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New insights in RA-ILD therapeutics
RA associated ILD (RA-ILD) is the most common extra-articular manifestation in RA. Its prevalence varies considerably, ranging from 5% to 30%, and is often underestimated since patients only become symptomatic or display abnormalities on chest X-Ray at a late stage of disease, leading to subsequent delay in diagnosis. In this context, several groups advocate for an earlier and more precise detection, using high resolution chest computed tomography (HRCT), which is the most sensitive for pre-clinical RA-ILD diagnosis.
But why would we want to diagnose early a manifestation that we cannot treat?
Turning the Corner on CV Risk in Rheumatoid Arthritis
Cardiovascular (CV) disease remains the leading cause of mortality in rheumatoid arthritis (RA). A number of studies progressed our knowledge in the session Rheumatoid arthritis - comorbidity and clinical aspects – I on Thursday at EULAR 2021.
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Pregnancy is a minefield for RA pts:
dx activity➡️preg risk
PNL➡️preg risk, but dx activity proxy?
bring on Swedish/Danish linked data:
1739 RA preg matched 1:10
⬆️pre-term/SGA risk with bDMARDs/PNL
adj for dx activity: less bad, but still concern?
OP0210 #EULAR2021 @RheumNow https://t.co/AlwFtmGcZH
David Liew drdavidliew ( View Tweet)
In the ESPOIR cohort of 813 RA followed for 10 years, polypharmacy associated w/ less DAS28 ESR Remission at 5 (45.0% in vs. 56.3% (p=0.03)) and 10 yrs (32.5% vs. 67.5% (p=0.06)) BUT no longer significant when adjusted for comorbidities!
#EULAR2021 @Rheumnow #OP0098 https://t.co/pSrr1dzKFP
Aurelie Najm AurelieRheumo ( View Tweet)
Acute Coronary Syndrom incidence in > 24,000 RA from Nordic registers followed up to 5 yrs = 5.5/1000 pyrs. After 5yrs RTX show > risk of ACS compared to ETA. In patient with >= 2 previous DMARDs ABA, INF and RTX > risk of ACS compared to ETA.
#EULAR2021 @Rheumnow #OP0114 https://t.co/MjW9LI2cjt
Aurelie Najm AurelieRheumo ( View Tweet)
Patients with RA > 70yo and risk of severe infection: which therapeutic strategy is the safest?
#EULAR2021 @Rheumnow #OP0116
Aurelie Najm AurelieRheumo ( View Tweet)
Dr Yoshida analyze data from US registry 40,721 RA patients. High 2.11 [1.13, 3.96] and moderate 1.97 [1.13, 3.43] CDAI associated w/ > HR of major adverse CV events. HRs decrease during follow up.
Tight and early disease control reduces CV burden!
#EULAR2021 @Rheumnow #OP0101 https://t.co/A0ZYE4v8uf
Aurelie Najm AurelieRheumo ( View Tweet)
In 16,448 RA from ACR’s RISE registry: no difference in disease activity TNFi and non-TNFi at 12 months. Stratified analysis: ⬆️disease activity for TNFi vs. non TNFi in patients of Black and Asian ethnicity. To be confirmed in independent cohorts.
#EULAR2021 @Rheumnow #OP0117 https://t.co/7bFnOKR9uz
Aurelie Najm AurelieRheumo ( View Tweet)
MTX or ETA which one withdraw first? @RADoctor SEAM-RA trial: PROs following withdrawal of MTX or ETN in RA patients with sustained SDAI remission receiving combination ETN+MTX. ETA > MTX for maintaining SDAI remission at W48 (49.5%-28.7% P=0.004)
#EULAR2021 @Rheumnow #OP0118 https://t.co/MSOclXGMEK
Aurelie Najm AurelieRheumo ( View Tweet)
Can we predict pre-clinical RA-ILD?
@Juge_P_A ESPOIR cohort. model w/ 4 variables: male gender, older age @ diag, mean DAS-28 over follow-up and MUC5B variant ▶️ preclinical ILD after 13 years of RA w/ AUC=0.82 CI 95% (0.72-0.91) (Sens 80%, Spe 56%)
#POS0095 @Rheumnow #EULAR2021 https://t.co/bPyidNhNuO
Aurelie Najm AurelieRheumo ( View Tweet)
Can machine learning show JAKi effects for safety? Off target binding predicted in #tofacitinib 58, #baricitinib 41 but NO pathway for thrombosis or viral infection. Could have repurposing for + effects on lung vasculature & antifibrotic effects POS0091 #EULAR2021 @RheumNow
Janet Pope Janetbirdope ( View Tweet)
MACE events with #JAKi is as clear as mud! You voted >50% NOT Sure 1/3 only some Jakis vs MACE in #TNFi! Dunno #EULAR2021 @RheumNow @eular_org https://t.co/vWUgKSwAap
Janet Pope Janetbirdope ( View Tweet)
Poorer outcomes with #JAKi in pts who get #SARSCoV2 but ? related to line of therapy - worse off if 2nd line advanced Rx in RA vs 1st line? JAKi has short half life so it washes out? And..#baricitinib added to #remdesivir improves outcomes NEJM @RheumNow #EULAR2021 #OP0006 Dunno! https://t.co/583z6Mlw3y
Janet Pope Janetbirdope ( View Tweet)
News Feature: EULAR 2021 – Day 1 Report #EULAR2021
https://t.co/igpQYMkf9l https://t.co/qESsN3meJe
Links:
Dr. John Cush RheumNow ( View Tweet)
How common is RA ILD? @RheumNow #EULAR2021 @eular_org
Janet Pope Janetbirdope ( View Tweet)
RA ILD is NOT a needle in a haystack! Older age& makes & COPD is a risk MUC5B gene SNIP are risks NOT ACPA. 7-10% will have relevant RA ILD. Are you ready to identity & treat it? @RheumNow #EULAR2021 BI RA ILD symposium @eular_org https://t.co/4mS6Jejjqk
Janet Pope Janetbirdope ( View Tweet)
Leave my MTX alone says pt & #rheumatologist if pt has chronic ILD. Acute pneumonia from MTX is NOT chronic ILD in RA @RheumNow @eular_org #EULAR2021 #BoehringerIngelheim RA ILD silent killer symposium https://t.co/IQTINuUpVq
Janet Pope Janetbirdope ( View Tweet)
Great talks on comorbidities in RA at #EULAR2021 today. What do we struggle most with in RA management? @RheumNow
Richard Conway RichardPAConway ( View Tweet)
RA ILD will kill pts esp UIP pattern and extent & presence of honeycombing on HRCT. Think about it esp if older pt #EULAR2021 #BoehringerIngelheim symposium @RheumNow @eular_org https://t.co/be2Z7KMqpg
Janet Pope Janetbirdope ( View Tweet)
#POS0093 Collaborative registry studies are to be encouraged! BUT
@k_lauper outlines the heterogenity between registries concerning #AE reporting - Jak-pot study - 18 registries with #RA patients on #tofacitinib - Rates of discontinuation vary across registry
#EULAR2021 @RheumNow https://t.co/oczJAG8hzv
Paul Studenic Stiddyo ( View Tweet)
