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Mortality in Low Dose Prednisone

Eric Dein, MD

Upon release of the new ACR 2020 Pharmacologic Treatment Recommendations for the Management of Rheumatoid Arthritis, many practitioners were surprised that the new guidelines recommended against glucocorticoid initiation at disease onset.

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Taiwanese claims data on new RA (2003‐2016) shows decreasing incidence over time. After RA Dx the life expectancy was 26.3 yrs; lifetime cost US$ 72,953. On avg RA pts live 4.97 years less (historically this was 8-11yrs); has biologic era improved this? https://t.co/gHbZx1bw0A
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1st refractory to DMARD can be bad omen. RA Study showed 41/402 (10%) were multi-DMARD refractory (MR) and 18% achieved remission/LDAS. DMARD MR predicted by erosions, younger age, high baseline DAS28, delta-DAS < 1.2 1st 6 mos (OR 11.12) https://t.co/KxdK97uuSI
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#BestACR20Tweets RT @KDAO2011 : Big wins for #pedirheum! #FDA had approved for JIA;2 y.o: 9/29 golimumab iV for JIA/PsA 9/25 tofacitinib (weight based dosing) for polyarticular JIA (tofacitinib dosing for JIA: 10 kg-20kg: 3.2 mg bid, for 20-40 kg 4 mg bid, for 40 kg 5 mg bid)
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#BestACR20Tweets RT @RichardPAConway : Dr Kaellmark reports on immunogenicity of adjuvant herpes zoster subunit vaccine in RA patients treated with JAKi. 40 RA patients and 20 controls. Satisfactory serological responses and tolerability seen. @rheumnow #ACR20 Abstr#1997 https://t.co/TR9IS9hUgu
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#BestACR20Tweets RT @MeralElRamahiMD : A large observat study showed no difference in risk of major CV events in RA pts that were newly started on either MTX or HCQ. A greater stroke risk but lower risk of MI; hospitalized HF was seen in MTX initiators. #Abst1993 #ACR20
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#BestACR20Tweets RT @MeralElRamahiMD : Wonder if you can predict which pts you can taper off bDMARDs? Abst#1538 from Denmark showed that a neg IgM-RF (OR 0.26); low Doppler serum score for 24 jts predicted discontinuation of bDMARDs at 2yr f/u in RA pts w/ DAS28-CRP&lt;2.6. https://t.co/6hv5M1CQwT
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