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#ACR23 @RheumNow
SGLT2 inhibitors help CV & renal outcomes, but SLE pts excluded @AprilJorgeMD
ComparedSGLT2 to DPP4 inhibs, real world observation emulation study in SLE pts with T2DM
Lower incidence of MACE & renal progression
Subgroup w LN - risk reduction 10.2 MACE/100 py https://t.co/JpJ0yWNQBe
Eric Dein ( View Tweet)
Excellent start to Plenary II
Should we borrow SGLT2i and DPP4i use from endocrine?
SLE pts who initiated SGLT2 or DPP4: lower risk of MACE and renal progression
@RheumNow #ACR23 Abs#1579 https://t.co/RsaWuetyft
Robert B Chao, MD ( View Tweet)
RA peripheral blood mononuclear cells display IFN-gamma signature
Driven by 2 cell subsets: T cells & macrophages
IFNg driven transcription factors
Increased only in ACPA+ RA
Differential biology could inform ACPA stratified therapy
ABST1271 @RheumNow #ACR23 https://t.co/EN2noKGupK
Aurelie Najm ( View Tweet)
Glucocorticoids-free zone in SLE?
For over 70 years, glucocorticoids, (GC) have been a part of standard therapy in SLE. They are classically used to not only induce remission or treat an acute flare, but also as maintenance therapy. #ACR23
https://t.co/sfRhNj6OpZ https://t.co/k6VoG5lKO7
Dr. John Cush RheumNow ( View Tweet)
To remind us. Glory be! GLORIA a #RCT in elderly active #RA: MTX+10 mg daily #prednisolone which was better than MTX alone. But more infections and no comparison of inexpensive Rx such as adding #HCQ. Still debated as to benefit vs risk of this strategy @RheumNow #ACR23 @ACRheum https://t.co/slOmESbIOW
Janet Pope ( View Tweet)
Rather unsurprising finding at this point, but valuable nonetheless
Per usual, joint efficacy for bimekizumab (IL17i) ~similar to TNF
New twist; similar loss in efficacy over time. Nice to have another IL17i; not sure this is a "blockbuster"
@RheumNow #ACR23 Abstr1437 https://t.co/4sVfSz7ZnK
Mike Putman EBRheum ( View Tweet)
In axSpA, the mean and median progression were 0.54 and 0.38 points in mSASSS per year respectively, lower than what has been reported in similar cohorts, LBP before diagnosis was a strong predictor of progression, Granados R Abst#1389 #ACR23 @RheumNow https://t.co/fvkOzhUG97 https://t.co/k18HxWswbs
Dr. Antoni Chan ( View Tweet)
Great Debate on the use of biologics in treatment of Giant Cell Arteritis and Polymyalgia Rheumatica!
Let's begin with Dr. Robert Spiera on why we should NOT use IL-6i
No evidence of disease modifying
Lose biomarker activity
Cost
@RheumNow #ACR23 #ACRbest https://t.co/XCT02wYb2s
Robert B Chao, MD ( View Tweet)
Interesting abstract re:dx trajectories, I have a counter-intuitive take
I expect pts w/high dx activity to respond BETTER than pts w/LDA at diagnosis
More autoimmunity + less fibro = higher chance to respond to DMARD?
Anyone else feel that way?
@RheumNow #ACR23 Abstr1426 https://t.co/D6GU7tMcY6
Mike Putman EBRheum ( View Tweet)
How does Dr. Robert Spiera manage GCA?
1) Tx with steroids alone, taper by 6 months
2) Do not chase ESR/CRP
3) Pay attention to steroid complications
4) Low threshold to use IL-6i
Similar plan for PMR
Taper steroids by month 4
@RheumNow #ACR23 https://t.co/KSwyfjobFY
Robert B Chao, MD ( View Tweet)
Here is the popular answer@to the #ACR23 debate of up front bDMARD in GCA and PMR Yes vs No. the audience has no consensus. Access is Impt, experience and criteria of who to use it in. @ACRheum @RheumNow https://t.co/7pxF4w926m
Janet Pope ( View Tweet)
Debaters and moderators acknowledge IL6i may not be the only steroid sparing agents that would work for #GCA. Abatacept, secukinumab, JAKi are being evaluated #greatdebate @rheumnow #ACR23
TheDaoIndex KDAO2011 ( View Tweet)
@philseo on why we SHOULD use IL-6i in GCA and PMR
1) Infection risk similar to TNFi
2) Too many (63%) pts remain on steroids at 1-2 yrs
3) May accelerate remission
4) Steroids are Bad, even at low doses
@RheumNow #ACR23 https://t.co/muPPcAc6LC
Robert B Chao, MD ( View Tweet)
Still uncomfortable with IL-6i in GCA or PMR especially given the pt population and potential AE?
Be on the look out for NEW biologics!
Mavrilimumab
Secukinumab
and MORE!
@RheumNow #ACR23 https://t.co/gdcDIcvffa
Robert B Chao, MD ( View Tweet)
More vitamin D during pregnancy is better, right?
Hopkins Lupus cohort, vit D levels & adverse pregnancy outcomes
Actually, there's a sweet spot
(too high just as unfavourable as too low)
Maybe popping vit D pills isn't always limitless
@jhrheumatology #ACR23 ABST1364 @RheumNow https://t.co/TVPCqP3dq9
David Liew drdavidliew ( View Tweet)
Patients with autoimmnue diseases have a high maternal and fetal complication rate!
Abst 1003 #ACR23 @RheumNow https://t.co/pnvvBUN2JG
Bella Mehta bella_mehta ( View Tweet)
Quick curmudgeonly complaint
WHY are we doing 316 week extensions? That's 292 weeks of $$$ data... for what?
1. Insufficient N to assess meaningful safety signals
2. Open label, no comparator
It's just a very very expensive observational study
@RheumNow #ACR23 Abstr1434 https://t.co/Thj1XjeAn1
Mike Putman EBRheum ( View Tweet)
Have we forgotten our physical rehab roots in RA?
RA with severe functional disability
1y of personalised exercise program vs routine care
n=215, Leiden
broad functional gains as expected
Remember:
the meds are critical, but can only take you so far.
#ACR23 ABST1335 @RheumNow https://t.co/FszhGAv7ln
David Liew drdavidliew ( View Tweet)
A bit of talk about treating pre-RA, but how do patients feel about it?
Clinically suspect arthralgia pts, Leeds
Influenced by different factors:
symptoms
personal risk
meds experience
knowledge
perceived effort
Acceptable tradeoffs are very personal
#ACR23 ABST1258 @RheumNow https://t.co/wZGfdffNji
David Liew drdavidliew ( View Tweet)
Pregnancy Updates That Will Change The Way I Practice
Dr. Rachel Tate ( @uptotate) shares two abstracts related to autoimmune patients and pregnancy risks, and her take home practice updates. #ACR23
https://t.co/X85lkKpcea https://t.co/djDujw810T
Dr. John Cush RheumNow ( View Tweet)