All News
Pre-clinical RA: starting off the wrong foot
Patients with clinically suspect arthralgia can represent a challenge for clinicians, in a sense that there are not yet reliable markers to predict evolution to clinical RA nor enough evidence to support routine prescription of conventional synthetic DMARDS or biologic treatments in this setting.
Read Article
Abs0266 #acr21 @RheumNow study of impact of pandemic on pts w/SLE (67%), RA (19%), & pSS (8%): 63%reported a flare since the pandemic & 16% had COVID-19. 19% reported no changes to their care.76% reported a change in their mood& emotional health. Was your pts experience similar?
Olga Petryna DrPetryna ( View Tweet)
#ACR21 Abst#0284
My 56 yo ♀RA pt expressed concern for developing dementia last wk. This study helps recognize her RF beyond aging:
➡️ Large joint swelling (HR 2.2)
➡️ CVD (HR 2.4): stroke (HR 3.2) + chronic HF (HR 1.8)
➡️ DM (HR 1.6)
#ACRBest @Rheumnow
https://t.co/wsZnaLwSmD
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Provocative study in pre-RA. SC Abatacept in patients with pre-clinical RA can:
-improvement MRI inflammation
-⬇️evolution to clinical RA at 6 months
-No new safety signal
Yes, but we need longer term follow-up and an estimation of NNT.
#OP0505 @Rheumnow #ACR2021 https://t.co/2P1Yk3IyeR
Aurelie Najm AurelieRheumo ( View Tweet)
Do RA autoantibodies incr the risk of MACE?
In study of ~2000 pts, ⬆️ concentrations of RA-related autoantibodies assoc. w/ MACE and/or CVD-mortality.
Autoantibodies may therefore directly contribute to excess CVD risk in RA...
Abs#0269 #ACR21 @RheumNow
https://t.co/ju3YCRonJt https://t.co/UcOMsYxVMP
Mrinalini Dey DrMiniDey ( View Tweet)
Abs 0463 #ACR21 @RheumNow
Park & colleagues compared treatment persistence across abatacept, TNFi, and JAKi in dual seropositive RA patients using Medicare database
- Users of abatacept were more persistent to index time of 12 months and showed longer time to discontinuation https://t.co/0huE7zZjLq
Akhil Sood MD AkhilSoodMD ( View Tweet)
Pre clinical RA: don't miss the feet 🦶🏼! Among 577 patients
with clinically suspect arthralgia undergoing MRI:
-23% intermetatarsal bursitis > ACPA + 56% vs. 19%
-higher risk or RA HR 3.3.
Would we find the same results w/ US?
#OP0468 @RheumNow #ACR2021 https://t.co/VkzUu93qGq https://t.co/GGw7UgdPVR
Aurelie Najm AurelieRheumo ( View Tweet)
Accdg to this study by Dr. B VanDijk et al, intermetatarsal bursitis (IMB) was seen in 23% of clin suspect arthralgia(CSA) pts; predicted clinical arthritis in ACPA+; ⬆ frequent w/ synovitis & tenosynovitis
Addtl tool for early RA dx?
@RheumNow #ACR21 abs0468 #ACRBest https://t.co/bcUuy8bHLJ
sheila RHEUMarampa ( View Tweet)
#ACR21 Abst#0455 ARIAA Study: Abatacept for subclinical arthritis
⭐️ ACPA + arthralgia + MRI inflammation 🔥
⭐️ ⬇️ MRI inflam (primary) and ⬇️ progression to arthritis (secondary)
▶️ Many patients likely early RA, would still rec starting MTX 1st
https://t.co/4aREvqlpUI @Rheumnow https://t.co/vqRgsd75Il
Links:
Eric Dein ericdeinmd ( View Tweet)
#ACR21 Abst#0293:
Lung involvement in 67 sero+ RA pts assoc w/:
⭐︎ SSc-specific ab
➡️ RP155, Th/To, fibrillarin, NOR90 in ILD group
➡️ Ku, Pm/Scl100, CENP-A/B in non-ILD group
⭐︎ older age, ⚦ sex, heavy 🚬
⭐︎ ↑ WBC, CRP, RF
#ACRBest @Rheumnow
https://t.co/Yo4jRKqvfV https://t.co/l5gbKoZBkm
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
ARIAA study of abatacept in pre-RA. Abatacept ⬇️MRI inflammation and reduces progression to RA. Of course it does. Like all these studies, really not sure what this is telling us. Abstr#0455 #ACR21 @RheumNow https://t.co/yNVVZFBWDq
Richard Conway RichardPAConway ( View Tweet)
Prevention study using Abatacept in 100 patients with arthralgia is superior (61%) to placebo (31%) in improving subclinical inflammation in RA at-risk patients (ACPA+, MRI+, Arthralgia+) at 6 months. No new safety issue emerged @RheumNow #ACR21 Abst#0455 https://t.co/DoRItcHfBE
Dr. Antoni Chan synovialjoints ( View Tweet)
Can we stop RA developing? Not previously.
Double-blind RCT:
- arthralgias+ACPA+MRI changes
- but no clinical synovitis
- abatacept for 6m
didn't progress to arthritis: 92% v 65%
improvement in MRI: 61% v 31%
+ benefit to 18m not shown
"provocative"!
#ACR21 ABST0455 @RheumNow https://t.co/TGxCBhk4r9
David Liew drdavidliew ( View Tweet)
#ACR21 Abst#0155
⭐︎ Tenosynovitis on MRI hand/foot in ACPA(-) undifferentiated oligo-arthritis pts is predictive of RA
➡️NPV 93%, Se 85%
⭐︎ BM edema not prognostic of RA development
Do you already use MRI to help detect early RA?
@Rheumnow
https://t.co/mpageAYeT2
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
ARRIA Study: Abatacept vs PBO in pre-clincial RA (N98) pts x 6 mos. Showed ABA prevented arthritis (8 vs 35%), improved MRI inflamm (61 v 31%), fewer D/C (14 vs 43%) - all signif. Further FUV 12 mos off therapy still significant at 18mos #ACR21 Abstract 0455 https://t.co/ZxFUj6KfLT
Dr. John Cush RheumNow ( View Tweet)
#ClinicalPearl What lasts longer/⬆️retention in sero+ RA: Abatacept or TNFi or JAKi? #ACR21 abst#0463 @RheumNow Adjusting for confounding incl line of Rx / past bio Rx, #abatacept wins. But data not stratified for bio naive or exposed. Not sure if that would alter results https://t.co/1dEQncwPQF
Janet Pope Janetbirdope ( View Tweet)
What increases risk of RA-assoc #bronchiectasis, separate from #RA-ILD?
Results from @BrighamResearch find seropositivity (esp high +ve RF/CCP), older age, disease duration, & low BMI incr. risk of isolated bronchiectasis in RA.
#ACR21 Abs#0288 @RheumNow
https://t.co/jvvRucqTjL https://t.co/aFCfxrbUdV
Mrinalini Dey DrMiniDey ( View Tweet)
@BethIWallace et al. on fibromyalgianess and GC in #rheumatoidarthritis pts.
Accdg to their study, pts w/⬆ levels of fibromyalgianess at BL had higher odds of GC persistence on ffup.
Something to consider when evaluating need for GC adjustment.
@RheumNow #ACR21 abs0120 https://t.co/MTWEXGHJ2n
sheila RHEUMarampa ( View Tweet)
#ACR21 Abst#0290:
Ever wonder about other predictors of mortality in pts w/ RA-Lung Disease besides ILD (OR 2.3) or older age?
⭐︎ ↑ mortality associated w/ pleural effusions (OR 3.3)
AND, notably...
⭐︎MTX use was protective (OR 0.4)!!!
@RheumNow
https://t.co/KKRkQVY2pf https://t.co/JsU2Rqzi6R
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
This study looked into the prevalence of subclinical atherosclerosis in #rheumatoidarthritis pts w/n 5 yrs of dx using carotid US.
📌vs. controls, RA pts had ⬆ CPs, cIMT
❗Screen RA pts for CV risk early on in their diagnosis
@RheumNow #ACR21 abs0271 https://t.co/btU6IcM3xb
sheila RHEUMarampa ( View Tweet)
