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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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What do we see in GCA, with serial PET/CT after five years?
In this Australian cohort:
cranial uptake disappears
extra-cranial uptake sometimes emerges (but not for pts on DMARDs)
Still understanding the trajectory of smouldering activity
@tonysammel #ACR23 ABST1645 @RheumNow https://t.co/mKB3mjBuBt
David Liew drdavidliew ( View Tweet)
Factors predicting fatigue in RA differ by disease activity.
Synovial lining hyperplasia and synovial lymphocytic inflammation on histology were key factors.
@rheumnow #ACR23 session 13M148 https://t.co/yPBZX2Rxft
Bella Mehta bella_mehta ( View Tweet)
RA-ILD: the study that exonerates TNFi ?
TNFi vs. other BioDMARDs/JAK do not increase risk of death or hospitalization over 1 and 3 yrs follow up.
No subgroups stand out
VHA cohort, 50% smokers
No info on ILD patterns or disease trajectory
ABST1582 @RheumNow #ACR23 https://t.co/frv16oRLqv
Aurelie Najm ( View Tweet)
Lovering et al. Synergestic effect of RA and CVD on dementia risk. 35% increased risk RA, 89% increased risk RA+CVD. Abstr#1628 #ACR23 @RheumNow https://t.co/Brj8XrG2o4
Richard Conway ( View Tweet)
#ClinicalPearl or #pathology pearl? Using synovial #biopsies to guide therapy in #RA #RCTs is a reality. But likely #fibrotic #phenotype won’t respond and #lympho_myeloid has more RA damage. #ACR23 session 13M140 #Precision #medicine #ACRbest @ACRheum @RheumNow https://t.co/DmI9dNpu8w
Janet Pope ( View Tweet)
PET/CT real-world performance in GCA diagnosis, Sydney @tonysammel:
comparable to other modalities
can optimize for sen or spec based on managing equivocal results
?some steroid confounding
but definitely one of 3 complementary imaging options for GCA
#ACR23 ABST1646 @RheumNow https://t.co/FvdLMvpqEU
David Liew drdavidliew ( View Tweet)
#ACR23 Abstr#1634 Promising therapy for two #Sjogren groups: 1 (high ESSDAI & ESSPRI) & 2 (low ESSDAI, high ESSPRI). Phase 2 RCT of Iscalimab (anti-CD40ab) showed more ISC-treated pts met the primary endpoint (ESSDAI and ESSPRI changes at WK24) vs PBO. Going to Phase 3 @RheumNow https://t.co/3bN3IS1zCO
Md Yuzaiful Md Yusof ( View Tweet)
@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)