnow https://t.co/l4hIBQ5XN5
TheDaoIndex KDAO2011 ( View Tweet)
Fascinating Abs 0653 #ACR22 In vitro models show JAKis counteract celluar cytotoxicity of HCQ in a human retinal pigment epithelial cell line and podocytes. Possible new way to dec. retinopathy/nephropathy? @RheumNow
https://t.co/5NtLoDzjKG https://t.co/GG2R03xAes
Dr. Rachel Tate uptoTate ( View Tweet)
Global survey of rheumatic irAE people (me included)
Standard case
Variable answers, broadly distributed
none are wrong
We'll move from expert extrapolation of concepts to data-driven answers, with the right foundations👍
ABST0776 @MDAndersonNews @msalmazor #ACR22 @RheumNow https://t.co/5gMzWuCXd7
David Liew drdavidliew ( View Tweet)
Exposure to DMARDs prior to ICI treatment was not associated with 2-year crude mortality rates. Abs 0764 #ACR22 @RheumNow https://t.co/WvTy84Si7u https://t.co/X4RvYAVSMC
Dr. Rachel Tate uptoTate ( View Tweet)
Emphasis that drug holiday is NOT drug retirement in osteoporosis. Ideal time to re-initiate is quite uncertain however. Continue to monitor DEXA and fracture risk factors.
@RheumNow #ACR22 #osteoporosis https://t.co/iLKrxdzpAR
Julian Segan JulianSegan ( View Tweet)
💠CYC confers a 27% risk of congenital malformations and ⬆️miscarriage rate
💠Contraception is recommended during use and 3 mos after tx
#ACR22 @Rheumnow https://t.co/A73vCMZdxd
sheila RHEUMarampa ( View Tweet)
Most rheums round down on dosing because of the weight based recc's, but hydroxychloroquine dosing less than 5 Mg/kg/day leads to increased hospitalizations for #SLE flares abst#1654 #ACR22 #PressConference @rheumnow https://t.co/GGnnl14cy9
TheDaoIndex KDAO2011 ( View Tweet)
#abs0948 #acr22 @rheumnow perception on fertility&ART in pts w/rheum Dx: 60% believe their Dx affects fertility/25% believe meds do: most cited MTX, steroids, TNFi, HCQ, NSAIDs. 92% heard of ART but unsure if safe or successful w/their Dx. Hx of infertility 29%/only 52% go w/ART https://t.co/lmaM773gP5
Olga Petryna DrPetryna ( View Tweet)
Did you know?
Teratogens may take the form of:
✳️Drugs & chemicals
✳️Physical agents
✳️Infections
✳️Metabolic conditions
#ACR22 @Rheumnow #MedTwitter https://t.co/GfHL28RYjm
sheila RHEUMarampa ( View Tweet)
Early TNFi use and cardiovascular events in AS
Abstract #0415 #ACR22 @RheumNow
📍17.6k patients, 91% male, 80% white
📍TNFi initiators were younger with lower prev. of HTN and DM
📍TNFi was associated with higher risk of incident CVD, CVA, and MACE https://t.co/7bCkfk7EYY
Catherine Sims, MD DrCassySims ( View Tweet)
I questioned HCQ dose reducing in my recent newsletter & podcast; more evidence!
Receiving less HCQ = more damage and more CVD
Observational, not clearly causal, but should make you wonder...
Are we sure we should be shooting for <5mg/kg/day?
#ACR22 @RheumNow #0982 https://t.co/SuAwSumgu1
Mike Putman EBRheum ( View Tweet)
In non-renal SLE, BEL associated w/ a lower risk of severe infection and hospitalizations due to severe infection compared to MTX, AZA, MMF. Abs 0349 #ACR22 @RheumNow https://t.co/0EBpCMPOqF https://t.co/vdxKVJSaZA
Dr. Rachel Tate uptoTate ( View Tweet)
#ACR22 Abstr#0783. Rituximab impacts on humoral immunity. Our study on 400 RMD pts showed:
Breakthrough infection 30% mostly mild; Severe 4%; 1 death
Poor outcomes predicted by comorbidities & low IgG
Risk reduced by 50% with each vac dose
OK for RTX if vaccinated @RheumNow https://t.co/xyJsukm1Rh
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Broder et al. HCQ alone vs steroid alone as maintenance in ESKD due to SLE. HCQ less cardiac events, less infection. @RheumNow #ACR22 Abstr#0539 https://t.co/mb3Eof2Uiv https://t.co/3i3ZTY25ru
Richard Conway RichardPAConway ( View Tweet)
How can we differentiate statin-assoc autoimmune necrotizing myopathy from toxic statin #myopathy?🔎
Remember this important slide👇
#ACR22 @Rheumnow #acrreview https://t.co/hKMJuGDJWt
sheila RHEUMarampa ( View Tweet)
Statin therapy may exacerbate underlying neuromuscular disorders.
‼️REMEMBER☝️The only ABSOLUTE contraindication to statins are pts who are HMGCR+
#ACR22 @RheumNow #acrreview https://t.co/A3XGHlrm0X
sheila RHEUMarampa ( View Tweet)
