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ACR21 Best Abstracts - Day 1
The RheumNow faculty have been glued to their monitors all day, watching video, and running down abstract presentations to find the best – several of these stood out as #ACRBests. Here is a listing of “Best” they saw on Day 1.
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The Influence of Obesity on Choice of Biologic Agent in Rheumatoid Arthritis
In rheumatoid arthritis we have a wide range of options available to us when we progress to a biologic treatment option. We have little to differentiate between these agents based on the clinical trials.
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We need to control not only inflammation but also lipids levels in our patients w/ IA! Dr Plutzky brilliantly talking us through CV risk and RA showing data on how poor LDL control and coronary microvascular dysfunction lead to worse long term CV outcomes.
@RheumNow #ACR21 https://t.co/o6GWHDai5z
Aurelie Najm AurelieRheumo ( View Tweet)
@MilenaGianfran @JYazdanyMD present on differential effects of biologics on CDAI in obese patients with rheumatoid arthritis. Abatacept better than TNFi in obese. Tocilizumab better than TNFi in non-obese. Abstr#0588 #ACR21 @RheumNow #ACRBest https://t.co/UcEpMAmNVw
Richard Conway RichardPAConway ( View Tweet)
Abstr 0579
Kim & Colleagues examined predictors of Tx change among RA patients w/ TNFi as 1st line biologic agent
- Females & GC use more likely to switch agent
- Vitamin D use & hx of other immune-mediated diseases (eg. Psoriasis, IBD) less likely to switch
#ACR21 @RheumNow https://t.co/FM5mSWmSNA
Akhil Sood MD AkhilSoodMD ( View Tweet)
#ACR21 Abs#0825
Early RA -Rx-naive: 48 wk, csDMARD+GC vs. 3 bDMARD+MTX (CZP/ABA/TCZ)
⭐️Superiority for ABA+MTX and CZP+MTX vs. to csDMARD+GC, not in TCZ+MTX
⭐️ Radiographic progression low in all
▶️ Short study w very aggressive 1st line combo Rx
https://t.co/TJPZkqmN8z @Rheumnow
Links:
Eric Dein ericdeinmd ( View Tweet)
#ACR21 Abs#0828. SELECT-COMPARE UPA vs ADA for RA at 3 yrs
⭐️More pts stay on UPA vs ADA (47 vs 36%)
⭐️Adverse drug events similar between groups. UPA has ⬆️ zoster, lymphopenia, hepatic and CPK elevations
https://t.co/eLCytSX7Gz @Rheumnow https://t.co/i8NjSgImVq
Links:
Eric Dein ericdeinmd ( View Tweet)
🩸 Hb levels markers of RA activity and structural progression? Boston BRASS registry: 1500+ patients.
Low hb at headline associated w/ MTX TNFi and ⬆️ increase in TSS.
Not that surprising provided low Hb is a marker of systemic inflammation. #Abtr0786 #ACR21 @Rheumnow https://t.co/eQLGxsANkk
Aurelie Najm AurelieRheumo ( View Tweet)
Can RA be cured?
Dr. Thomas' proof of concept RA immunotherapy study: DEN-181 is a liposome immunotherapy given by SQ injx; it's presented by LN-DCs causing: CTL exhaustion while controlling autoreactive CD4+ T cells #ACRbest @rheumnow #ACR21
Abst#0967should have been a plenary! https://t.co/6ZzDgavafS
TheDaoIndex KDAO2011 ( View Tweet)
Does #RA treatment affect low Hb levels? Is there a relationship between Hb and radiographic progression?
#ACR21 Abs#0787
👉🏼Sustained improvements in Hb when treated with bio/non-bio DMARDs
👉🏼Low Hb assoc with incr radiographic progression
@RheumNow
https://t.co/DWgoiqYfAt https://t.co/aSRCT2vGjW
Mrinalini Dey DrMiniDey ( View Tweet)
@KronzerMD @jeffsparks on association of respiratory diseases with incident RA. Upper airway diseases (sinusitis, pharyngitis) seem to associate even more strongly than asthma/COPD. Abstr#564 #ACR21 @RheumNow https://t.co/HvoBOs3OOF
Richard Conway RichardPAConway ( View Tweet)
Dr Mahajan on lung disease in early RA. Common, airway disease in 60%, parenchymal disease in 30%. But minimal/no progression over 1 year which is reassuring. Abstr#574 #ACR21 @RheumNow https://t.co/s9r06MSStF
Richard Conway RichardPAConway ( View Tweet)
MUC5B and RA-ILD. Dr McDermott @jeffsparks show that MUC5B is associated with RA-ILD, older age at RA diagnosis, and ILD within 5 years of RA onset. Is this a different disease to other RA or modulation by the promotor variant? Abstr#0576 #ACR21 @RheumNow https://t.co/r2fQqxVY6N
Richard Conway RichardPAConway ( View Tweet)
And here is ORAL-Surveillance, small increase in MACE and malignancy with tofacitinib vs TNFi. 1 extra MACE per 319-567 patient years, 1 extra malignancy per 275 patient years. Abstr#0831 #ACR21 @RheumNow https://t.co/wMJnspTTBy
Richard Conway RichardPAConway ( View Tweet)
For rheumatologists, instinct says in RA everything’s better with MTX. For tofacitinib, where immunogenicity not an issue, is that actually true?
Canadian registry data: maybe no
after 36m, low no. ?valid, markups mine
Need to see more of this!
#ACR21 ABST0827 @RheumNow https://t.co/VVwd4SZgVx
David Liew drdavidliew ( View Tweet)
Dr. Thomas reviews risk for progression to RA
👉+ACPA (9% risk)
👉1st degree relative 3-9X risk
👉70% risk in 5 years of both are true!👈
#ACR21 @rheumnow https://t.co/y5eUyacBFT
TheDaoIndex KDAO2011 ( View Tweet)
An important message from Dr Ranjeny Thomas on #RA #disease control: "Patients can have a significant impact on the control of their disease, and the interventions we recommend need to be personalised to their resilience ability." #ACR21 @RheumNow https://t.co/h63uz5kfU8
Aurelie Najm AurelieRheumo ( View Tweet)
Booking regular clinic visits for controlled RA pts - can we be more efficient?
12m RCT
Self-monitoring app, supported self-initiated care
only one scheduled follow-up visit
controlled RA pts
DAS28/pt satisfaction same
visits/y: 1.7 vs 3.0
@reade_020 #ACR21 ABST0830 @RheumNow https://t.co/600XTKo9GM
David Liew drdavidliew ( View Tweet)
Risks for RA:
- chromosome 6 has HLA risk genes encoding HLA-I and -II
- HLA-DRB1 *04:01 and *04:04 stonrgly assc w/ RA in white Americans/Europeans
- the Shared epitope increase risk for RA & severe disease; high assc with ACPA+
Protective➡️HLA-DRB1*13:01 @rheumnow #ACR21 2/2
TheDaoIndex KDAO2011 ( View Tweet)
Chances for RA if a family member has RA?
Dr. B Masri reviews familial studies:
👉person w/1st degree relative w/ RA has 2-4 X risk
👉Multigen study standard incidence ratios: 3.02 child, 4.64 siblings, 9.31 in multiplex family, 6.48 twins, 1.17 in spouses #ACR21 @rheumnow 1/
TheDaoIndex KDAO2011 ( View Tweet)
