Since reduced proteinuria at one year is the best predictor of improved long-term renal outcomes in lupus nephritis, is there rationale to set a tighter treatment target?

The prioritisation of pain, and its evaluation, is important in those with psoriatic arthritis, when the already incredibly heterogenous nature of the condition can complicate assessment. Whilst we lean towards all pain in PsA being nociceptive in nature, evidence suggests that a significant proportion of patients with PsA also have nociplastic pain, characterised by fibromyalgia.

In the wake of the 2016 AAOS Guidelines, rheumatologists dutifully reduced the dose HCQ take by patients with SLE to some number south of 5mg/kg per day. Though I believe the ophthalmologists correctly interpreted a 2014 paper in JAMA Ophthalmology that quoted a much-higher rate of HCQ associated retinopathy than had previously been appreciated, they and subsequent guidelines published in the field of rheumatology lacked a critical piece of information: what actually happens when you do this?

On Thursday, November 21, 2022, Dr. Arthur Kavanaugh and Dr. Jack Cush reviewed the best and most interesting data and sessions presented at ACR22 in Philadelphia, PA. These are the research abstracts discussed:

The ACR Great Debate was on "To treat or not to treat in pre-RA?". What is the clinician to do?

Despite the fact that polymyalgia rheumatica is the most prevalent inflammatory rheumatic disease in those over 65 years of age, progress in its diagnosis, monitoring and management have failed to garner momentum in decades past.

However, ACR22 has fostered significant promise for its future.

It was great to be back at an ACR annual meeting, this one in Philadelphia - Philly was great. A walking town, rich in culture, history and good places to meet and mingle. 

I loved the city, but not the convention center (not easy to navigate). 

Familial Mediterranean fever (FMF) is an inherited autoinflammatory disease characterized by recurrent attacks of fever and acute inflammation of the membranes lining the abdomen, joints and lungs. These attacks are often short-lasting, around 1-3 days.

Interstitial lung disease is common in RA, occurring in approximately 8% of RA patients. It is associated with a poor prognosis, and a median survival of 3 years. This important condition has often been neglected within the spectrum of RA research. That is changing, with excellent research initiatives presented at ACR22. I am going to highlight two select abstracts from Monday’s dedicated RA-ILD session.

For people living with psoriatic arthritis (PsA), the comfort of a good night's sleep may feel out of reach for many.

Inhibition of B-cell Activating Factor (BAFF) has revolutionised the treatment of patients with systemic lupus erythematosus. However, outcomes of therapies within the same class (i.e. BAFF-inhibitor) when evaluated in randomised controlled trials have been inconsistent.

The last day was jammed with important reports and research including the late breaking abstracts. 

Curcumin, the active constituent of turmeric extract, has increasingly been promoted as a potential rheumatoid arthritis therapy, but data presented at ACR22 suggests that even in ideal situations, it is unable to do any better than placebo in replacing conventional RA therapies.

One of the enduring legacies of ACR 2022 for me will be the emphasis on polymyalgia rheumatica (PMR). Despite being highly inflammatory and relatively common, a remarkable paucity of trials have been run in this space. Read on for a quick PMR-roundup from the meeting! 

Strategies to identify patients with suspected inflammatory back pain in the general population is critical for timely and proper diagnosis.