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Methotrexate and hepatic fibrosis: we must be doing something right
Methotrexate may be a rheumatologist’s best friend, but a key part of counselling any patient about its use has always been the risk of hepatotoxicity.
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Can tender and swollen joint counts work in a telemedicine world?
In a world where telemedicine and virtual care are not going away, is there value in patients assessing their own tender and swollen joints?
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After failing a JAK inhibitor, can you still hit a JAK-pot?
Januse kinase (JAK) inhibitors are targeted synthetic disease modifying anti-rheumatic drugs (tsDMARDs) that have risen in popularity as earlier treatment options for rheumatoid arthritis.
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Does #baricitinib affect #fatigue in RA patients?
👉🏼Results from RA-BEAM and RA-BEACON
👉🏼4mg baricitinib significantly reduced fatigue, starting week 16, compared to placebo
👉🏼Effect independent of disease activity in active RA
Abs#1235 #ACR21 @RheumNow
https://t.co/0SKhUKJHd7 https://t.co/R76wc56u6I
Mrinalini Dey DrMiniDey ( View Tweet)
What predicts response to MTX in RA?
👉🏼DAS28-ESR
👉🏼RA duration
👉🏼Pt global assessment
👉🏼Swollen joint count
Abs#1227 #ACR21 @RheumNow
https://t.co/s942zvFiZ1
Mrinalini Dey DrMiniDey ( View Tweet)
Plenary Abs#1428 #ACR21
👉🏼Long-term #steroid use is common in RA incl in pts with high risk of #MACE
👉🏼30days of steroids ➡️ 15% increased odds of MACE
@RheumNow
https://t.co/fCM3m04ruS https://t.co/FWGmAatYu5
Mrinalini Dey DrMiniDey ( View Tweet)
26K Veterans data with RA #ACR21 plenary abst#1428
30 days on glucocorticoids - ⬆️15% odds of Major Adverse Cardiovascular events @RheumNow @BethIWallace https://t.co/BOram4o2rp
Bella Mehta bella_mehta ( View Tweet)
Role of GC on MACE in RA:
US database analysis 26000+pts
23% on GC >90d/6mo
Each 30days of GC dispensed ⏭15% increase in odds of MACE in the following 6month period!
Adjustment on several confounders but not disease activity.
#Abts1428 #ACR21 @RheumNow https://t.co/prdA7D5fLz https://t.co/F3wCcRAfuf
Aurelie Najm AurelieRheumo ( View Tweet)
Plenary Abs#1427 #ACR21
👉🏼#Statins assoc w/ reduced #CVD & all-cause mortality, outweighing
modest #T2DM risk increase in RA pts
👉🏼Reduction in all-cause mortality greater in RA than gen population
👉🏼Incr in T2DM risk is NOT greater in RA compared to gen population
@RheumNow https://t.co/WcF11B0C2s
Mrinalini Dey DrMiniDey ( View Tweet)
Statins in RA - plenary at #ACR21 UK Clinical
Practice Research Datalink 1989-2018 @RheumNow
Reduction in CVD risk, All cause mortality
INCREASE in Type 2 DM risk🧐 - need to make sure we look into it for RA patients!
Great work @UNMC_Rheum by Gulsen Ozen! https://t.co/YmTO0xcdjj
Bella Mehta bella_mehta ( View Tweet)
RA and CVD: take your statins!
Obs UK study
Statins ⬇️CVD HR=0.46
⬇️All cause death HR=0.68
w/ mild ⬆️ T2DM risk HR=1.33
(but not more than in general population)
⭐️NNT to prevent CVD 102
⭐️NNT to prevent death 46
⭐️NNH 127
#ACR21 #Abst1427 @RheumNow https://t.co/v6TinuklNv https://t.co/r0rD4jMmuh
Aurelie Najm AurelieRheumo ( View Tweet)
In a telemedicine world where you can't palpate joints virtually, how can we use pt self-joint counts well?
Patients & rheums might not always rate the same, but:
when RA pts say their joints are up or down,
rheum exam usually agrees👍
@earlyarthritis #ACR21 ABST1203 @RheumNow https://t.co/spUNTlMnDY
David Liew drdavidliew ( View Tweet)
#ACR21 Abst#1205- Discordance bw pt and MD global assessment in RA?
⭐️15% discordance (>30 mm difference in GA score)
⭐️⬆️ in LDA and mod disease, ⬇️ remission/high disease
⭐️♂️ sex, pain VAS, normal CRP, less TJC&SJC predictive
@Rheumnow https://t.co/N2qAaDiBE5
Links:
Eric Dein ericdeinmd ( View Tweet)
#ACR21 Abs#1210: Frequency of anterior atlanto-axial sublux in RA
⭐️Anterior atlanto-axial subluxation (aAAS) = 3+ mm, frequency = 25%
⭐️Radicular pain 20%, surgery 6%
▶️Longer disease duration, ⬆️ frequency of extra-articular manifestations
https://t.co/BfjCTlRJbt @Rheumnow https://t.co/xd9h5e9cDH
Links:
Eric Dein ericdeinmd ( View Tweet)
#clinicalpearls Cervical involvement in RA: is it underestimated? Cohort of 240pts: anterior atlantoaxial subluxation (aAAS) found in n=25 10.4 % patients, 1/3 with no neck pain! Joint restriction OR: 5.8 hx arthroplasty OR:3.6
#Abst1211 #ACR21 @RheumNow
https://t.co/KRkDP4ETMu https://t.co/soKTMPiMwy
Aurelie Najm AurelieRheumo ( View Tweet)
#RA pts on #baricitinib less likely to discontinue treatment & more likely to achieve remission than pts receiving biologic /other tsDMARD.
👉🏼Results from RA-BE-REAL observational study
👉🏼Bari(2 or 4mg) vs biologic/other tsDMARD
Abs#1223 #ACR21 @RheumNow
https://t.co/WRN1OCX9Bq https://t.co/UCFF6hAY7G
Mrinalini Dey DrMiniDey ( View Tweet)
#ACR21 Abs#1224. ⬇️ CD39 expression on B cell predicts occurrence of anti-drug Ab in RA on RTX
⭐️13/23 pts on RTX became ADAb+. No diff in concomitant MTX usage
⭐️Baseline CD73 similar, but lower CD39 predictive of ADAb
https://t.co/QzbAmXtTmZ @Rheumnow https://t.co/CLtEev69YD
Links:
Eric Dein ericdeinmd ( View Tweet)
#ACR21 Abs#1225: B/L Extracell Matrix Biomarkers predict ABA response in MTX-naive, +ACPA early RA
⭐️ECM biomarkers predict SDAI remission or DAS28 w ABA+MTX vs PBO+MTX.
⭐️⬆️CTX1 biomarker predicts efficacy endpts for ABA+MTX
https://t.co/7wHQefb5D4 @Rheumnow
Links:
Eric Dein ericdeinmd ( View Tweet)
Wk 12 disease activity predicts wk 24/26 remission/low disease activity with #upadacitinib 15mg in MTX-naïve or inadequate responders to MTX and/or TNFi pts.
≥50% improvement in SJC/TJC at Wk 12 was assoc with wk 24/26 remission/low disease activity.
Abs#1237 #ACR21 @RheumNow https://t.co/PAaCe5MAcu
Mrinalini Dey DrMiniDey ( View Tweet)
Ultrasound in CSA patients:
Retro US cohort 110pts
28.2% w/ 💥Power Doppler synovitis. 36.8% at 6mo evolved to RA among which 100% PD+ vs 25% PD-
PD + predicts evolution to clinical RA (OR 13.1; CI 1.07-161.04)
Easier and less invasive than MRI!
#Abstr1525 #ACR21 @RheumNow https://t.co/MkhWTvnv3L
Aurelie Najm AurelieRheumo ( View Tweet)
