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Advances in RA-ILD
Dr. Jeffrey Sparks gave a state of the art update on Advances in RA-ILD, many of which he and his group have played a big part in, on Saturday at RNL26.
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ALTO: Long-Term Abatacept Outcomes in At-Risk RA
Lancet Rheumatology has published the ALTO results - long term outcomes of the APIPPRA trial, demonstrating that treatment with abatacept (ABA) in at risk patients can delay progression to rheumatoid arthritis (RA) for up to 4 years.
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RT @richardPAconway
Dr Sparks shows risk factors for RA-ILD. Important for diagnosis (and screening?) Focus interventions on the modifiable ones! #RNL26 https://t.co/lE9Mkbq8oh
Dr. John Cush RheumNow ( View Tweet)
RT @richardPAconway
UIP is predominant radiologic pattern in RA-ILD. Contrast with our other diseases. But by no means exclusive - up to 50% of RA-ILD have a more inflammatory pattern. Important treatment implications! #RNL26 https://t.co/HmW1mz429i
Dr. John Cush RheumNow ( View Tweet)
RT @richardPAconway
Updated data on RA-ILD from Olmstead County. Cumulative incidence of 15.3% over 20 years! #RNL26 https://t.co/wVrTc3QM6Y
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinmd
Mucosal Hypothesis RA #RNL26
Demoruelle
Mucosal origins of RA?
Key sites of immune-environment interaction initiate local inflamm, becomes systemic
Link of lung inflamm/immune dysregulation - ass w/ smoking, ILD
NETs in lung drive RA path?
Gut/oral microbes drive
Dr. John Cush RheumNow ( View Tweet)
Advances in RA-ILD
Dr. Jeffrey Sparks gave a state of the art update on Advances in RA-ILD, many of which he and his group have played a big part in, on Saturday at RNL26.
https://t.co/xO7hBRKeqE https://t.co/rs1MS08Svl
Links:
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinmd
Mucosal Hypothesis RA #RNL26
Demoruelle
ACPA can predate RA development
Nam et al: non-specific jt pain: 42% developed RA in 12 mos
Circiumaro et al: MSK complaints 38% devel RA in 36 mo
APIPPRA: 29% at 12 mo, 37% at 24 mo, StopRA 18% in 12 mo, 33% at 36 mo https://t.co/DxGhhFL1gO
Dr. John Cush RheumNow ( View Tweet)
RT @richardPAconway
Dr Sparks. RA-ILD is common. Pooled prevalence of 11% from recent meta-analysis. Less common than SSc or IIM, but more frequent than we think! #RNL26 https://t.co/mJSmMakSBM
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinMD
Mucosal Hypothesis RA #RNL26
Demoruelle
ACPA can predate RA development
Nam et al: non-specific jt pain: 42% developed RA in 12 mos
Circiumaro et al: MSK complaints 38% devel RA in 36 mo
APIPPRA: 29% at 12 mo, 37% at 24 mo, StopRA 18% in 12 mo, 33% at 36 mo https://t.co/JYiWmn0N0g
Dr. John Cush RheumNow ( View Tweet)
RT @richardPAconway
Dr Sparks. RA-ILD is common. Pooled prevalence of 11% from recent meta-analysis. Less common than SSc or IIM, but more frequent than we think! #RNL26 https://t.co/TCsDfeQjZC
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinmd
Mortality risk in RA #RNL26
Myasoedova
Most common mortality:
1.5-1.6x increase risk CVD
2-3x increase risk ILD
+ACPA increases risk in both https://t.co/Luwyy6UFg6
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinmd
Mortality risk in RA #RNL26
Myasoedova
Premature deaths in up to 1/4 of pts
Decline in mortality in RA after year 2000
Full siblings of RA also high mortality (shared genetic or environ factors affect risk?)
Risks: Seropositivity, esp ACPA, CRP, extra-artic https://t.co/ytm6odmtgR
Dr. John Cush RheumNow ( View Tweet)
Methotrexate intolerance in rheumatoid arthritis
A current large rheumatoid arthritis (RA) cohort study from Cairo assessed methotrexate (MTX) use and found over half were MTX intolerant and a third of patients were noncompliant with MTX.
https://t.co/ODiVqUXBb9 https://t.co/QwmNkrjvn6
Dr. John Cush RheumNow ( View Tweet)
Always on exams, but I've never seen a case! JAMA Dermatology reviews Multicentric Reticulohistiocytosis - pt w/ multiple nodules on hands & pain in shoulders, elbows, MCPs, IPs. Erythema over face, chest, & back & bead like Perionychial papules. Rx w/ MTX + Pred https://t.co/QgS5VBOB51
Dr. John Cush RheumNow ( View Tweet)
ALTO: Long-Term Abatacept Outcomes in At-Risk RA
Lancet Rheumatology has published the ALTO results - long term outcomes of the APIPPRA trial, demonstrating that treatment with abatacept (ABA) in at risk patients can delay progression to rheumatoid arthritis (RA) for up to 4 https://t.co/Lb8md9cYbG
Dr. John Cush RheumNow ( View Tweet)
Study of 286 RA pt finds comorbidity burden—particularly psychological comorbidity—was strongly associated with poorer HRQoL and greater management difficulty in RA. https://t.co/F90S55DaI6 https://t.co/4Hw1yTUgP5
Links:
Dr. John Cush RheumNow ( View Tweet)
RA outcomes according to onset: typica RA vs undifferentiated inflam arthritis (UIA) or palindromic rheumatism (PR). Progress to RA = RA > UIA > PR. PR has more +FHx & ACPA; UIA more females w/ Knee Sxs. Best remission rates w/ PR onsets. https://t.co/JJRCdKcs1u https://t.co/n385f6EF59
Links:
Dr. John Cush RheumNow ( View Tweet)
Methotrexate intolerance in rheumatoid arthritis
A current large rheumatoid arthritis (RA) cohort study from Cairo assessed methotrexate (MTX) use and found over half were MTX intolerant and a third of patients were noncompliant with MTX.
https://t.co/PDUv2YRFIq https://t.co/2DuBXjNqec
Dr. John Cush RheumNow ( View Tweet)
2016 ARTIC trial tested T2T w/ MTX & "bridging" tapered Prednisolone (15 mg --> 0mg over 7wks) in 237 new DMARD naive RA pts. PRED discontinuation successful in 84% @7wks, 89% @3mos, 95% @ 24 mos. Only 5% require Pred @ every visit for 2 yrs. You can D/C pred! https://t.co/O23PHq81YP
Dr. John Cush RheumNow ( View Tweet)
