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Maintain Vigilance for CV Risk Postpartum in Autoimmune Diseases
Pregnant women with autoimmune rheumatic diseases (ARDs) and antiphospholipid syndrome (APS) face significantly increased risks of cardiovascular events (CVEs). This increased risk is often attributed to ARDs, its medications or comorbidities associated with it.
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@Dr_K presenting long COVID data from FORWARD RA.
These pts had some symtoms before COVID!- More comorbidites, depression patient reported scores, fibromyalgia but no different DMRD use.
PHQ8 and wodepread paid were the most important PROMs @RheumNow
#ACR23 https://t.co/JaWc4oDnaI
Bella Mehta bella_mehta ( View Tweet)
Window of opportunity in PsA
Higher time to diagnosis in
-female
-higher enthesitis
-less swollen joints
-lower CRP
If diag > 52 wks, over 3 yrs
Less MDA, less remission
Worse HAS-DI, PSAID
Same Rx progression
No diff between <12 wk & 12-52 wk
@RheumNow #ACR23 ABST1641 https://t.co/Ek1CDFwENg
Aurelie Najm ( View Tweet)
#Precision #Medicine in RA RCTs. Treat w right drug at right time?
Possible problems -sample variation on synovial #bx, some won’t respond ex fibrotic phenotype variable drug distribution/resistance. AI is helping to separate Pts #ACR23 @ACRheum @RheumNow 13M140 https://t.co/D7NxpM4YNw
Janet Pope ( View Tweet)
Michaud et al. RA patients with long COVID had more fibromyalgia pre-COVID (41% vs 13%), higher rates of pain, depression, and worse PROs pre-COVID. Authors suggest long COVID may partially reflect pre-existing illness Abstr#1629 #ACR23 #ACRbest @RheumNow https://t.co/mrcGWrSD6c https://t.co/YiGCbvBDtn
Richard Conway ( View Tweet)
Haberman et al. In PsA non-white patients have higher tender (but not swollen) joint counts, higher radiographic axial disease, worse skin disease. Women have higher RAPID-3 scores. Abstr#1639 #ACR23 @RheumNow https://t.co/4SL7FLzNuE https://t.co/sVwk1VaSLS
Richard Conway ( View Tweet)
SGLT2 inhibitors compared to DPP4i may be better at reducing risk for MACE & renal progression in patients with SLE/LN and diabetes. SGLT2i risk for MACE (HR 0.69, 95% CI 0.48-0.99), and renal progression (HR 0.71, 95% CI 0.51-0.98). abst# 1579 #ACRbest #ACR23 @rheumnow
TheDaoIndex KDAO2011 ( View Tweet)
#ACR23 Abstr#1512 Can we improve trial design of Bcell depletion in #SLE? Feasibility RCT of RTX in organ specific MSK showed: a) feasible to use ultrasound & clinical as endpoints, b) new tool LAMDA is responsive, c)potential worsening before later improvement with RTX @RheumNow https://t.co/YmbUOWVdWS
Md Yuzaiful Md Yusof ( View Tweet)
Do you discuss HPV vax & cervical CA screening w/SLE & RA pts?
In this study, more women w/SLE discussed cervical CA screening w/their rheums(33.3% vs. 11.4% p<0.01) & more likely to have persistent abn paps on ffup
Similar HPV vax status for both grps
#ACR23 ABST1356 @RheumNow https://t.co/Vbu8hbZ1uh
sheila ( View Tweet)
#ACR23 Abstr#1509 SLR & Meta-Analysis of RCTs in lupus nephritis (N=16 studies):
-CNI (VOC/TAC/CyA) alone (OR 1.4) or combined MMF (OR 2.1) was assoc with CR vs SOC (MMF/Cyclo)
-Less GI AEs & cytopenia in CNI
Assuring data esp when cost is a hurdle for VOC @RheumNow #ACRBest https://t.co/9ScakIdXBN
Md Yuzaiful Md Yusof ( View Tweet)
Karpouzas et al. MTX reduces IHD in males but not females with RA. 4362 patients. 66% lower risk MACE and 55% lower risk any ischaemic CVE. Abstr#1627 #ACR23 @RheumNow https://t.co/MC4W0dinUv https://t.co/1hkBoawt4b
Richard Conway ( View Tweet)
RA males 81% increase MACE & 58% ischemic CVE
2 folds Males>Females in MTX non users
Makes MTX users reduction 66% & 55% risk MACE & ischemic CVE and no diff w/ females
MTX use not assoc w/ reduction MACE in females
@RheumNow #ACR23 ABST1627 https://t.co/qbAc2bWdcM
Aurelie Najm ( View Tweet)
RheumNow’s expanded coverage of the #ACR23 annual meeting is sponsored in part by Bristol Myers Squibb and UCB. All content is chosen by RheumNow and its faculty.
Dr. John Cush RheumNow ( View Tweet)
SMART study in RA, splitting MTX
Split dosing better at wk 16 but ~similar at wk 24
Caveat: wonky design from wk16-wk24 makes it hard to interpret?
Surprsingly, adverse events ~similar but smallish sample
Mostly supports my practice of splitting?
@RheumNow #ACR23 #ACRBest https://t.co/g7s4EUHeCW
Mike Putman EBRheum ( View Tweet)
#ACR23 QD Clinic - Hemoptysis
SLE patient with Alveolar Hemorrhage
QD Clinics are sponsored by RheumNows Coverage of ACR2023 live from San Diego
https://t.co/V2wSYVkWDj https://t.co/4kdgS2WJeJ
Dr. John Cush RheumNow ( View Tweet)
SMART study - MTX split into morning and evening once weekly vs all together. 253 patients. Split dosing better efficacy (DAS28 4.1 vs 4.5, p=0.03), more LFT elevation but less neutropenia. Abstr#1583 #ACR23 @RheumNow https://t.co/tkrds4uqQP
Richard Conway ( View Tweet)
#ACR23 Abs #1641 found early referral & dx in PsA associated w/ better clinical outcomes. MDA & DAPSA remission over 3 years less likely after > 52 weeks from symptom onset to dx. Likely delays in females w/ less swollen joints & lower CRP/ ESR https://t.co/meVQ1UisKY @rheumnow https://t.co/EBN7wJfjzK
Dr. Rachel Tate ( View Tweet)
Split dose oral MTX (15/10mg) versus single dose (25mg) in RA RCT 250pts
EULAR good resp
16wks 22 vs 10% (sig)
24wks 37 vs 28% (ns)
50% more addition of 2nd csDMARD in single dose
#ACRBest @RheumNow #ACR23
ABST1583
For more thoughts, have a read https://t.co/urA6X4rY0D 👇🏼
Aurelie Najm ( View Tweet)
SMART on MTX
Ab#1583 @RheumNow #ACR23
Single dose MTX 25 mg v Split dose (same day 15/10 mg). FA 5 mg 2x/wk. 16w can add csDMARD
Split 29% vs 22% - EULAR response improve - not signif. Better DAS28
Split: 35% added 2nd csDMARD vs. 54.5% in single dose
No stat diff in sAE
#ACRBest
Eric Dein ( View Tweet)
with The @RheumNow John Cush
#ACR23 https://t.co/muRAOn3Cb9
Dr M Nazibur Rahman, MD (Rheumatology) ( View Tweet)