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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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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)
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)