It’s good to be back into full, big meeting mode.
Highlights included a EULAR Recommendation Session, where updated guidelines were presented for the management of a) ANCA-associated Vasculitis, b) ASAS/EULAR recommendations for axSpA and c) RA. Here are a few of my favorites from Day 1.
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Intervention in individuals predisposed to develop rheumatoid arthritis (RA), with a holy grail of prevention of RA, has long been a hot topic. It is well known that seropositivity for rheumatoid factor and antibodies to cyclic citrullinated peptides (ACPA) can precede RA disease by many years. Many, but by no means all, patients also seem to go through a pre-RA arthalgia phase of varying duration characterised by the presence of increasing joint pain without frank arthritis.
Richard Conway
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Perez-Garcia et al. MTX effect on semen parameters. I still frequently get queries about this. 48 participants here. No significant effect! @RheumNow #EULAR2022 OP0131 https://t.co/33NG6isehm https://t.co/g7Xn33i96u
David Liew
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Patient with 12 weeks inflamm-sounding arthralgias and functional impairment, high titre RF/CCP, osteitis on MRI, no clinical synovitis on exam.
Do you suggest to patient to treat with methotrexate?
#EULAR2022 @RheumNow
Aurelie Najm
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🚨 Study on MTX and male fertility
Analysis of semen parameters in
🙋🏼♂️HC
🙋🏼♂️RA, PsA and PsO MTX naive
🙋🏼♂️Post MTX
Reassuring data as NO significant effect of MTX was observed on several semen parameters.
#EULAR2022 @RheumNow
OP0131 https://t.co/Fq32lzAMAx
Dr. Antoni Chan
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Hamroun S et al for the GR2 Cohort showed that age HR 1.22 and use of NSAIDs HR 3.01 in the pre-conception period was associated with a longer time to conception in women with SpA. Research is needed on continuous NSAID use in the preconception period #EULAR2022 @RheumNow OP0153 https://t.co/hl6jUlK5PN
Aurelie Najm
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MIRACLE study: High or Low dose MTX w/ ADA in eRA?
✨ LOWd (6-8mg/w) 38.4% non-inferior to HIGHd (>10mg/w) 44.8%
✨But safety profile looks better 9.1% vs 22.1% 👀
Are you already looking for minimal dose of MTX in patients treated w/ biologics?
#OP0062 @Rheumnow #EULAR2022 https://t.co/dq0EIKSnOe
Aurelie Najm
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NORD-STAR substudy of coagulation and fibrinolytic parameters:
〽️Impairement in eRA
⚡️Biologic parameters restored by ttmt.
Effect seemed ▶️ with Biologic vs. MTX + GCs
❕No adjustment on disease activity #OP0059 #EULAR2022 @RheumNow https://t.co/CJHldOimBn
Janet Pope
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Cdn cohort of #PsA and CV events - u risk factors were associated with MACE and NSAIDS ⬆️ risk and TNFi ⬇️risk and poor HAQ⬆️ risk. #OP0030 @RheumNow @eular_org Too small events, lipids often absent and spanning 30+ yrs.
David Liew
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Once we add adalimumab in MTX-IR RA, can we dial down MTX & still keep control?
New data - now in East Asian pts (with already low MTX) says often yes, without ⬆️ADAb.
Obviously RA control 1st/2nd/3rd, but prob doesn’t have to be MTX 20 forever in everyone #EULAR2022 @RheumNow https://t.co/aZ0bsgY7dC
Pre-clinical RA TREAT EARLIER Trial: #Plenary OP0070
RDBPCT eval temporary MTX vs PCB in 136 pts with arthralgias >2 weeks at risk for RA (MRI hand/forefoot w/subclinical inflammation) followed for 2 yrs; 1/3 +ACPA. Rx 1 yr can delay but won’t prevent RA. #EULAR2022 @rheumnow https://t.co/v1GWOBFstz
Eric Dein
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#EULAR2022 TREAT-EARLIER OP0700
Arthralgia + subclinical inflammation in MRI without RA, treated with MTX + depo steroid injection
▶️In High risk patients, delayed development of synovitis, but does not prevent in long-term
▶️Reduction in disease burden on MTX Rx
@RheumNow https://t.co/SKlqMQQTui
Richard Conway
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MIRACLE (love it!) study. High (max tolerated up to 25mg) vs low dose (6-8mg) MTX in combo with ADA in MTX-IR. Low dose non-inferior with better safety. Japanese population so may not be generalisable. @RheumNow #EULAR2022 OP0062 https://t.co/l3CfzzM7mi https://t.co/lkjuoqLY56
Richard Conway
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Krijbolder et al on MTX to prevent RA in clinically suspect arthralgia. No effect on arthritis free survival (80 vs 82%). Some delay in RA onset in high-risk group. But there was a sustained improvement in symptoms in MTX group @RheumNow #EULAR2022 OP0070 https://t.co/0CPIP51yQd https://t.co/kWNmw1YzrH
Richard Conway
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NORD-STAR substudy looking at anticoagulant effects. Important as RA assoc. ⬆️DVT/PE. DMARDs improve haemostatic imbalance, with bDMARDs stronger effect than csDMARD (may relate to better disease control with this) @RheumNow #EULAR2022 OP0059 https://t.co/TKwAZMOZjY https://t.co/IazrfD7z7k
Aurelie Najm
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NORD-STAR TRIAL drug does better in ttmt naive eRA? 48wks
CDAI remission ▶️ w/ ABA and CERTO PEG vs. MTX+ GCs while TCZ not stat ▶️.
Is the difference clinically sufficient to recommend these in first intention over MTX ? not convinced 🧐
OP0058 #EULAR22
@rheumnow
Richard Conway
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Damien et al on Whipple's Disease presenting as RMD. 73 cases (wow!) Treat Whipples, 93% remission, 94% off DMARD @RheumNow #EULAR2022 OP0066 https://t.co/XQnQq4RNcq
10 year study showed NSAIDs associated with slowing radiographic progression in axSpA patients. mSASSS progression numerically lower in COX2i pts compared to non-selective NSAIDs.
@RheumNow #EULAR2022 #ABSTOP0021 https://t.co/dfz3rseikl
Combination tx of NSAIDs and TNFi (celecoxib and golimumab) did not show significant superiority compared to TNFi alone in slowing radiographic progression for treatment of radiographic axSpA. There was a numerical reduction however.
#EULAR2022 @RheumNow #ABSTOP0018 https://t.co/gUZAwd92dK


