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ENbrel works in long term for the few people left on the drug at 10 yrs with SpA. Enormous dropout. If you are still on Rx for a decade you are in the minority. Drop out of TNFi in SpA mirrors RA & PsA @RheumNow @eular_org @CRASCRRheum @earlyarthritis #EULAR2020 https://t.co/dLS2fw5uRP
Janet Pope Janetbirdope ( View Tweet)
Your #RA patients in low disease or remission, do you maintain, reduce or stop DMARDs #EULAR2020
Dr. John Cush RheumNow ( View Tweet)
#EULAR2020 Updated RA Mgmt Recc
Main points:
1. MTX 1st line (if contraind, then SSZ/LEF; NOT HCQ)
2. Add bDMARD/JAKi if 1st csDMARD doesn't work + poor Px
3. Use IL-6i or JAKi for pts who can only take monoRx and failed csDMARD
@RheumNow
https://t.co/AIXz2dEOrX
k dao KDAO2011 ( View Tweet)
Study of the French registries for TCZ, RTX, ABA, compared the risk of GI perforations (GIP). GIP risk was higher with TCZ (vs RTX,ABA) but was largely due to TCZ increasing the risk of diverticulitis. #EULAR2020 #OP0022 https://t.co/MGGWiVh5Jv https://t.co/nC2NblYnGO
Links:
Dr. John Cush RheumNow ( View Tweet)
Do not be tempted to stop MTX or other DMARDs perioperatively! They probably help rather than harm #EULAR2020 https://t.co/jb4ZuZlqSu
Christos Koutsianas Dr_C_Koutsianas ( View Tweet)
RA pt not responding to a 1st biologic; what you predict in a Head to Head - Abatacept vs Upadacitinib?
Dr. John Cush RheumNow ( View Tweet)
#EULAR2020 #fri0505 Still’s pts who are able to achieve remissions w/longer itnervals btw tocilizumab infusions & lower dose of prednisone more likely to successfully withdraw Toci. Time to symptom recurrence in relapse group 7.8 mo. Older pts more likely to relapse @RheumNow
Olga Petryna DrPetryna ( View Tweet)
Main factors influencing #physicalactivity in inflammatory #arthritis patients are psychological
➡️Main factor related to knowledge of benefits of #exercise & symptoms
➡️Modifiable
➡️Health professional support key
FRI0642-HPR #EULAR2020
👉🏽https://t.co/Vdc7rjnC6Y
by @DavergneT https://t.co/aMUHA5IMrn
Dr Ai Lyn Tan DrAiLynTan ( View Tweet)
Don’t forget significant fibrosis with ILD has +RCT with nintedanib INBUILD study. Lots of buzz of RA ILD where MTX is OK, TNFi may have more ILD than other bDMARDs, biomatkers KL-6 @eular_org OP0038 #EULAR2020 @CRASCRRheum https://t.co/OihF3LmNYQ
Janet Pope Janetbirdope ( View Tweet)
Can we predict which RA pts will have secondary failure to TNFi in advance?
B-cell activating factor (BAFF) may play a role, and in age >54, pre-TNFi BAFF levels predict anti-drug Ab.
A potential step toward better drug survival?
La Paz, Madrid THU0170 #EULAR2020 @RheumNow https://t.co/NRQHO2cVuf
David Liew drdavidliew ( View Tweet)
Predictors of not achieving remission in early RA, in Canadian CATCH cohort vary by sex:
men: seropos, smokers
women: obesity, TJC, lower education
Different mechanisms of poor outcomes in early RA in men and women?
@earlyarthritis SAT0053 #EULAR2020 @RheumNow https://t.co/fRgm6vtlPL
David Liew drdavidliew ( View Tweet)
The link between periodontal disease & anti-CCP seroconversion is well known, but does it affect progression from arthralgias to synovitis after that?
@LeedsBRC data says yes for localised periodontitis.
Got CCP+ arthralgia? Don't forget to floss!
SAT0045 #EULAR2020 @RheumNow https://t.co/CpqRyIWVK0
David Liew drdavidliew ( View Tweet)
For a drug that everything in RA has been built on, we're not great at predicting who will respond to methotrexate.
It's probably because we don't have all the info. Adding pharmacogenomics increased optimal AI prediction from 55% to 76%
@MayoClinic FRI0046 #EULAR2020 @RheumNow https://t.co/bwpSYQIBLG
David Liew drdavidliew ( View Tweet)
To truly address adherence, you need to understand what is impairing it, and tailor an approach to overcome those barriers.
Great to see this articulated in EULAR recommendations re: non-adherence - a big factor in our therapeutic outcomes!
EULAR projects #EULAR2020 @RheumNow https://t.co/0pazcDFTuV
David Liew drdavidliew ( View Tweet)
#EULAR2020 OP0019 DON'T STOP TNFi in RA remission per ARCTIC-REWIND trial: RCT X 1 year n=99 multicenter gov't funded- DAS28 remission X1 year, dz X10 yrs, 2/3 pts (RF+/CCP+), no doppler signal.
Results: 63% flared who had TNFi w/drawn vs. 5% when TNFi continued @RheumNow https://t.co/SsR1vUGbOe
k dao KDAO2011 ( View Tweet)
H2H UPA vs ABA RCT; UPA is clinically superior to ABA in DAS-CRP remission, ACR50, ACR70 at wk 12/24 (NOT diff in Pain, FACIT, Boolean remission); But UPA has more serious AE (vs ABA) - esp hepatic, OI, SIE, SAE, CPK (but not zoster VTE) #EULAR20 SAT0151 https://t.co/K96lybdg7L https://t.co/vQM2MSCNzD
Links:
Dr. John Cush RheumNow ( View Tweet)
VTE elevated risk is assoc up to 1 yr after high disease activity in RA 1% over 1 yr of active RA will get VTE OP0034 Data from Swedish popn study implications irrespective for which Rx pt gets? @eular_org @RheumNow @CRASCRRheum @earlyarthritis #EULAR20 #eular2020 https://t.co/A7mWoYZI9S
Janet Pope Janetbirdope ( View Tweet)
RA pts are at risk of pneumonia, & inflamed lung mucosa can produce RF/CCP. Are these linked via subclinical lung injury?
Seropos RA pts @BrighamWomens have double the pneumonia risk post-adjustment.
We're still learning more about RF...
@jeffsparks OP0111 #EULAR2020 @RheumNow https://t.co/C3CYpXABGc
David Liew drdavidliew ( View Tweet)
Tenosynovitis is underrated in RA.
A nice reminder from an Argentinian group, who USS scanned 90 RA pts in clinical remission >3m and followed them for 12m. Subclinical synovitis did not predict flares, but subclinical tenosynovitis did (adj OR 9.8)
THU0119 #EULAR2020 @RheumNow https://t.co/kcle8qyQbI
David Liew drdavidliew ( View Tweet)
Physician global assessment in RA is a murky beast, which we should standardise better (especially interrater).
Portuguese cross-sectional (n = 392): SJC/CRP/HAQ/PGA did not fully explain it.
What are we capturing, and does it matter?
THU0111 #EULAR2020 @Janetbirdope @RheumNow https://t.co/krL2yFIl8a
David Liew drdavidliew ( View Tweet)