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How do we manage difficult discussions about pregnancy in RA?
Most rheumatologists know that it is important to get pregnancy planning right for women of childbearing age living with rheumatic diseases. That is easier said than done, though: the details are difficult, it is overwhelming for the patient, and the conversations are hard.
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#ACR23 Abstr#1479 In N=66 patients with #SLE, 29% had high risk HPV infection. Associated with lupus disease duration. In 2nd screening ~1yr after, multiple infections occurred in 15%, about similar vs women with HIV. Call to promote HPV vaccination in SLE 💉 @RheumNow https://t.co/UGIrCwu32x
Md Yuzaiful Md Yusof ( View Tweet)
Should Methotrexate be prescribed as split dosing?
Multi-center, RCT of RA pts showed split dosing of 25mg MTX resulted in higher efficacy + reduced need for additional DMARDs, compared to single dose MTX
@RheumNow #ACR23 Abs#1583 https://t.co/zjjnzWUl5E
Robert B Chao, MD ( View Tweet)
Dr. AMendel et al:TMP-SMX prophylaxis assoc w⬇️serious infexns in RTX treated GPA pts; BL (aHR 0.5;95%CI 0.3-0.8) & time-varying exposure (aHR 0.5; 95%CI 0.3-0.9)
A good thing to consider but weigh benefits/harms w/TMP-SMX prophy. More studies req'd?
#ACR23 ABST1584 @RheumNow https://t.co/dfsfpcQu2A
sheila ( View Tweet)
Izokibep, IL-17Ai, #ACR23 abs #1688 demonstrated ACR70 in 52%, PASI100 in 71% and enthesitis complete resolution in 89% at week 46. Well tolerated, no dose-related AEs, similar safety with other IL-17Ai https://t.co/TQAIVa9H2j @rheumnow https://t.co/ihzxnuAsWw
Dr. Rachel Tate ( View Tweet)
TMP-SMX in AAV with RTX. 919 patients. Only given to 31% (40% on steroid>20mg), what!? TMP-SMX aHR 0.5 for serious infection, aHR 0.7 for minor infection. PJP 13 vs 0. Abstr#1584 #ACR23 @RheumNow https://t.co/4YQELIC82F https://t.co/U5l5KzSkB5
Richard Conway ( View Tweet)
MOSAIC study: #ACR23 Abs #1690 finds APR reduces clinical and objective MRI indices in PsA, confirming an effect of APR on clinical and inflammatory manifestations of PsA. https://t.co/F5D81FF1tj @rheumnow https://t.co/rGglgiOyDg
Dr. Rachel Tate ( View Tweet)
TMP-SMX PPx in GPA
A#1584 @RheumNow #ACR23
919 pt analyzed
TMP-SMX ass w/ decr serious ifn (HR 0.5), less outpt ifns (0.9)
Rates for AEs attrib to TMP-SMX per 100 py: 29.6, wo TMP-SMX: 13.4
13 PJP, all in non-TMP-SMX pts
Should we use Bactrim to prevent ifn beside PJP? GC effects
Eric Dein ( View Tweet)
#ACR23 Abstr#1584 Data N=919 pts with GPA vasculitis treated with rituximab showed Septrin prophylaxis (+/- 28days of RTX) reduced serious & any infection. PJP=1.4% not on septrin. Question remains re: how long for in those receiving repeat cycles & steroid confounding @RheumNow https://t.co/81f8hbMids
Md Yuzaiful Md Yusof ( View Tweet)
What is frailty?
How does it affect RA outcomes?
Pop based cohort study
13000+ RA vs. 26000+ matched ctrl
Over 2x more frailty 5.6% vs 2.6%
OR frailty in RA 2.3
Adjusted for rurality, neighborhood income quartiles AND BL comorbidities index
@RheumNow #ACR23 ABST1275 https://t.co/ZkOpgHPSE0
Aurelie Najm ( View Tweet)
17% of 1st degree relatives AS pts had MRI- defined sacroiliitis, however not all of them were diagnosed w/ SpA due to absence of back pain. 25% w/ 1st degree AS relative met the classification criteria for SpA #ACR23 Abs #1403 https://t.co/W1T9ZqD4o1 @rheumnow https://t.co/DnaNSLiqfU
Dr. Rachel Tate ( View Tweet)
SMART study #ACR23 Plenary abs #1583: po split-dose MTX (vs single dose) once weekly in RA pts had ^^ efficacy & reduced need for add'l DMARDs. No major AE, but slight increase in frequency of persistent transaminitis in split-dose group. https://t.co/wHzjpSnfuA @rheumnow https://t.co/0hNTMGbt47
Dr. Rachel Tate ( View Tweet)
Large VA study of >1k RA-ILD pts
No difference in risk of respiratory hospitalization or death in RA-ILD pts using TNFi vs. nonTNFi/JAKi
Data does not support avoiding TNFi in RA-ILD
@RheumNow #ACR23 Abs#1582 https://t.co/LTNLXEIAPo
Robert B Chao, MD ( View Tweet)
Ab#1582 @RheumNow #ACR23
RA-ILD outcomes of TNFi v non-TNF b/tsDMARD
VA Data, propens match emulation study
No incr risk of death in TNFi vs non-TNFi
But are TNF safe?
- Don't support systematic avoidance. But are there specific pops - unsure. Don't answer if efficacy in RA-ILD https://t.co/AApEjZs4DM
Eric Dein ( View Tweet)
Important plenary session, RA-ILD outcomes in VA cohort study
No difference in death/hospitalization for TNF vs non-TNF treated patients. Jives w/my priors; I do NOT avoid TNF in RA-ILD
Encouraging if you (like me) prefer RA-active tx for RA-ILD 😉😆
@RheumNow #ACR23 #ACRBest https://t.co/TIDzMLOfs4
Mike Putman EBRheum ( View Tweet)
World's largest jSSc cohort: djSSc pts had more severe dz vs ljSSc pts. DjSSc pts w/ more cutaneous, vascular, MSK involvement vs ljSSc pts w/ more cardiac involvement. No significant differences in ILD, PAH, GI involvement. #ACR23 Abs #1623 https://t.co/czAH0hpY2a @rheumnow https://t.co/RcfAJORXY3
Dr. Rachel Tate ( View Tweet)
Non TNFi b/tsDMARDs vs TNFi in RA-ILD. New-User, Propensity Score Matched Study. 454 patients. No difference! resp-related hospitalisation aHR 1.22 [0.92, 1.60] No difference mortality. Abstr#1582 #ACR23 #ACRbest @RheumNow https://t.co/HzzVo9dJHi https://t.co/mZuHq4GShU
Richard Conway ( View Tweet)
The SMART study by Dhir et al: once-weekly, oral split-dose MTX (10mg/15mg) in RA pts had⬆️efficacy & ⬇️need for addtl DMARDs vs. once-weekly, single-dose MTX
Reassuring.
. . .
In my practice, pts tolerate MTX split dosing better esp w/⬆️doses
#ACR23 ABST1583 @RheumNow https://t.co/F8p2aKmmH4
sheila ( View Tweet)
#ACR23 Abs #1032 identified six major themes of diverse patient experiences. Studying patient experiences is critical for understanding mechanisms of health disparity, targeting interventions and, ultimately, improving quality of care. https://t.co/Fd2m4yzlHp @rheumnow https://t.co/EhIIF9cquQ
Dr. Rachel Tate ( View Tweet)
RheumNow’s expanded coverage of #ACR23 annual meeting is sponsored in part by Novartis. All content is chosen by RheumNow & its faculty.
Dr. John Cush RheumNow ( View Tweet)