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The Heart of Lupus
Few people are aware of the EULAR recommendations for cardiovascular risk management in SLE published in 2022. The recommendations had 4 overarching principles: increase awareness of elevated cardiovascular risk, need for regular cardiovascular screening, assess and manage modifiable risk factors, and patient education. During ACR 2023 Convergence, several abstracts were presented evaluating the prevalence of CV disease and exploring new tools to predict CV disease.
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Canadian Consensus on MSK Ultrasound
Dr. Jack Cush discusses abstract 0726 presented at the 2023 ACR Convergence meeting in San Diego, CA.
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Do Probiotics Improve Psoriatic Arthritis?
Psoriatic arthritis and the gut microbiome have become more intertwined, especially in the past few years. It was to my amazement that one of the first abstracts I came across was the effect of probiotic modulation on gut dysbiosis and disease activity in psoriatic arthritis patients.
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Ph2a Nipocalumab: FcRn blocker
IV15mg/kg TNF IR RA 32 pts
Delta DASCRP -1 vs -0.5 PBO
ACR50 20% vs 0 PBO
DAS Remission 40% vs 16% Only in ACPA+ pts
SAEs 1 infusion related reaction
Not extremely convincing alone
Currently studied in combination w/ TNFi
@RheumNow #ACR23 ABST0839 https://t.co/6wTu2ellhN
Aurelie Najm ( View Tweet)
Utility of repeating assessments in chronic back pain pts suspected of early axSpA?
2 year study found a modest increase in new axSpA diagnosis after 2 years
Yield of repeating MRI is low but can be considered in B27+ males
@RheumNow #ACR23 Abs#0845 https://t.co/TgSEztUkTm
Robert B Chao, MD ( View Tweet)
RheumNow’s expanded coverage of the #ACR23 annual meeting is sponsored in part by Novartis. All content is chosen by RheumNow & its faculty
Dr. John Cush RheumNow ( View Tweet)
Ross et al. Fascinating study of infusion of etanercept into lymphatics in RA in inadequate responders to s/c etanercept. DAS28(CRP) reduced 5.40±0.16 to 3.55±0.21, PGA of Disease Activity and Pain decreased by 66% and 77%. Abstr#0838 #ACR23 @RheumNow https://t.co/RIMCS3nmy6 https://t.co/U2689atvmj
Richard Conway ( View Tweet)
LTE of REOVAS of RTX in EGPA. Relapse free survival 64% vs 51%, major relapse free 90% vs 79%. If MPO+ relapse free survival 92% vs 50%. Abstr#0854 #ACR23 @RheumNow https://t.co/76hlYRxWhY https://t.co/RSsgxxQKVC
Richard Conway ( View Tweet)
Thank you @RheumNow I appreciate your mission and appreciate your team’s kindness today at #ACR23
#Lupus awareness is fun! https://t.co/ifRXxmpUaM
Amanda G ( View Tweet)
APIPPRA trial of abatacept to prevent RA in sero+ arthralgia. Picture paints a thousand words - big difference at week 52 (on abatacept) and watch those lines converge Abstr#0835 #ACR23 #ACRbest @RheumNow https://t.co/cwX389TUZN https://t.co/2CQHYlW0nq
Richard Conway ( View Tweet)
IFN 5-gene signature to ID high IFN subsets as biomarkfor DEUC in PAISLEY P2 SLE trial
Ab847 #ACR23 @RheumNow
IFN 5 gene score - 78% IFN-high pt
IFN high ass w SLEDAI-2K, CLASI, PGA, dsDNA, low C3/C4/lmphocyte
DEUC reduc IFN 5 gene score in both grps, best clin response in IFN hi https://t.co/WpZHE5z8za
Eric Dein ( View Tweet)
PMR in the #ACR23 @US_FDA new approval update - not something you see every day!!
@RheumNow https://t.co/yll3d4AicK
David Liew drdavidliew ( View Tweet)
Ab#0848 @RheumNow #ACR23
Biomarkers to Differentiate Flare from Bacterial Ifn in SLE
CD14 and CD64 modest increase in infections v flare, better than IL-6 and MRP8/14
One marker not enough to differentiate, but in combo w/ complements, procal, dsDNA improves composite scores https://t.co/MeMYbkMTQH
Eric Dein ( View Tweet)
The critical mass of biosimilars in the US is surely getting there.
My opinion: now it’s time for price competition. Otherwise you have to ask, what was the point of it all?
Maybe I’m just a naive foreigner. But US patients deserve better.
#ACR23 @US_FDA session @RheumNow https://t.co/enHY6xffMa
David Liew drdavidliew ( View Tweet)
Baker et al. Danish registry study. Truncal vagotomy increases risk RA (but not OA), HR 2.62 (95% CI 1.47-4.67). Support for vagus nerve stimulation in RA? Abstr#0836 #ACR23 @RheumNow https://t.co/SbphSMLHc7 https://t.co/93SfyGizLt
Richard Conway ( View Tweet)
Inflammatory reflex suggests role of vagal nerve in inflammation regulation
Danish database
Truncal vagotomy
2000+ pts matched w/ 22000+ = Increase risk for RA HR 2.6
Not the case for supras elective vagotomy (HR 1)
No influence on OA
@RheumNow #ACR23 ABST0836 https://t.co/3ThYP1nKTe
Aurelie Najm ( View Tweet)
Lots of our patients taking CBD products, and they won’t always tell us…
but if you don’t ask, you’ll miss the drug-drug interaction that affects the meds we rely on.
#ACR23 @US_FDA session @RheumNow https://t.co/Q9UMJiTDkq
David Liew drdavidliew ( View Tweet)
The belimumab-rituximab combination has utility in SLE, but it comes at an incremental safety cost.
May well be worth it in many of our patients, but very understandable that the @US_FDA label gets further clarification
#ACR23 @US_FDA session @RheumNow https://t.co/RwF2wbsrQk
David Liew drdavidliew ( View Tweet)
Here's the counterpoint to the previous positive tweet on vagal nerve stimulation in RA. The previously promising data on auricular vagus stimulation falls flat on further study Abstr#0837 #ACR23 @RheumNow https://t.co/APnrPhWA9q https://t.co/adA0H1VETt
Richard Conway ( View Tweet)
This is particularly interesting considering this 👇🏼👇🏼
First RCT of NI auricular vagal nerve stimulation did not meaningfully improve RA disease activity or outcomes.
No SAEs
Is this supporting the need for other VNS modalities?
@RheumNow #ACR23 ABST0837 https://t.co/yFcMPoSc31 https://t.co/G069XwUyAz
Aurelie Najm ( View Tweet)