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Playing it Safe with RA? JAK vs. TNF Debate
Reported safety signals, at odds with the efficacy of these medications, have left rheumatology clinicians in a difficult position when considering when during a patient’s treatment course and in which patients, specifically, JAKi should be used. Two abstracts from ACR convergence 2024 further contribute to our understanding of this potential risk profile.
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Cognitive Impairment: The Hidden Burden in Lupus Care
Suppose you have a patient with lupus returning for follow-up. Their joint symptoms are well controlled. The kidneys—managed with a combination of biologic DMARD and mycophenolate—show no signs of active urinary sediment or protein. Yet, during the routine visit, your patient brings up fatigue and difficulty remembering things. How do you address this? Several studies presented at ACR24 focused on cognitive impairment in lupus.
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Wt ⬇️ = Better #PROs in
👇autoimmune #rheumatic #diseases if > 5% wt loss.
#ACR24 @ACRheum @RheumNow
Didn’t work for non overwt
Ex Normal BMI and T2DM 🤷 https://t.co/81OuTfZ0Nx
Janet Pope Janetbirdope ( View Tweet)
🚨 New SLE treatment update! 🚨 Dapirolizumab pegol (DZP), novel CD40L inhibitor, for moderate-to-severe lupus. Phase 3 trial, DZP reduced disease activity, helped taper steroids, and achieved a higher BICLA Safe and generally well tolerated! #ACR24 #L16 @rheumnow https://t.co/lFrKjz4CZ1
Bella Mehta bella_mehta ( View Tweet)
In this study by Dr CArriens et al, there was no difference between the vaccine response to Influenza by either HAI or Ab levels in Anifrolumab-treated pts.
AEs - mild, moderate
No serious aEs
💉#vaccinate your pts on anifrolumab with influenza
@RheumNow #ACR24 abs2424 https://t.co/XPwlzUS02i
Links:
sheila RHEUMarampa ( View Tweet)
Mitochondria: the powerhouse of the cell—but the fuel behind gout flares?
#ACR24 @RheumNow https://t.co/lV4dovLV18
Akhil Sood MD AkhilSoodMD ( View Tweet)
#CRISPR reviewed in
👇
#fibroblasts
Found deletion of certain genes
Ex JIA had marked change in expression
Yr in Preview ACR24 @RheumNow @ACRheum
Dr Chris Ritchlin 👏 https://t.co/jnmtk1eXGp
Janet Pope Janetbirdope ( View Tweet)
Mortality Risk After Stopping Glucocorticosteroids (GC) in RA.
In a study of 28,078 RA patients:
Mortality risk from CVD ↑ 7.5%/year of GC use; ↓ 1.3%/year after stopping.
Mortality risk from infections ↑ 6.8%/year of GC use; ↓ 4.9%/year after stopping.
Risks normalize 1.5–10… https://t.co/i6cKet1EEV https://t.co/ClMjIly20E
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Did you know? 🤔
Capillaroscopy is performed on the nailfold because it is the area where the capillaries are fully visualized compared to the skin where capillary tips are only seen.
This capillaroscopy session with Dr. Cutolo is so high yield I'd say! 🤓
@RheumNow #ACR24 https://t.co/8AN7RXUDrM
sheila RHEUMarampa ( View Tweet)
#Poorer responses to #Rx in
#Females vs #males
Sex hormone and pathway differences
explained
👇
Biological differences
F start worse in disease activity
F May have ⬇️ response to #Rx
Yr in Preview C Ritchlin
@lihi_eder’s PsA work quoted
ACR24 @RheumNow @ACRheum @ACRBest https://t.co/EWoCvzOLiL
Janet Pope Janetbirdope ( View Tweet)
VACIMRA Study showed timing matters for Methotrexate and Pneumococcal Vaccine in RA.
RA patients vaccinated with PCV13 1 month before MTX initiation had higher responder rates at 1 month:
88% (ELISA) vs. 75%
96% (OPA) vs. 88%
At 12 months, responses remained stronger in… https://t.co/bSbIazsRtG
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Hydralazine - known culprit of drug-induced AAV
How does hydral (H) AAV differ from primary (1) AAV?
💥 High dual positivity MPO/PR3
💥 DAH / pleuritis more common in H-AAV
💥 ENT, constitutional, nervous, ILD in 1-AAV
💥 More 6mo remission in H-AAV
@rheumnow #ACR24 Abst 2496
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Weinblatt et al. AMPLIFIED trial. No difference in response rates of RA to adalimumab or abatacept based on dual seropositivity/shared epitope status. Fits with my priors and refutes a previous pilot study. @RheumNow #ACR24 Abstr#2671 https://t.co/OUwnlsP6jU https://t.co/RBN6ivSKDr
Links:
Richard Conway RichardPAConway ( View Tweet)
Severe thrombocytopenia (TP) is rare but linked to major organ involvement and poor prognosis in #SLE. Data from the RISE registry shows TP in 9.3% of SLE patients, with higher prevalence in males, African-Americans+ those with multiple comorbidities.
#ACR24 @RheumNow abst#2680
Bella Mehta bella_mehta ( View Tweet)
In prelim analysis of this controlled clinical trial, SLE pts w/ active dse who weres given addtl NAC for 3 mos had significantly reduced dse activity.
Mechanism? NAC reduces rapamycin (mTOR) activation.
Common AEs: nausea, vomiting
@RheumNow #ACR24 abs2677 https://t.co/E4w2Qd7RwP
Links:
sheila RHEUMarampa ( View Tweet)
Dumoulin et al. 4 year results of TREAT EARLIER trial of 1 year MTX in CSA. In high risk ACPA- group, reduced risk of RA development, 8.6% vs 29%, HR 0.27. No difference at 4 years in ACPA+ or low risk ACPA- @RheumNow #ACR24 Abstr#2672 #ACRbest https://t.co/S2yJm196UV https://t.co/bJ9JySteUs
Links:
Richard Conway RichardPAConway ( View Tweet)
In the AMPLIFIED study (phase 3, single-blind RCT) ABA not superior to ADA in patients with dual seropositive early RA and HLA Class II
#ACR24 @RheumNow ABST#2671 https://t.co/VSorAiJUIe
Jiha Lee JihaRheum ( View Tweet)
Difficult to Manage Axial Spondyloarthritis
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, causing back pain, stiffness, and reduced mobility. #ACR24
https://t.co/5i5QtJJm16 https://t.co/c4bllA8ngJ
Dr. John Cush RheumNow ( View Tweet)
RheumNow’s expanded coverage of the #ACR24 Annual meeting is sponsored in part by Bristol Myers Squibb and UCB. All content is chosen by RheumNow and its faculty.
Dr. John Cush RheumNow ( View Tweet)
SELECT-GCA suggests JAKis may be the new kid on the block
Clinicians treating giant cell arteritis (GCA) have long had to contend with a disappointingly limited selection of drugs from which to select.
https://t.co/vtJzwFZMBq https://t.co/dikMRwjIZY
Dr. John Cush RheumNow ( View Tweet)
