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The Great Debate – Who Really Won?
My favorite session at ACR Convergence is often the “Great Debate.” The debate this year also evaluated one of my favorite topics – ultrasound in giant cell arteritis (GCA). More specifically, it asked the question of whether biopsy or ultrasound should be the preferred modality for diagnosing GCA.
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From Fitbit to first diagnosis: AI is rewriting the RA playbook
Two studies presented at this year’s #ACR25 meeting highlight just how close we may be to a future where algorithms flag disease before we can and monitor activity with minimal patient burden. https://t.co/8AwBZkyZIW
Dr. John Cush RheumNow ( View Tweet)
#Urinary #biomarkers #lupus #nephritis
#Tenascin C -suggests repair, fibrosis, progress of #LN
#IL16, #CD163, & more for LN activity
Sometime a biomarker may replace repeat #kidney #biopsies?
#AMP group #Accelerated #Medicines #Program
#ACR24 @ACRheum @RheumNow abst#851
Janet Pope Janetbirdope ( View Tweet)
#2686 Using HR-pQCT, researchers tracked bone changes in RA & PsA. Seropositive RA showed worst bone density & microstructure, worsening with disease activity. TNFi, RTX & BARI improved MCP bone density, highlighting the impact of inflammation and treatment. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
#2702 @ClevelandClinic Vascular ultrasound (VUS) for suspected GCA showed excellent specificity (100%) but low sensitivity (21%) compared with 6m confirmed diagnosis.
Fair agreement with TAB (κ=0.64).
Findings highlight need for standardised VUS protocols in US. @RheumNow #ACR25 https://t.co/LRFpFBnWWz
Mrinalini Dey DrMiniDey ( View Tweet)
Lots of interest in MRI for GCA diagnosis... but what about monitoring?
Case series of 14 pts: MRI identified relapse prior to symptoms or inflammatory markers in 2 cases, including those on TCZ, which hides them
More available in US context, noninvasive, & more structures https://t.co/pnrI9SEpll
Mike Putman EBRheum ( View Tweet)
In early axSpA vs non-axSpA CBP, 2 year spinal x-ray progression was minimal in both groups. But on MRI, fat lesions increased significantly in axSpA (0.16 units/yr vs –0.02), with 15% having ≥3 lesions at 2 year vs 1% in non-axSpA. Fat lesions may signal early structural https://t.co/zvgU1Gt0po
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Observational study from VCRC AAV patinet, >70% had pulm involvement at some point
As expected, nodules favor GPA (63% vs 12% MPA) & DAH favors MPA (61% vs 31%)
More ILD in MPA (11% vs 1%) & more endobronchial in GPA (12% vs 2%)
Helpful pearls!
@RheumNow #ACR25 Abstr#0721 https://t.co/Iu5MdiTABR
Mike Putman EBRheum ( View Tweet)
Use of AI in AxSpA imaging for diagnosis. ASembleNet, a hybrid deep learning model, achieved 99% accuracy on coronal and 98.1% on axial MRI for AS classification, outcomes higher than ResNet50, Xception, and InceptionV3. Validated on ASAS cases, with Grad-CAM interpretability and https://t.co/yU8shaIdP2
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Lung Ultrasound in CTD-ILD
Prospective cohort 146 pts CTD-ILD
30 preclinical ILD
76 limited ILD
40 extensive ILD
Median LUS scores higher if Extensive ILD
LUS scores correlation w/ fibrosis severity, DLCO & FCV
Agreement between LUS and HRCT severity 0.74
Excellent inter https://t.co/R9zGmCTT8Q
Aurelie Najm AurelieRheumo ( View Tweet)
Making sense of machine learning. Key slides on Discriminative AI vs Generative AI. Liubov Arbeeva @RheumNow #ACR25 https://t.co/Xli1mSTVQf
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Dr. John Stone on IgG4RD
⬆️ common in males
⬆️internal organ involvement
🔸Mimics cancer
🔸Indolence makes it dangerous —-> organ complications
Diagnosis highly dependent on the rheumatologist based on clinical features, serologies, imaging & pathological data
#ACR25 @Rheumnow https://t.co/St4EbA7Dcj
sheila RHEUMarampa ( View Tweet)
Can a Fitbit track RA?
This Japanese clinic is using Fitbit data and have seen it correlate with CDAI across their RA clinic.
Maybe instead of asking about our patients mobility and sleep, we should be measuring it?
#ACR25 ABST2253 @RheumNow https://t.co/rg2SKgn7K2
David Liew drdavidliew ( View Tweet)
Benson et al. Clinical features that predict CV risk in PsA. Median 3.53 year follow up. 56 CV events. 766 patients. Dactylitis emerged as key predictor in adjusted models. @RheumNow #ACR25 Abstr#2317 https://t.co/5O3G7vGYbq
Richard Conway RichardPAConway ( View Tweet)
How great would it be to have a diagnostic RA-ILD Urine Dipstick?
Small cohort 14 RA-ILD vs. 64 RA no ILD
Urine ILDScore includes 2 proteins
SPOCK1 and PGRMC1
Independently asso with ILD w/ OR 6.19
Urine ILD score alone AUC 0.9
ILD urine score + clinical data AUC = 0.95
Needs https://t.co/7PqX8kdjKJ
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
IgG4-RD continues to present in new and unusual ways
Hasbani et al. report 9 IgG4-RD patients with coronary artery involvement
RCA and LAD most affected
Seen on CTA
Majority received RTX
7/9 pt at least partially improved imaging on f/u
@RheumNow #ACR25 Abst 2531 https://t.co/Na0gdq3dgb
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Is taking NSAIDs +TNFi better for the joints?
Abstract 2359: In radiographic axSpA, NSAIDS + TNFi associated with
-fewer syndesmophytes 36% vs 58% TNFi
- no significant effect on hip structural changes
- @RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Konsta et al. Adding NSAID to TNF inhibits spinal but not hip radiograpic progress. 262 patients, TNF+NSAID 100, TNF alone 162. New syndesmophytes 36% vs 58%. ΔmSASSS-score/year 0.1 vs 0.7. No effect on progression of hip radiographs. @RheumNow #ACR25 Abstr#2359 #ACRBest https://t.co/k9j2M2E3ze
Richard Conway RichardPAConway ( View Tweet)
Great debate on GCA ultrasound vs biopsy. Wolfgang Schmidt making the case for GCA US with the rise of its use in guidelines @RheumNow #ACR25 https://t.co/ORxzzG8xnF
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#ClinicalPearl
#seroneg #arthritis often has
👇
#involvement of
1st toe IP joint
Look at the feet 🦶
@RheumNow @ACRheum #ACR25
#28T08
Session secrets &pearls Tues https://t.co/EfqkLsTKmt
Janet Pope Janetbirdope ( View Tweet)
