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SpA Sleuths: The Case of Undiagnosed IBD
Abstract #0494 provides context to our continual search for better understanding of inflammatory bowel disease in patients with AS, nr-AxSpA, and PsA.
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Who gives a ‘JAK’ why and how they work, as long as they do!
Several abstracts have studied the mechanism of action of JAK inhibitors (JAKi) in various diseases. JAKi alter many other mediators affected by the JAK STAT pathway. For instance, T cell signature in blood that is proliferative was associated with a response in RA.
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Issues in AxSpA: Treatment Intensification, Pregnancy
A lot of interesting studies will be presented at the poster sessions on Sunday, November 12 and some of them address practical real-world issues such as treatment intensification and the impact of pregnancy on axSpA imaging.
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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)
Late-Breaking Ph 2b RCT of TAK-279, oral TYK2 Inhib, in Active PsA. ACR20 in 53-54% (30 mg qd) vs 29.2% PBO at wk 12 (p = 0.002). Abst #L12 presented on Tuesday. #ACR23
Dr. John Cush RheumNow ( View Tweet)
#ACR23 Abstr#0782 Triple therapy in #lupus nephritis. Propensity match data AURORA vs ALMS showed pts treated with voclosporin+MMF+low dose GC vs MMF+High dose GC achieved earlier reduction in UPCR & fewer AEs. Cdnt control for everything e.g. HCQ but assuring @RheumNow #ACRBest https://t.co/dmriAyQPr0
Md Yuzaiful Md Yusof ( View Tweet)
Clinical pearls in #CNS vasculitis: Dr. R.Hajj-Ali
🧠Clinical dx is difficult bec it presents w/ an array of clinical features
🧠CSF analysis essential in dx; can r/o infexns
🧠Nonvasc imaging highly sensitive
🧠biopsy is valuable esp when alt dx is considered
#ACR23 @RheumNow https://t.co/QOAfSHn8ND
sheila ( View Tweet)
What is D2T PsA?
A proposal of definition in ABST0777
Thoughts:
A lot of features are extrapolated from the EULAR RA definition
RA & PsA population are hardly comparable
Lack of emphasis more problematic domains ie. dactylitis
Further work is required
@RheumNow #ACR23 https://t.co/A28e6XBME3
Aurelie Najm ( View Tweet)
DRESS-PS study LTE. 12 month observational extension. 114 patients PsA/AxSpA. Essentially patients TNFi tapered or not in T2T fashion. TNFi dose remained lower in tapering group but it is consistently creeping back up. Abstr#0775 @RheumNow #ACR23 https://t.co/aYoOl6Ccin https://t.co/BtMR95lIfs
Richard Conway ( View Tweet)
Fascinating how upadacitinib may well have an effect on pain in RA, beyond inflammation.
Now seen similar for bari in RA & guselkumab in PsA. And, if real, for some people could be a massive get. Love to see dedicated studies
SELECT-COMPARE post-hoc #ACR23 ABST0429 @RheumNow https://t.co/Tk278mGJYY
David Liew drdavidliew ( View Tweet)
MEDIPSA: probiotic vs PBO RCT in PsA
12 weeks
Using strains Bifidobacterium and Lactobacillus
No effect on DA or PROMs in PsA
No effect on gut parameters either
Good safety profile
Wrong strains or not an generally efficient intervention?
ABST0778 @RheumNow #ACR23 https://t.co/RPgT7LoRgC
Aurelie Najm ( View Tweet)
What do you think of CAR T Rx in severe #SLE? @RheumNow @ACRheum #ACR23
Janet Pope ( View Tweet)
Ab#0596 #ACR23 @RheumNow
R Furie on Decravacitinib in SLE
48wk double-blind trial. PBO v DEU 3mgBID, 6 mgBID,12 mg qd
Higher response, faster time to SRI(4), BICLA and dual response v PBO. More likely to sustain response from w32-48. https://t.co/M34d3nQmwv
Eric Dein ( View Tweet)
LEGACY Cohort - Rx monitoring AZA/Tacro in SLE pregnancy
Ab#0586 #ACR23 @RheumNow
70 pregnancie. 33% prescribed AZA, 9% TAC
AZA - 91% subtherapeutic or non-adherent
More likely in non-Caucasian, on steroids, longer SLE duration, prior lupus nephritis
TAC - 3/6 therapeutic levels
Eric Dein ( View Tweet)
Do probiotics improve psoriatic arthritis?
Unfortunately no difference in disease activity compared to placebo.
Limited effects on gut dysbiosis
Minor effects on T cell composition
@RheumNow #ACR23 Abs#0778 https://t.co/JuBesyfnV2
Robert B Chao, MD ( View Tweet)
Targeted OX40L (co-stimulatory APC protein w/ possible polymorphisms in SLE) study by Womba et al, found OX40L targeted CAR-Tregs had superior in vitro suppression of activated T cells & dendritic cells relative to Control-Tregs. #ACR23 Abs 0799 https://t.co/GgCGGIvhHF @rheumnow https://t.co/GZMEUCTooh
Dr. Rachel Tate ( View Tweet)
Should the cost of #CAR-T stop us from considering in severe refractory #lupus? So far update of German group show remission - drug free and great safety. But hold on..we need RCTs with an active control and longer f/u, but I am impressed! #ACR23 #ACRbest @ACRheum @RheumNow #784 https://t.co/mRMWLCbpCY
Janet Pope ( View Tweet)