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Playing it Safe with RA? JAK vs. TNF Debate

Brian Jaros, MD

Reported safety signals, at odds with the efficacy of these medications, have left rheumatology clinicians in a difficult position when considering when during a patient’s treatment course and in which patients, specifically, JAKi should be used. Two abstracts from ACR convergence 2024 further contribute to our understanding of this potential risk profile.

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statin

ORAL Surveillance - Is Statin Use the Problem/Solution?

Eric Dein, MD

The findings from ORAL Surveillance Study have been a dominant conversation at recent ACR Convergence, with the seminal findings and subsequent analyses a target of debate. Subsequent post-hoc analyses, follow-up studies, and claims data analyses have been used to further interpret the data, though a clear answer on safety is not certain. A study presented on Sunday reported on a new post-hoc analysis that provides new insights.

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heart,CV,MI.cardia,

Addressing CV Risk in RA: Are we doing enough?

Mrinalini Dey, MD

ORAL surveillance was a post-authorisation safety study of tofacitinib 5mg and 10mg versus TNF inhibitors, focusing on rates of adverse events, including MACE. A higher incidence of MACE was observed with the use of tofacitinib. Statins are recommended in patients with a history of atherosclerotic disease or 10 year predicted risk of MACE. But, how many patients with rheumatoid arthritis, at risk of MACE, are actually taking a statin?

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ACR 2024 - Day 2 Report

Jack Cush, MD

Plenary sessions began the day, followed by thousands on the abstract floor. Here are a few of my favorite presentations from day 2 at ACR 2024.

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Shedding Weight and Pain: The Promise of Anti-Obesity Medications in RA For years, rheumatologists have championed weight loss as a cornerstone of care for patients with rheumatoid arthritis (RA) and obesity. RA is an independent risk factor for cardiovascular disease (CVD), a… https://t.co/iozo0FQFzj https://t.co/93e4nZMHJo
Dr. John Cush RheumNow ( View Tweet)
ICYMI: Precision medicine in Ssc ILD? Yes! -Watch and wait approach can cause irreversible lung damage. -⬆️CRP: biomarker of response (predicts mortality) -⬆️KL-6: biomarker of severity (predicts progression of fibrosis) -FAPI-PET: can eval disease activity vs response to ttx.… https://t.co/bTepwrsuNN https://t.co/e6xjtuquka

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Adela Castro AdelaCastro222 ( View Tweet)
Does CVD mortality risk change after stopping GC in RA? ➡️28078 incident GC users ➡️Incr mortality risk from CVD &infections persists post-cessation ➡️Risk never returns to pre-GC level after prolonged use ⏩Use GC at lowest dose for shortest time possible Ab2673 #ACR24 @Rheumnow https://t.co/dtLU8obLke

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Mrinalini Dey DrMiniDey ( View Tweet)
#PAH in #SSc still has a poor #prognosis 👎 Esp #ILD with PAH - a double whammy But also group 1 PAH And Some are unclassifiable ▶️also bad px Need Earlier detection More interventions ?prevention Abst#0678 #ACR24 @RheumNow @ACRheum @sclerodermaUM https://t.co/AEQsTC1pzQ

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Janet Pope Janetbirdope ( View Tweet)
Loiseau et al. 4700 pSS, 47000 comparators. pSS associated with increased risk of every CV/VTE outcome. Did not have that in my priors! @RheumNow #ACR24 Abstr#2631 https://t.co/QKemUhbcG8 https://t.co/twpjdS2L63

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Richard Conway RichardPAConway ( View Tweet)
Triboulet et al. JAKi in RA-ILD. 42 patients. Stability of PFTs over median 21 months. HRCT stable in 62%. Progressive ILD on HRCT in 19%. @RheumNow #ACR24 Abstr#2249 https://t.co/PY9BrCfNHc https://t.co/r8fIgrjyDu

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Richard Conway RichardPAConway ( View Tweet)
Cardiology is on! Dr. Olin discusses Fibromuscular Dysplasia findings on imaging Definite: string of beads and/or focal narrowing in right setting / location Possible but nonspecific: dissection, ecstasia, aneurysm, and tortuously @RheumNow #ACR24 https://t.co/Dr81KQfLSf

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Brian Jaros, MD Dr_Brian_MD ( View Tweet)
#2222 📊 New data on #RA-ILD: 🔴In early RA, ILD prevalence hits 21.4% after 10 years, with 8.2% cumulative incidence at 5 years (IR 14.9/1000 PY). 🔴ILD often precedes or coincides with RA onset. 🔴NSIP > UIP 🔴airway involvement less common than expected. #acr24 @RheumNow

Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)

The 🫀is muscle‼️ 💥From the maestro herself @JuliePaikMD underscores why cardiac involvement in myositis can't be overlooked. 🔥Crucial insights with major implications for patient care and outcomes #acr24 @RheumNow @HopkinsMedicine @jhrheumatology https://t.co/mw6BvkdF2w

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Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)

Risks for HCQ cardiotoxicity: 👉>5 yrs use 👉>5 mg/kg/d (cumulative dose >500,000 mg) 👉CKD 👉use NSAID 👉preexisting heart dz 👉presence of ocular, derm, SkM toxicity - Dr M Garschik #ACR24 @rheumnow https://t.co/LFobgls4jm

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TheDaoIndex KDAO2011 ( View Tweet)
Dentition is important in RA, but it's easy to forget it's a matter of life or death. NHANES data shows fewer teeth strongly correlates with higher mortality (esp cardiovascular). Missing teeth = CV death HR >30 Holistic dentition is holistic RA care #ACR24 ABST1325 @RheumNow https://t.co/Z40bSFybuS

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David Liew drdavidliew ( View Tweet)
Dr. BDinneen et al reported predictors that can help screen axSpA pts w/o traditional CV RFs for carotid doppler utz: - shorter dse duration - no family hx of IHD - HLAB27+ - ⬆️ dBP, WHratio, ferritin, TC, LDL and TC:HDL ratio Small size, more data reqd @RheumNow #ACR24 abs1440 https://t.co/3pZxFmutJz

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sheila RHEUMarampa ( View Tweet)
Wallace et al. Case control study. 648 cases 1241 controls. Cumulative glucocorticoid dose and risk MACE. Dose dependent increase in risk, OR 1.01 for 10% increase GC, 1.21 for 10-fold increase GC. @RheumNow #ACR24 Abstr#1719 https://t.co/wraiWOl1dv https://t.co/feht58RDNc

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Richard Conway RichardPAConway ( View Tweet)
A#1694 To get one or two lungs for lung transplant? 🫁 Autoimmune related ILD transplant outcomes? 145 single (SLT), 461 double (DLT) Similar 1 yr mortality - HR SLT 1.19 unadjusted, 1.49 adj - not statistically significance @RheumNow #ACR24 https://t.co/uo8WbrNFAm

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Eric Dein ericdeinmd ( View Tweet)
#Gout attack is assoc w 1.5 X MI, MACE in next 30 days @ACRheum @RheumNow #ACR24 https://t.co/7IeFbW6xW8

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Janet Pope Janetbirdope ( View Tweet)

A#1693 Change in FVC @ W12 or 24 has progn value @ w52 in AI-ILD Study SENSCIS (SSc) & INBUILD (SARD) trial PBO gps SENSCIS: OR for ILD progression 1.9 @ w12, 2.5 @ w24 INBUILD: OR 2.2 @ w12 & w24 Early PFTs predict outcomes @ 1 yr, short trials may be feasible #ACR24 @RheumNow https://t.co/8cICAeG0nr

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Eric Dein ericdeinmd ( View Tweet)
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