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Cognitive Impairment in Patients with Rheumatoid Arthritis
Evidence suggests that RA patients are at increased risk for cognitive impairment. This is likely mediated by certain factors, including chronic inflammation and accelerated atherosclerosis. In the clinical setting, it is important to identify RA patients at increased risk for cognitive impairment.
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Monitoring Infliximab Drug Levels Improves Efficacy
Should we start considering therapeutic drug monitoring when prescribing TNFi for treatment of our rheumatologic conditions?
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Abst 1515
Williams & colleagues studied role of CD4+ and CD8+ PD-1+ T cells in patients with early RA
- CD4+ and CD8+ T PD-1+ T cells were dominant cell types in synovial tissue
- 6 months after treatment, gene expression of CD4+ PD-1+ T cells decreased
#ACR21 @RheumNow https://t.co/TWLym8oHuK
Akhil Sood MD AkhilSoodMD ( View Tweet)
Put those two RF together (essentially nailing down RA pts at risk of cancer):
age >65 or ever smoked, all tofa vs TNFi: HR 1.55 (1.05-2.30)
age >65 or ever smoked, tofa 5 bid vs TNFi: HR 1.44 (0.93-2.24)
neither RF, all tofa vs TNFi: HR 1.16 (0.53-2.55)
#ACR21 @RheumNow https://t.co/Uvr4wBhFVF
David Liew drdavidliew ( View Tweet)
#ACR21 Ab#1941: ORAL Surveillance VTE risk
▶️Tofa 10 BID risk > 5 BID > TNFi for VTE, DVT, PE
▶️Age, male, obesity, HTN, h/o VTE, oral contraception/HRT, steroids, antidepressants were risk factors
@RheumNow
https://t.co/JOKNyYVZfX https://t.co/mTkgkwPIT6
Links:
Eric Dein ericdeinmd ( View Tweet)
Hospitalisation for heart failure ⬆️ in inflammatory diseases. RA>PsA>AS>PsO . HRs 1.1-1.6 compared to general population. Abstr#1925 #ACR21 @RheumNow https://t.co/kKlGQM5Tcg
Richard Conway RichardPAConway ( View Tweet)
#ACR21 Ab#1939: Tofa CV Outcome (STAR-RA)
▶️Pooled data does not show ⬆️ risk of CVD
▶️Trend in pts w prior CVD -HR 1.27 (0.95-1.7), cannot r/o CVD risk in pts w risk factors
Less clear than oral surveillance data, but concerns in those w risks
https://t.co/JOKNyYVZfX @Rheumnow https://t.co/GGYJfxcqhc
Links:
Eric Dein ericdeinmd ( View Tweet)
Why is there more CHF in #RheumatoidArthritis ? Also dose response between highest inflammation RA the PsA then axSpA then PsO. ?Cytokine profile varying with disease and maybe CRP. Who knows. Abst#1925 #ACR21 @RheumNow https://t.co/JIH3qwkLpx
Janet Pope Janetbirdope ( View Tweet)
Should we be measuring drug levels in pts taking infliximab?
⭐️Drug monitoring vs. standard dosing showed 73% sustained control vs. 55% (RA, PsA, SpA, UC, Crohn's, PsO)
#ACR21
Abs#1946
#ACRBest @RheumNow
https://t.co/sWMen50ljP https://t.co/F4Wpqis3id
Links:
Robert B Chao, MD doctorRBC ( View Tweet)
Anti-MAA Ab is not ‘baa’ humbug. In prevalent #RheumatoidArthritis, + MAA Ab was predictive of developing #RA #ILD. ? Novel biomarker. Needs validation but nice convincing data @RheumNow #ACR21 #ACRBest abst#1916 https://t.co/wuTPzSIsey
Janet Pope Janetbirdope ( View Tweet)
Another study linking long term GC and CV risk in RA!
Medicare data >65yo 130000+ pts
1-year incidence CV ⬆️ as follows:
📍Dose ≤5mg 1.4%
📍Dose 5-10mg 1.7%
📍Dose >10mg 1.9%
Not replicated in younger pts (Optum data)
#ACR21 #Abst1915 @RheumNow https://t.co/DLXdfvfiBW
Aurelie Najm AurelieRheumo ( View Tweet)
Abst 1916
England & colleagues determined if anti-MAA Ab = predictor of incident RA-ILD
- Anti-MAA Ab significantly associated w/ incident RA-ILD
- Strongly associated w/ higher concentrations anti-MAA
- Antibody associations = antigen/isotype dependent
#ACR21 @RheumNow https://t.co/z1RspmxBvc https://t.co/hvUm4O6RmX
Akhil Sood MD AkhilSoodMD ( View Tweet)
DAS-28 independently associated survival in RA-ILD. As I keep saying, treating the rheumatoid disease properly is the current best strategy for treating RA-ILD. Abstr#1918 #ACR21 @RheumNow #ACRBest https://t.co/FpUK6upyOi
Richard Conway RichardPAConway ( View Tweet)
Is there a relationship between the weather and RA disease activity?⛈️
#ACR21 Abs#1912
🌡️Temperature & humidity significantly affect pain, TJC & SJC
🌦️PGA was mostly influenced by humidity
Should we take the weather into account when assessing patients?
@RheumNow https://t.co/e3PewZWkLR
Mrinalini Dey DrMiniDey ( View Tweet)
RA ILD survival. The ‘smoking’ gun! RA ILD in VA pts mostly menand smokers - data showed disease activity of #RheumatoidArthritis & ⬆️HAQ both reduced survival independently #ACRBest #ACR21 abst#1918 @RheumNow https://t.co/8GD7rHV07t
Janet Pope Janetbirdope ( View Tweet)
Preventive Window of Opportunity in RA? Dr. Aurelie Najm ( @AurelieRheumo) discusses abstract #0455 presented at the #ACR21 annual meeting.
https://t.co/bCN1k5hhUc https://t.co/gpEHk0XIRc
Links:
Dr. John Cush RheumNow ( View Tweet)
Can we predict who will develop #RA-ILD?
Perhaps anti-MAA is the answer!
#ACR21 Abs#1916
👉🏼⬆️anti-MAA antibody assoc with incident ILD risk
👉🏼Associations are antigen &
isotype dependent
👉🏼Antibody measurement may be useful to risk stratify for RA-ILD
@RheumNow https://t.co/nC0OkuWtGU
Mrinalini Dey DrMiniDey ( View Tweet)
Once again #steroids are bad in #RheumatoidArthritis from 2 large admin databases in age >65 in Medicare data, not in younger pts -Optum data. Clear dose response #ACR21 #ACRBest @RheumNow abst#1915 https://t.co/XL93jty7C9
Janet Pope Janetbirdope ( View Tweet)
HCQ adherence (>90%) associated with 52% reduced cardiovascular mortality in RA and SLE. Seen for MI, stroke, not VTE. Abstr#1909 #ACR21 @RheumNow https://t.co/5UncmqZVNp
Richard Conway RichardPAConway ( View Tweet)
Claims data looked at 21,114 #RA & #SLE pts - 4.3% had CV Death. The risk of CVD was worse w/ HCQ nonadherence (HR 1.08; 0.91-1.31) and better w/ HCQ adherence (HR 0.51;0.42-.66) HCQ nonadherence shows higher CV mortality #ACR21 Abst# 1909 https://t.co/di1mBliMN6
Dr. John Cush RheumNow ( View Tweet)
