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Methotrexate: shall we split up?
Methotrexate is widely used in rheumatic diseases yet poses common tolerance issues, especially for the oral form; and bioavailability is known to be limited for doses over 15mg. In the SMART study, Prasad et al. present the first RCT comparing either single dose (25 mg) or split-dose (10 mg morning, 15 mg evening, same day) once weekly MTX for 24 weeks.
Does TNFi use in pts with RA and early breast cancer affect survival?
TNFi did not affect overall survival or breast cancer specific survival compared to cDMARDs
Steroids did increase mortality
@RheumNow #ACR23 Abs#1675
Robert B Chao, MD ( View Tweet)
No significant difference in overall survival in early stage breast cancer (BC) patients treated with TNFi (alone -/+ cDMARDs, in 1st year of BC) and cDMARDs in RA. Those on glucocorticoids had worse survival. Suarez-Almazor M, Abst#1675 #ACR23 @RheumNow https://t.co/lnZx3OpuN5
Dr. Antoni Chan ( View Tweet)
Petri @jhrheumatology data on SGLT2i in SLE
A#1490 #ACR23 @RheumNow
Prior to Rx, average annual change in eGFR was -3.1
After starting SGLT2i, average change decr to -0.9
Did not reach signif (p=0.27)
Average annual incr in UPCR was 0.4 -> 0.37 on SGLT2i, also not signif https://t.co/TviFyAwXbA
Eric Dein ( View Tweet)
Insights into pathogenesis venous & arterial thrombosis in RA + JAKi
Significant dysregulation of clotting pathways in myeloid & increased clot formation in context of microbial challenge (TLR4)
Observed across all JAKI, but selective JAK3i
@RheumNow #ACR23 ABST1676 https://t.co/nboy0znfAW
Aurelie Najm ( View Tweet)
Suarez-Almazor et al. TNFi in early breast cancer do not impact overall survival, HR=0.75 (0.41-1.37), HR=0.86 (0.55-1.34). Better cancer specific survival HR=0.29 ( 0.09-0.98)! Abstr#1675 #ACR23 #ACRbest @RheumNow https://t.co/qS5W7WehiN
Richard Conway ( View Tweet)
Two-week interruption of MTX for IMIDs enhanced boost of antibody responses after COVID-19 vaccination, sustained at 12, 26 weeks. Consistent across ages, MTX doses, route, IMIDs, primary vaccination platform,COVID-19, Abhishek A Abst#1677 #ACR23 @RheumNow https://t.co/T0KdsGh6vg
Dr. Antoni Chan ( View Tweet)
VROOM 🏎️ study
2 wks interruption of MTX just after COVID vaccine:
-Increase S1-RBD Ab response for 26 wks
-Improves Neutralizing Ab titres (Wuhan Hu-1)
-Leads to more flares wks 4 & 12
Greater effect when MTX dose>15mg
@RheumNow #ACR23 ABST1677 https://t.co/SJmaRHtbRH
Aurelie Najm ( View Tweet)
Abishek et al. 2 week break from MTX enhances response to COVID-19 vaccination, mirroring what we saw for flu. Trade off is short term worsening of disease activity. Abstr#1677 #ACR23 @RheumNow https://t.co/gguRWER81x https://t.co/1hncvDTahH
Richard Conway ( View Tweet)
There was a lower hazard ratio for incident cancer with exposure to TNFi compared to non-TNFi (RTX and ABA) and JAKi. Limits: potential for residual confounding by indication and small number of outcomes per drug class, Xavier S, Abst#1678 #ACR23 @RheumNow https://t.co/vJpFwl6Ivj
Dr. Antoni Chan ( View Tweet)
A#1403 #ACR23 @RheumNow
17% of 1st degree relatives of AS pts have MRI-defined sacroiliitis
Study of 100 subjects w FHx AS
- 13/100: new dx of AxSpA, 7 w radiographic changes
- 4/100: Sacroiliitis without back pain
- 1 periph SpA
- 12 met clinical ASAS classification but not dx https://t.co/V7LCbaDXBe
Eric Dein ( View Tweet)
OA and Syncope #ACR23
OA patient on NSAIDs presents with a peptic ulcer and GI Bleed.
https://t.co/vhRnv6dPim https://t.co/H4gsCivyxN
Dr. John Cush RheumNow ( View Tweet)
GCs Major Driver of Depression in SLE Ab#1446 #ACR23
@RheumNow
1463 pts with SLE, prospective longitudinal study GC use: 49-57% of pts Prevalence of depression at any time: 89.8%, most of time 35%!! Risk factors: - Fibromyalgia OR 2.9 - GC OR 1.85
Eric Dein ( View Tweet)
Hand movement video: more promising than photos as a computer vision concept for remote monitoring of RA disease activity.
Of course: validation, training, clinical evaluation all must happen before it is ready for your clinic
https://t.co/HyN6ElKF0F #ACR23 ABST1293 @RheumNow https://t.co/DltI9HFiFE
David Liew drdavidliew ( View Tweet)
Fatigue 😴 in RA & synovial biology
In DAS LDA pts Fatigue asso w/
-female sex
-synovial lymphocytic inflammation
In DAS moderate DA:
-female sex
-synovial lining layer
-Anxiety
Limitations: arthroplasty tissue, small sample size, no Immunohisto
@RheumNow #ACR23 ABST1630 https://t.co/4vhzvdPgyd
Aurelie Najm ( View Tweet)
PRES in SLE
A#1478 @RheumNow #ACR23
303 cases of Posterior Reversible Encephalopathy Syndrome in SLE
- Mean age 28, 91% F
- 42% HTN, HLD 15%, DM 10%
- 83% lupus nephritis. 80% dsDNA, 41% Sm, 38% aPL
- 78% seizures
- 3% mortality
- Transient in 45%, persistent in 19%, 8% sequelae
Eric Dein ( View Tweet)
#ACR23 Abstr#1636 Phase 2 crossover RCT of Dazodalibep, Anti-CD40L-i in #Sjogren pts with high disease activity showed primary endpoint, change in ESSDAI was met in DAZ vs PBO. More COVID in DAZ in Stage 1 but trial was at the start of pandemic. Phase 3 is starting soon @RheumNow https://t.co/hZcpOHumB3
Md Yuzaiful Md Yusof ( View Tweet)
Fisher et al. In high disease activity, fatigue associates anxiety and synovial lining hyperplasia, 1.57[1.01,2.5]; p=0.047) In LDA, fatigue associates chronic lymphocytic synovial inflammation, 1.92[1.09,3.57]; p=0.024) Abstr#1630 #ACR23 @RheumNow https://t.co/Gev6pU3srq https://t.co/Ys8etP36ir
Richard Conway ( View Tweet)
Do we miss RA activity in obese pts?
Pre-clinical trial entry MSK USS:
similar DAS28
but lower SJC/US scores in obese
Is it because, in obese RA patients:
we underdetect on exam?
we undertreat?
higher risk, so lower penetrance of severe dx endotypes?
#ACR23 ABST1287 @RheumNow https://t.co/3FFPdBJOpz
David Liew drdavidliew ( View Tweet)
Vasculitis in SLE
A#1443 @RheumNow #ACR23
804 SLE pts, 74% black, 9.5% h/o vasculitis
45% visceral vasculitis, 43% cutanous, 8% both
Pts w vasculitis: younger age of SLE dx- 27 v 31y
Risks: other SARD, renal dx, neuro dx, low compl
Trend to higher mortality 21 to 14% (no signif)
Eric Dein ( View Tweet)