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Dr Lillegraven presents a randomized open-label phase 4, non-Inferiority trial of TNFi tapering in RA patients in sustained remission. 63% of tapered patients flared over 12 months vs 5% of maintained. Good response to reintroduction of TNFi @rheumnow #ACR20 Abstr#2010 https://t.co/Ki7PTsetbH
Richard Conway RichardPAConway ( View Tweet)
Abst#2000. PRIME team Medicare database study pts with new RA started on MTX higher VTE risk than HCQ (HR 2.3). Unable to assess disease activity because claims database, but would imagine MTX grp more severe, driving increased VTE risk @RheumNow #ACR20 https://t.co/Z14xFTVXTp
Eric Dein ejdein1 ( View Tweet)
2020 #ACR20 RA guidelines were against steroid usage in RA. ESPOIR French cohort: 10 years of very low dose GC show increase events (death/CVD/fracture/severe ifn) even on low doses. HR increases every year. Cum GC dose-effect esp ifn, CVD. @RheumNow #ACRBest https://t.co/7b7chCPRxm
Eric Dein ejdein1 ( View Tweet)
Another great late-breaking asbtract: #HerpesZoster in patients w/ #rheumatoidarthritis taking #upadacitinib #JAKinhibitor
-HZ events more common in patients taking 30mg vs 15mg
-HZ more common in UPA vs those taking ADA+MTX & MTX
Abs#2002 #ACR20 @RheumNow
https://t.co/tQ03wBueW5
Mrinalini Dey DrMiniDey ( View Tweet)
Late breaking: in older #rheumatoidarthritis patients, those taking MTX have 2x risk of #VTE compared to those on HCQ. Important to consider #thromboembolic risk factors when starting new RA treatment.
Abs#2000 #ACR20 @RheumNow
https://t.co/lt8xDT4Ne8
Mrinalini Dey DrMiniDey ( View Tweet)
Which DMARD would you use in an RA pt Rx naive pt with mod dz activity and who has RA lung dz?
#acr20 @RheumNow
k dao KDAO2011 ( View Tweet)
Which JAKi will you use after MTX failure? #acr20 @rheumnow
k dao KDAO2011 ( View Tweet)
Which biologic will you use after MTX and TNF failure for RA pts? #acr20 @rheumnow
k dao KDAO2011 ( View Tweet)
Large cohort of older RA pts newly rx w/HCQ or MTX:
👉~2-fold ⬆ risk of VTE – both PE and DVT- among patients newly treated with MTX vs. HCQ.
@RheumNow #ACR20 abs#2000 @DanielHSolomon https://t.co/ZnDuMhTMYF
sheila RHEUMarampa ( View Tweet)
HCQ not associated with ⬆ incidence of cardiac dse in this cohort of RA pts.
We should continue using it. Benefits >>>risks.
@RheumNow #ACR20 abs1999 https://t.co/zYpbX0CsR1
sheila RHEUMarampa ( View Tweet)
NEW ACR2020 Draft Guidelines for the Pharmacologic Treatment of RA
All the guidelines in 2 tables!
1. MTX 1st, oral > SC
2. Minimize GC!
3. TTT TTT TTT
4. Biologic/tsDMARD > Triple Tx
5. Taper MTX 1st
Close to my practice; suspect will be controversial!
#ACR20 #ACRambassador https://t.co/iFSlq1H65V
Mike Putman EBRheum ( View Tweet)
Rheum Now shares Day 3 highlights from #ACR20.
https://t.co/xNv1fG97ib https://t.co/Psa8bRqlVh
Links:
Dr. John Cush RheumNow ( View Tweet)
Abst#1717 confirms that early start of csDMARDs as 1st line tx & keeping ts/bDMARD as 2nd line tx (or more) is associated w/ a favorable outcome at 10 yrs in the ESPOIR cohort (a French multi-center cohort that followed patients w/ early RA). #ACR20 @RheumNow https://t.co/bzZiShCF97
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
This - very cool.
Not as impressive as the implanted vagal stimulation pilot data, but once a day and well tolerated. Very early days but enticing, we will see!
#ACR20 ABST1995 @RheumNow https://t.co/QZ8npob2H9 https://t.co/fRlFwIHqky
David Liew drdavidliew ( View Tweet)
Wonder if you can predict development of clinical RA in those at risk either w/ a
- +RF or +CCP
- Relevant sxs w/ or w/o abs
- 1st deg relatives do RA pts?
Abst#1722 shows patterns of pain or degree of jt swelling from SPARRA Qnairre can do so. #ACR20 @RheumNow https://t.co/bQ4ZmSYhBe
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Interesting Swedish abstract 1997 at #ACR20. Adjuvant #herpeszoster vaccine (Shingrix) not effective for 25% of JAKi-treated RA pts (n=40) for antibody response (T cell response usually worse, not reported). Is better than nothing good enough? Maybe we need to hold JAKi briefly?
Jeffrey Curtis RADoctor ( View Tweet)
Fantastic session about the 2020 guidelines for management of RA! Soon to be published.
One major difference from 2015 guidelines ➡️ Conditional recommendation to choose a Biologic over Triple Therapy in MTX-inadequate responders (Discussion about patient preference is key!) https://t.co/s016piIN7Q
Dr. Tina Mahajan drtinamahajan ( View Tweet)
Very strong push by #ACR20 to recc MTX in most RA patient scenarios including RA ILD, RA nodules, NAFLD in new RA guidance document @rheumnow
k dao KDAO2011 ( View Tweet)
You have a patient with RA on 25 mg MTX SQ, tolerating well without side effects. They have moderate disease activity. Your next step: @Rheumnow. #ACR20
Eric Dein ejdein1 ( View Tweet)
New #ACR RA guidelines is cost conscious:
1. DMARD naive: Preferred MTX over LEF>HCQ/SSZ and preferred MTX over biologic/tsDMARD
2. DMARD naive low DAS: HCQ or SSZ preferred >MTX>LEF
3. T2T goal LDA/remission
@rheumnow (thread)
k dao KDAO2011 ( View Tweet)
