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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.
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Blurred line indeed, one could argue that a patient with ACPA+, arthralgia and sub-clinical inflammation detected on MRI is already transitioning toward early RA and fall into the category of patients we should treat anyway. https://t.co/Y1JceOijK0
Aurelie Najm AurelieRheumo ( View Tweet)
Torgutalp et al.
⭐️Included Early axSpA - 166 nr-axSpA (symptom duration ≤5 y) and 135 with r-axSpA (symptom duration ≤10 y) from German Cohort
⭐️Assessed TNFI use over 2 years and has shown🔽 in radiographic sacroiliitis progression.
Abst#0451 #ACR21 @RheumNow #ACRBest https://t.co/xP0wMLSyGw
swethaann23 swethaann23 ( View Tweet)
Can we predict who which PsA pts will be radiographic progressors?
Abs#449 identified 103 candidate biomarker peptides corresponding to 69 proteins that could ID progressors
More data needed
#ACR21
@RheumNow
https://t.co/OLfPRNjTKV https://t.co/6UTn1J7nJH
Robert B Chao, MD doctorRBC ( View Tweet)
Wanted to highlight our work @HSpecialSurgery presented at #ACR21 using unsupervised clustering of multimodal data - histology and ultrasound to identify phenotypes such as moderately inflammatory subtype in #osteoarthritis @RheumNow #abst0212
some features highlighted in fig https://t.co/HRzhMXctB9
Bella Mehta bella_mehta ( 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)
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)
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)
Functional MRI eval neuro-connectivity in 78 SLE pts
Cognitive impairment occurred in 48%; pts had:
👉longer disease duration
👉likely +LAC
👉abnormal fMRI
👉>blood brain barrier permeability
#ACR21 #Plenary Abstr# 0456 @rheumnow https://t.co/WI5CD73rvM
TheDaoIndex KDAO2011 ( 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)
Pearls on Rheum imaging:
👉CPPD is not erosive
👉SC joint in OA is common (hard to image)
👉AC joint is 1st place OA affects shoulders (not GH)
👉Neuropathic OA progress rapidly, look at the TMTs
👉Get more views if you aren't seeing what you need
#ACR21 Radiology Bootcamp
TheDaoIndex KDAO2011 ( View Tweet)
Factors that predict trajectories of radiographic progression in #axialspondyloarthritis 4 major patterns in the PSOAS cohort. Male gender, longer disease duration, raised CRP and smoking associated with higher spinal progression @RheumNow #ACR21 Abst#450 https://t.co/PvDE7T0MZp
Dr. Antoni Chan synovialjoints ( View Tweet)
We should aim for early treatment and good retention in ax-SpA to prevent structural evolution. >12 months of TNFi treatment in the previous 2 years associated w/ ⬇️ radiographic progression of SIJ in r- and nr-axSpA in GESPIC, #Abst0174 @RheumNow #ACR21 https://t.co/2V1q4dUwFO https://t.co/lxQU4zAP1I
Aurelie Najm AurelieRheumo ( View Tweet)
🔥 Ready for the next level of imaging? The radio-labelled tracer binding to integrin αvβ3 99mTc-maraciclatide is able to detect hypervascularization in RA joints and correlates w/ PDUS findings
⭐️ Sens 78%
⭐️ See 91%
Fancy, yet more invasive than US! #Abst0174 @RheumNow #ACR21 https://t.co/eCOxjJsERh
Aurelie Najm AurelieRheumo ( View Tweet)
What's the added value of MRI in diagnosing #rheumatoidarthritis among pts w/ undiff'd arthritis?
Accdg to this study by N. Hollander et al, Tenosynovitis was independently assoc'd w/ RA development esp. among ACPA- UA pts 👇
@RheumNow #ACR21 abs0155 https://t.co/F6xlZ1Hy7u
sheila RHEUMarampa ( View Tweet)
Completely new one for me, Dr Taniguchi presenting on using ear ultrasound to diagnose and monitor disease activity in relapsing polychondritis. Appears useful, I suspect in clinical practice more so for diagnosis. Abstr#0169 #ACR21 @RheumNow https://t.co/PLJtkYkP3A
Richard Conway RichardPAConway ( View Tweet)
RheumNow Podcast – Like Father, Like Daughter (10.29.2021)
Bad things happen when our patients go into the ICU and it's not always due to the disease. Good things happen when we rise from sitting. And guess what? Rheumatologists are setting cardiology straight about hydroxychloroquine and chloroquine. This, and a special recognition of parent-child rheumatologists, along with the news and articles from this week on RheumNow.
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Rheumatoid Arthritis Thrombotic Risk Influenced by DMARD Choice
RA patients have an increased risk of venous thromboembolism (VTE) related to disease activity and inflammation, yet a large real-world study of older RA patients shows methotrexate to be associated with a 2-fold increased VTE risk (compared to hydroxychloroquine).
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