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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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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)
#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)