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A Big Leap in Modulating Rheumatoid Disease
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.
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#EULAR2022 OP0071
Association between long-term exposure to air pollution (fine particulate matter) and immune-mediated disease in Italy
⭐️⬆️ risk of autoimmune disease, esp RA as well as CTD, IBD
⭐️Every 10 ug/m3 increase in PM, associated with incremental 7% risk
@RheumNow https://t.co/x57CXUHSHb
Eric Dein ericdeinmd ( View Tweet)
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
Aurelie Najm AurelieRheumo ( View Tweet)
🚨 Depression = major comorbidity!
DANBIO register 10000+ patients:
❗️10% prescription antidepressants💊
❗️Cumulative mortality ⬆️ w/ OR>6
❗️Particularly in age group <55
#OP0067 #EULAR2022 @RheumNow https://t.co/le8VWBFjPK
Aurelie Najm AurelieRheumo ( View Tweet)
Have always been fascinated by the idea that some b/tsDMARDs might have effects on pain and fatigue beyond inflammation control.
Baricitinib data in RA before, & now this from guselkumab. Substantial effect on pain beyond SJC/CRP attributable?
POS1030 #EULAR2022 #IL23 @RheumNow https://t.co/fxqIGnlkwU
David Liew drdavidliew ( View Tweet)
#EULAR OP0072: SMILE: Self-Management Individualised Learning Environment for RA
😀5 modules, with 3-4 more planned in 2022
😀Learning objectives
😀Plan to target resources to questionnaire
@RheumNow
Eric Dein ericdeinmd ( View Tweet)
More from the VITAL study Dr Costenbader @karen_kc123 et al. 5 year supplementation followed 2 year follow up. Vit D 2000iu ⬇️incident autoimmune disease 21%. RA, PMR, psoriasis trend towards reduction. No effect omega-3 @RheumNow #EULAR2022 OP0038 https://t.co/kbKqDhtN9z https://t.co/HcFXbweEPm
Links:
Richard Conway RichardPAConway ( View Tweet)
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
David Liew drdavidliew ( View Tweet)
↘️Education level🟰↗️risk of clinical RA in at risk patients. HR=1.8 although partially explained by ↗️ MRI inflammation at Dx.
Adjusted on smoking status, age and BMI.
Shall we follow this group of patients more closely?
OP0035 #EULAR2022 @RheumNow https://t.co/8EJZpaxn3k
Aurelie Najm AurelieRheumo ( View Tweet)
Retrospective nation-wide italian study:
Long term exposure to :
🌫 PM10 ⬆️ risk of RA aOR 1.4 but not other AI diseases
🚗PM2.5 ⬆️ risk of RA aOR 1.6 CTDs aOR 1.1 IBDs aOR 1.2
OP0071 #EULAR2022 @Rheumnow https://t.co/HOOEnh7KWW
Aurelie Najm AurelieRheumo ( View Tweet)
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
TheDaoIndex KDAO2011 ( View Tweet)
Adami et al on risk of RMDs with air pollution. Mainly RA - OR 1.4 for PM10, 1.6 for PM2.5 @RheumNow #EULAR2022 OP0071 https://t.co/zDr2jMsIWv https://t.co/f0Y2rQxWRD
Links:
Richard Conway RichardPAConway ( View Tweet)
#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
Eric Dein ericdeinmd ( View Tweet)
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
Links:
Richard Conway RichardPAConway ( View Tweet)
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
Links:
Richard Conway RichardPAConway ( View Tweet)
Early RA - does the biologic matter?
NORD-STAR: largely seropos, high CRP early RA
Perhaps unsurprising abatacept shone vs TNFi or TCZ
One of the few pt subgroups with plausible rationale & some data for comparative advantage. Shame it’s less & less common?
#EULAR2022 @RheumNow https://t.co/CrOILKVpIp
David Liew drdavidliew ( View Tweet)
#ClinicalPearl Update on @eular #rheumatoid #arthritis guidelines. Reassuringly not much of an update. Very reasonable discussion of #JAKi safety. @RheumNow Day 1 of #EULAR202 T2T, shared decision making, limit #glucocorticoids to shortest time. Change MOA or not, after failure.
Janet Pope Janetbirdope ( View Tweet)
The amazing @SuAnnYeoh1 oral presentation showing terminally differentiated T effector memory re-expressing CD45RA are associated persistent disease activity in TNF non-responders (but not other bDMARDs) ?role in driving disease @RheumNow #EULAR2022 OP0011 https://t.co/OFradjuGvo https://t.co/flpFmcvixO
Links:
Richard Conway RichardPAConway ( View Tweet)
178,000 cells from knee synovium studied to eval diff in RA vs PsA transcriptomes. With RA:
👉synov Tcells ⬆️TGFB1 express'n
👉⬆️FAP+ THY1+ synovial fibroblasts
👉receptor ligand network➡️synovial T cell & macrophage synergy
👉IL-1b & TGFb synergy #EULAR2022 OP0067 @rheumnow https://t.co/0uaFyqZqBg
TheDaoIndex KDAO2011 ( View Tweet)
#Plenary OP0066. Consider Whipple Dz in pts inflammatory rheum dz Screen with PCR saliva/stool samples, confirm with duodenal bx or PCR on joint fluid. pts on doxycycline and HCQ can lead to rapid remission. @rheumnow https://t.co/VcGp8pr3dT
TheDaoIndex KDAO2011 ( View Tweet)
