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Outcomes of COVID-19 in Patients with Rheumatoid Arthritis

Akhil Sood, MD

Patients with rheumatic diseases – requiring lifelong immunosuppressants— are at high risk for respiratory and viral infections. Over the past decade, an armamentarium of biologic and targeted therapies has led to better control of disease activity in patients with rheumatoid arthritis. Whether these patients, especially those receiving newer biological and targeted therapies such as JAK inhibitors, are at an increased risk of severe COVID-19 outcomes remains uncertain. 

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RheumNow Podcast – ACR Convergence Begins (11.5.2021)

Jack Cush, MD

Dr. Cush reviews the news, and kicks off ACR21 learning and how to take in the annual meeting.

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Prolonging the Controversy of Hydroxychloroquine

Kathryn H. Dao, M.D.

Since the start of the pandemic, hydroxychloroquine (HCQ) was forced into the limelight for the prevention/treatment of COVID-19.

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ACR21 Previews from Creaky Joints

Jack Cush, MD

CreakyJoints will present 11 posters and two oral presentations at ACR 2021. COVID-19 research revealed significantly high levels of anxiety, anger, depression, and social isolation, which were linked to medication interruptions and associated flares suggesting during the pandemic, patients often felt unsupported by all levels of the healthcare system. 

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Industry Press Releases - BMS, Abbvie, UCB, Janssen

Jack Cush, MD

The pharmaceutical companies will feature the results of their pivotal clinical trials and data analyses at ACR Convergence 2021.  Below is a listing of some of their best studies for you to review and look for in the meeting.

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Industry Abstract Previews #ACR21 - Horizon, Aurinia, AstraZeneca

Jack Cush, MD

The pharmaceutical companies will feature the results of their pivotal clinical trials and data analyses at ACR Convergence 2021.  Below is a listing of some of their best studies for you to review and look for in the meeting.

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NOR-DRUM Study: TNF Inhibitor Therapeutic Drug Monitoring is Effective

ACR

New research presented this week at ACR  Convergence, the American College of  Rheumatology’s annual meeting, shows that proactive therapeutic drug monitoring, a newer treatment strategy where a patient’s drug serum levels are regularly assessed to adjust the dose and intervals, controlled disease more effectively than standard therapy with infliximab, a tumor necrosis factor (TNF) inhibitor.   

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Dr. Chambers review @MotherToBaby prospective data on HCQ use in pregnancy (n=279): 👉no major defects (regardless of dose) 👉no oral clefts 👉SGA slightly lower in exposed group b/c of underlying dz 👉no case of retinopathy in babies after 1 year f/u @rheumnow #Pregnancy https://t.co/vw2eryFgro
TheDaoIndex KDAO2011 ( View Tweet)
Abst#271 #ACR21. RA activity predicts left ventricular mass change in pts without CVD ⭐️35% had abnormal LV geometry at baseline TTE ⭐️55% at f/u TTE 3-6 years later ⭐️Increase in concentric remodeling on LV @Rheumnow https://t.co/uHnqITcTy9 https://t.co/KmV8volVwd

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Eric Dein ericdeinmd ( View Tweet)
#ACR21 Abst#0276: Pulse pressure (PP) = Systolic BP - Diastolic BP, measures arterial compliance ⭐️RA: higher PP than controls ⭐️PP was independent risk factor for subclinical atherosclerosis ▶️ Look at the vitals, we have this at every pt visit! @Rheumnow https://t.co/KZaf1AwO6Q https://t.co/kN4xGxWiV9

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Eric Dein ericdeinmd ( View Tweet)
It's what's below the surface that's most scary. see: RA & the heart - why do RA pts without cardiovasc dx/Sx get LV remodelling over time - why is it worse with worse RA control? RA goes deeper than the joints & our pts need to hear that! @Columbia #ACR21 ABST0272 @RheumNow https://t.co/NDHLZwoEjy
David Liew drdavidliew ( View Tweet)
Despite >20y of bDMARDs, our patients still have a 50% greater risk of cardiovascular issues (similar to family history or abdominal obesity) Cardiovascular disease in RA is not historic, it's today's reality we too often ignore. 2020 data @VUamsterdam #ACR21 ABST0286 @RheumNow https://t.co/Az4wHNUOGe
David Liew drdavidliew ( View Tweet)
#ACR21 Abst#0284. RA and Dementia? ⭐️1366 pts with RA, retro pop-based cohort ⭐️Risks: older age, diabetes, CVD. ⭐️Large joint swelling swelling HR 2.2 (1.2-3.9). No significance by RF/CCP/ESR/erosions/nodules ▶️CVD risks appear > RA activity https://t.co/2uN2lBs4tr @Rheumnow https://t.co/HEOXPosE5Z

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Eric Dein ericdeinmd ( View Tweet)
Diabetes puts you at risk of cardiovascular disease, right? What about RA? Look at this graph and compare the pair. "already it was impossible to say which was which” - George Orwell, Animal Farm #ACR21 ABST0287 @RheumNow https://t.co/r0yaeC530l https://t.co/mKJhoyJ2Cn

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David Liew drdavidliew ( View Tweet)
Study by @BethIWallace @Tuhina_Neogi shows that we seem to treat fibromyalgia symptoms with steroids in RA patients. Its a bad idea in fibromyalgia, and has got to be bad practice in RA too. Abstr#0120 #ACR21 @RheumNow

Richard Conway RichardPAConway ( View Tweet)

#ACR21 Abst#0271. ⬆️ Risk of carotid atherosclerosis in first few years of RA diagnosis. Authors recommend routine carotid screening in pts at time of diagnosis. Q: would you routinely screen all patients at time of diagnosis? @Rheumnow https://t.co/A9akqyVRGF https://t.co/SYGkJHQzWf

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Eric Dein ericdeinmd ( View Tweet)
Abst#0276: Pulse Pressure (PP) can predict carotid plaque in RA! ➡️PP (SBP – DBP) assoc w/ subclinical CVD in gen populat. How about in RA? ⭐︎ RA pts had higher PP than controls ⭐︎ PP = only independent RF for subclinical athero #ACR21 @Rheumnow https://t.co/esLDW8iggf https://t.co/6d2D9hXC1i

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Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Abst#0269: Autoabs confer risk of incident CVD in US ⚦ veterans w/ RA ⭐︎ MACE risk: ↑ concentrations of RF (HR 1.15) & malondialdehyde acetaldehyde (anti-MAA) (HR 1.2) ⭐︎ CVD Death: ↑ concentrations of CCP (HR 1.27) & anti-MAA #ACR21 @Rheumnow https://t.co/UeOz91Bh3P https://t.co/PJwP1H4eNk

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Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR21 Abst#0269 ⭐️TCZ: ⬆️cholesterol, LDL, TG. ⬇️ hsCRP compared to TNFi. No ⬆️ risk of Reynold risk score (RRS) Take-away: good data on TCZ effect on lipids, but I wouldn't use RRS to calculate CVD risk on med that ⬇️ CRP @Rheumnow https://t.co/zMltktfHkS https://t.co/bwKXiGIi8a

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Eric Dein ericdeinmd ( View Tweet)
Abst#0268 ➡️Do lipids change w/ some bDMARDs in RA? YES! ⭐︎ TCZ: ↑ TC, LDL, TG & ↓ in hsCRP relative to initiating TNFi. ➡️Does this lipid ↑ confer risk for CVD? Not necessarily as it may not be atherogenic per Reynolds Risk Score! #ACR21 @Rheumnow https://t.co/Gy62mg6GhZ https://t.co/5uC8Zy0Lbr

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Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
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