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The Decade Ahead: Predicting Long-Term Proteinuria Risk in SLE
The ACR Convergence 2025 in Chicago opens with engaging topics curated for the global rheumatologist. As a clinician, I always look forward to sessions that provide updates and practical key points that I can bring home and apply to my practice.
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Zavada et al. 52 patients. bDMARD therapy improves sexual function at 6 months in r-axSpA. Improvements in function, desire, satisfaction in those with baseline erectile dysfunction @RheumNow #ACR25 Abstr#2346 https://t.co/IUMGCFnXZh
Richard Conway RichardPAConway ( View Tweet)
Konsta et al. Adding NSAID to TNF inhibits spinal but not hip radiograpic progress. 262 patients, TNF+NSAID 100, TNF alone 162. New syndesmophytes 36% vs 58%. ΔmSASSS-score/year 0.1 vs 0.7. No effect on progression of hip radiographs. @RheumNow #ACR25 Abstr#2359 #ACRBest https://t.co/k9j2M2E3ze
Richard Conway RichardPAConway ( View Tweet)
Paging the pharmacist
Abstract 1973: Dedicated clinic pharmacist -> benefits
Tasks included:
🔹 74% PA support
🔹 55% patient education
🔹 40% medication management
~50% pts had clinically meaningful improvement
Providers report ↑ care quality & ↓ admin burden
@RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Hojiej et al. Prevalence and Impact of lifestyle factors in PsA. Lifestyle factors impacted disease activity. Cumulative effect of increasing number of factors @RheumNow #ACR25 Abstr#2309 https://t.co/oDGQyLBRDO
Richard Conway RichardPAConway ( View Tweet)
MAINRITSEG: RTX vs. AZA for maintenance in EGPA
RTX not superior in primary remission outcome
RTX favored in secondary outcome of remission with pred <4mg daily
Limitation: only ~50% pt with FFS 1+
@RheumNow #ACR25 Abst 1765 https://t.co/dh5ZWCT12T
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Girolami et al. VA study. Safety of DMARDs in RA following melanoma. 644 patients. 3 year all cause mortality. No significant difference, but graph sure looks like b/tsDMARDs are better. No melanoma specific mortality/recurrence data however. @RheumNow #ACR25 Abstr#2237 #ACRBest https://t.co/IN4LDkioT7
Richard Conway RichardPAConway ( View Tweet)
Is RA-ILD associated with/ higher risk of infection?
Retrospective US cohort study
151 RA-ILD
980 matched controls
79% higher risk of any and pulmonary infections in RA-ILD
Pathogen type: bacterial, viral and fungi
Some of these infections are preventable!
Take Home: https://t.co/fPmRjLL7Po
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
In DISCOVER-2, male PsA patients had greater radiographic progression than females despite similar baseline scores. Early joint response (W8 cDAPSA LDA) was linked to less progression more strongly in men. Highlights the sex differences in PsA outcomes. Abstract#2345 @RheumNow https://t.co/zIo59FYPVg
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Macedo et al. Increasing exercise improved QoL in axSpA. Mobility limitation and obesity worsened it. At least to some degree these effects appear independent. @RheumNow #ACR25 Abstr#2326 https://t.co/Ei4cKTNHyn
Richard Conway RichardPAConway ( View Tweet)
A prediction model for RA-ILD in RA pts: is it possible?
Not quite yet!
Veterans Affairs RA registry 2700+ pts
5% of prevalent ILD
Associated w/
-GDF-15
-Pentraxin 3
No prediction for Incident disease
Needs more work to understand implications for practice
@RheumNow #ACR25 https://t.co/CmW72nybcQ
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Does specific ANCA subtype inform infectious risk?
Retrospective review of 270 AAV patients revealed that about 1/3 pt developed severe infections... of these:
- 64.1% MPO+
- 35.9% PR3+
Most infx during year 1 of tx
No difference between CYC vs. RTX
@RheumNow #ACR25 abst 2510
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Gender differences in p/axSpA in Turkiye from ASAS-PerSpA:
Males - early onset IBP (<45yrs); sacroiliitis on CR, HLA-B27+ (vs. females)
Females - peripheral dse, enthesitis, Pso, dactylitis; ⬆️dse activity, FM (vs. males)
Individualize & optimize tx.
#ACR25 @RheumNow Abs2322 https://t.co/vcisNguJLB
sheila RHEUMarampa ( View Tweet)
Great debate on GCA ultrasound vs biopsy. Wolfgang Schmidt making the case for GCA US with the rise of its use in guidelines @RheumNow #ACR25 https://t.co/ORxzzG8xnF
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Simulation modeling by Patel et al helps generate probability of remission, relapse, and adverse events in newly dx AAV
Projected risk by model were similar to observed rates in RCTs
@RheumNow #ACR25 Abst 1764 https://t.co/xevkJ2Ih0M
Links:
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Rotation or Change in Biologic post TNFi failure in axSpA. Switching biologic class after TNFi failure improved outcomes in axial SpA. In a randomized trial of axSpA patients with inadequate response to a first TNFi, switching to an IL-17Ai was not superior to cycling to a second https://t.co/MEsokWeT8e
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
This cohort study from Ontario of 🚺w/axSpA
✳️GDM, antepartum hem, SMM (severe maternal morbidity) -⬆️ in axSpA
✳️Neonat complications-preterm birth
Factors assoc w/SMM- age, comorbidity, gestational age at delivery
Better strategies for maternal care
#ACR25 @RheumNow Abs2200 https://t.co/LrVzJLnvWe
Links:
sheila RHEUMarampa ( View Tweet)
HCQ weight-based dosing: out
HCQ whole blood monitoring: in
Whole blood levels more precisely balance risks of SLE flare (under-dosing) vs. toxicitiy (over-dosing)
Many pt on <5 mg/kg had supra-therapeutic blood levels with risk for toxicity
@RheumNow #ACR25 #ACRBest Abst 1722 https://t.co/qIbACxAW39
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Mimics of ANCA-associated vasculitis: How can we tell?
With increased disease awareness and more regular, accessible testing for anti-neutrophil cytoplasmic antibodies (ANCA), ANCA-associated vasculitis (AAV) has become an increasingly recognized clinical entity in rheumatologic https://t.co/LYRk0rHlzx
Dr. John Cush RheumNow ( View Tweet)
#1727
360k+ postmenopausal women w osteoporosis: >1/3 untreated patients were at v high fracture risk, yet few received recommended anabolic or antiresorptive therapy.
Even among treated women at very high risk, >50% were still on oral bisphosphonates
@RheumNow #ACR25 https://t.co/9S66tAU68P
Mrinalini Dey DrMiniDey ( View Tweet)
