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The Long View of Diagnostic Delay in Axial Spondyloarthritis
Axial spondyloarthritis (axSpA) remains a diagnostic challenge, particularly in its early stages before structural sacroiliitis is visible on imaging.
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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)
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)
#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)
Excited (and a little nervous!) to be presenting on a topic I’m very passionate about- social determinants of health & shared decision making, alongside some fantastic speakers & chairs.
Join us in room W184D, 10:00-11:30
Looking forward to a lively discussion!
#ACR25 @RheumNow https://t.co/FsDDrjisR3
Mrinalini Dey DrMiniDey ( View Tweet)
SLGT-2 and GLP-1 in RA: More than Weight Loss https://t.co/SRKMHNlHZo
Future of rheumatology is bright , Shreya Sakthivel discussed her work on TriNetX database , looking specifically for effect of SLGT-2. GLP-1 on RA flare incidence.
@RheumKay
@RheumNow
#acr25
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
In a retrospective study of TAK patients, ~about 1/3 developed new lesions on imaging over time
Most lesions:
- stenotic
- L carotid
- Abdominal aorta
- SMA
50% of the 1/3 = 2 or more lesions
Serial imaging is crucial!
@RheumNow #ACR25 Abst 1631
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Delay in PsA diagnosis
Meta Analysis of 32000+ pts
Median diagnostic delay 2.5 years
Median delay in referral 1 year
Increase odds of Rx damage from 50%
Geographic variation
We need to do better
#ACR25 @RheumNow #ABSTRACT1713 https://t.co/CWwqosa5NT
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
A largely understudied area:
Impact of peri-menopause in PsA
Toronto Cohort 473pts, HRT 1.5%
Peri menopause =
increase DAPSA, TJC, SJC, FACIT-fatigue, HAQ
compared to pre- and post-menopause
No association w/ BMI, but with fatigue
Less impact when education level increases https://t.co/bSuGxZCbGn
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Functional MRI studies have been out there for a while, but mechanisms and significance underlying fMRI findings are unclear
fMRI study in 38 active PsA pts w/ significant fatigue
Altered functional connectivity between posterior insula to cerebellum & superior frontal gyrus https://t.co/3s9CJUg2uN
Aurelie Najm AurelieRheumo ( View Tweet)
How many patients do you need to treat to prevent one RA conversion in at-risk individuals?
APPIPRA and ALTO Interception studies, long term data
Number Necessary to Treat to prevent 1 RA conversion across time:
1yr = 4
2yrs = 7
3, 4, 5 yrs = 9
6 yrs = 11
#ACR25 #ABSTRACT1678 https://t.co/GBzUJG8jVk
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
So who with inflamm arthralgias might benefit from abatacept, in terms of delaying RA onset?
ALTO study (APIPPRA continuation)
1y abatacept then follow
If autoAb x5 (RF, ACPA IgG, IgA, anti-CarP, AAPA): sustained delay of RA
If not: benefit only on Rx
#ACR25 ABST1678 @RheumNow https://t.co/3Pc5ZLzVf6
Links:
David Liew drdavidliew ( View Tweet)
#ACR25 Abstr#1401 Sjogren’s #SjD is definitely not a benign disease! Real world study using US database showed high disease burden within 12 mths of diagnosis (i.e. healthcare resource use). GC use was high (~50%). Better therapy is needed to improve outcomes @RheumNow https://t.co/MI3vQ5LByr
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
TNFi induction first year in RA leads to:
- less D2T RA at 5y
- more sustained remission from 10y onward
- less DMARD utilization
- less healthcare utilization
in these real-world matched cohorts
given biosimilar prices, this might be worth considering
#ACR25 ABST1677 @RheumNow https://t.co/uL9nHtLkXZ
Links:
David Liew drdavidliew ( View Tweet)
Early TNFi treatment leads to
-Less D2T at 5 yrs
-More sustained remission at 10yrs
-Less bDMARD escalation at 5yrs
-More DMARD free remission at 5yrs and 10 yrs
-20% reduction annual healths costs
-11 mo delay in ttmt escalation
Safety data were not presented
#ACR25 https://t.co/jPMGUGPtqP
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
SELECT-COMPARE RA UPA vs. ADA
What do we learn from 7 years data? Not much
Patients who did well on the first drug, keep doing well
Patients who required switching for primary failure don't do as well, w/ 26% pts reaching DAS remission in UPA + MTX vs. 16% in ADA + MTX gp
No https://t.co/JLUTRZuZOm
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
In case you missed it in @ACR_Journals: HCQ for 1y does not prevent RA development in people with CCP3 >2x ULN, either:
- during 1y of treatment
- in 2y follow-up
https://t.co/gtzNiSmutb
but StopRA will give us plenty of insights - data is never wasted
#ACR25 ABST1674 @RheumNow https://t.co/DDZib5VGtX
Links:
David Liew drdavidliew ( View Tweet)
Start strong, stay strong.
With early anti-TNF induction (vs csDMARD T2T)
- At 5 yrs: D2T RA in <1% vs 7% (OR 0.11, p=0.03)
Drug-free remission 13% vs 6% (p=0.049)
- At 10 yrs: more sustained remission (62% vs 45%) & fewer multi-MoA failures.
@RheumNow #ACR25 Abstract #1677
Jiha Lee JihaRheum ( View Tweet)
Implantable vagal stimulator led to benefit in TNF-inadequate responder RA in this sham-controlled double-blind RCT (RESET-RA study)
- 82% off b/tsDMARDs at 12mo
- also with benefit to control group after crossover at 3mo to an active device
#ACR25 1675 @RheumNow https://t.co/yYwWCKm6HF
David Liew drdavidliew ( View Tweet)
This study evaluated effectiveness of SEC in PsA prevention of a subgroup of pts from SELENA: PsO pts w/o PsA & nail dse (n=292)
At 5 yrs:
🎯98.3% didn't develop PsA (yEAIR 0.49)
🎯 Sustained PASI, PGA 0/1
💡Longterm SEC effective for PsA prevention?
#ACR25 @RheumNow Abs1463 https://t.co/t7P1Oerbrw
sheila RHEUMarampa ( View Tweet)
