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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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Day 2 Report from ACR21
This report highlights the VITAL trial; the ORAL Surveillance Study; and the Microbiome study of monozygotic psoriasis patients.
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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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New Hope for NonAlcoholic Fatty Liver Disease
The current issue of the NEJM has two articles on nonalcoholic fatty liver disease (NAFLD also called NASH - nonalcoholic steatohepatitis), one dealing with the prognoses, outcomes and mortality of NAFLD and another prospective and promising interventional trial in NASH patients.
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ICYMI: Filgotinib (Jyseleca) was approved by European Commission approved for EU use in adults with moderately to severely active Ulcerative colitis (not responding to conventional therapy or a biologic). Rec based on Phase 2b/3 SELECTION trial. https://t.co/9VbCJse6Tr
Links:
Dr. John Cush RheumNow ( View Tweet)
#ACR21 Thieves! TM11. Belly pain in patient with RA nodules:
⭐️ A: rheumatoid nodulosis of pancreas and duodenum.
Great case!
@Rheumnow https://t.co/PuO4tka3FJ
Eric Dein ericdeinmd ( View Tweet)
#ACR21 #Abstr1492 Could gut microbiome contribute to Anti-Ro+/autoimmunity in #lupus? Analyses of 125 stool samples from mother of children with neonatal lupus and/or heart block revealed its potential role in genetic-environment interaction @RheumNow https://t.co/FnJtZJSCRj https://t.co/ttRdP9NIrG
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Loved this session on: Preclinical Rheumatoid Arthritis- Can we stop RA? As a patient advocate living with RA, my providers have always ran tests on my microbiome. The findings have correlated with my disease flares, and was a big trigger overall. #ACR21 @ACRheum Thank you! https://t.co/6hm6hr85JS
Effie Koliopoulos RisingAboveRa ( View Tweet)
Love-hate relationship with #methotrexate. Side effects are common ex nausea/GI in 1/3 and alopecia in women. ?if you ask do you get more AES. Tough to treat especially SEs are early. ?Coach pt to help w persistence abst1444# @RheumNow #ACR21 https://t.co/NDQDVz8lk2
Janet Pope Janetbirdope ( View Tweet)
Low incidence of GI-related serious AE in pooled 1 year data from VOY1&2 and DISC1&2 trials of Guselkumab for PsA/PsO treatment
⭐️no new onset IBD or exacerbation of IBD
⭐️no uveitis, infections, TB
Abs#1342
#ACR21
@RheumNow
https://t.co/x3OmLgInV0
Robert B Chao, MD doctorRBC ( View Tweet)
In one institution, 25% of Crohn's patients had abnormal SI findings on MRE/MRI. Majority without back pain, were female with intestinal complications.
Abs#1306
#ACR21 @RheumNow
https://t.co/z8Yvc98s67
Robert B Chao, MD doctorRBC ( View Tweet)
⭐️Imaging of the SIJ in psoriatic axSpA is similar to axSpA associated with iritis or colitis!
Abst#0902 (https://t.co/f55Vfi1LSS)
#ACR21 @RheumNow https://t.co/UCXrwPiyhh
Meral K. El Ramahi, MD MeralElRamahiMD ( 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)
Interesting study with Dr. Julia Manasson on gut and skin microbiome in monozygotic twins discordant for psoriatic disease. (red = Psoriatic). Gut ruminococcus bromii virtually absent in psoriatic pts. Eager to see further studies!
#ACR21 Abst#0944 @RheumNow https://t.co/zrZPBAjh5p
Pedro Castillo _Castillo_Pedro ( View Tweet)
Monozygotic twin study in PsO patients showed a gut and skin microbiome difference compared to their "normal" twin
⭐️Ruminococcus decreased/absent in gut flora of PsO
⭐️microbiome differences even in healthy PsO skin
Abs#944
#ACR21
@RheumNow
#ACRBest
https://t.co/VlfVh5Kt3Y https://t.co/W0eSqi77lx
Robert B Chao, MD doctorRBC ( View Tweet)
MTX and liver: FibroScan scores compatible with liver fibrosis are significantly correlated w/ several parameters
-BMI
-waist circumference
-male gender
-age
but NOT MTX cumulative dose in a cohort of 500+ patients.
#Abst0786 @RheumNow #ACR21 https://t.co/RkSpVqN4qF https://t.co/9TENaR0WZ3
Aurelie Najm AurelieRheumo ( View Tweet)
AxSpA pts share a gut microbiome signature with Crohn's disease and anterior uveitis pts
⬇️Blautia
⬆️Veillonella and Lactobacillus
⭐️SpA pts uniquely enriched in Collinsella
Abs#0062 #ACR21 @RheumNow #ACRBest
https://t.co/sdlHxNbhr8 https://t.co/r8eG9c9vwa
Robert B Chao, MD doctorRBC ( View Tweet)
Is it time to consider targeting gut microbiome for treatment of AS?
Large study identified:
⭐️Ruminococcus torques associated with FUT2 gene influences risk of developing AS
Abs#0068
https://t.co/E1hL18KZbQ
#ACR21
#ACRBest
@RheumNow
Robert B Chao, MD doctorRBC ( View Tweet)
"I don't want rheumatologist only use BLMB and nephrologist using only VCS."
- Dr. M Petri on how we should work together with nephrologists on managing lupus nephritis.
(She did give a final dig & added "BLMB can be used with any GFR")
#ACR21 #GreatDebate @rheumnow
TheDaoIndex KDAO2011 ( View Tweet)
Nature has published a full read over of "Homing in on an oral link to inflammatory disease" how the microbiome may be a pathogenic link to diseases like RA. https://t.co/wwB9Eg9nsH
Dr. John Cush RheumNow ( View Tweet)
