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Are Emulation Trials a Fantasy?
Are emulation ‘trials’ helpful, despite the biases that occur with observational data, or do they truly mimic the results of randomized controlled trials (RCTs)?
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RA-ILD:
💡Lifetime prevalence seems low but ~40% can have subclincal.
💡Screen early in symptomatic pts.
💡RA disease control decreases ILD progression and mortality.
💡RA-ILD UIP pattern seems to respond to immunosuppression.
#ACR24 @RheumNow https://t.co/q3iACMeYVU
Links:
Adela Castro AdelaCastro222 ( View Tweet)
A#1690 fibroblast activation protein inhibitor (FAPI)-PET in SSc ILD
Introduces FAPI quantification algorithm
FAPI uptake predicts greater rate of FVC decline. Trend for DLCO, not statistically signif
FAPI volume & intensity both predict accel lung decline
#ACR24 @RheumNow https://t.co/YA2ptLDaMy
Links:
Eric Dein ericdeinmd ( View Tweet)
#1689: race-neutral 🫁 function equations in SSc improve equity:
🔹 Race-specific equations underestimate disease severity in Black patients.
🔹 Switching to race-neutral reclassified 45% of Black patients to more severe, 16% of White patients to less severe
@RheumNow #acr24 https://t.co/BfK2PsCMX5
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
More data from PAISLEY, deucravacitinib in SLE
Small but significant benefit w/respect to joints, a little disappointing tbh
Would like to see this for all manifestations ie pericarditis, pleuritis, etc
Anyone have an infographic or useful chart?
#ACR20 @RheumNow Abstr#1552 https://t.co/tXUoUtssxo
Links:
Mike Putman EBRheum ( View Tweet)
Study on cardiovascular deaths in SLE:
- Analyzed 1999-2020 data
- Overall decline in mortality rates, but recent increase since 2014
- Higher rates in women and African Americans
- Geographic disparities noted
#ACR24 abst#0998 @rheumnow https://t.co/dpjsl0gI0x
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Bella Mehta bella_mehta ( View Tweet)
Zhang @jeffsparks et al. Even more evidence that MTX does not cause ILD, and in fact prevents ILD, in RA, OR 0.48 in meta-analysis. @RheumNow #ACR24 Abstr#1384 https://t.co/YvQnmmvNjF https://t.co/crYUwHahDb
Links:
Richard Conway RichardPAConway ( View Tweet)
Slick poster, but must be careful w/real world data. Big risk of confounding/channeling bias
Pts with MACE risk (not always well-characterized by ICD codes) also less likely to receive JAK & therefore less liekly to have subsequent MACE
#ACR24 @RheumNow Abstr#1394 https://t.co/lilU0byJ1s
Mike Putman EBRheum ( View Tweet)
Findings from Abstr#1436 reveal that cigarette smoking is not positively associated with radiographic progression in psoriatic arthritis (PsA). Current and past smokers showed a longer time to joint damage progression. This suggests a complex relationship that warrants further… https://t.co/ERsAKoivA4
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Serrano-Combarro et al. Case series of upadacitinib in RA-ILD. 18 patients. Report stable/improved dyspnoea and HRCT over 12 months. PFTs shown, relatively stable @RheumNow #ACR24 Abstr#1372 https://t.co/yncy0lPq60 https://t.co/mrDMtEDwUt
Links:
Richard Conway RichardPAConway ( View Tweet)
Reason for consult: aortitis- evaluate for systemic causes
Abstract 1638: Kmetova et al highlight the promising clinical utility of calprotectin as a marker for clinically isolated aortitis
@RheumNow #ACR24 https://t.co/2qPaAqWswG
Akhil Sood MD AkhilSoodMD ( View Tweet)
🫁RP-ILD a/w high morbidity and mortality
How to Predict RP-ILD Development?
➡️AutoAb: anti-MDA5, anti-ARS, anti-Ro52
➡️Biomarkers: CRP, LD, Ferritin, KL-6
➡️CT: Lower consolidation/GGO
#ACR24 @RheumNow https://t.co/OIrHfVTZcM
Links:
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Abstract 333 showed that in a cohort of patients with IIM-ILD increased age, PH, FVC decline at 1 yr, SOB at 2 years were predictors for mortality and lung transplant ! #ACR24 @RheumNow https://t.co/NgOj7WKeE3
Gabriela Martinez Zayas, MD MartinezZayasMd ( View Tweet)
How does #cardiovascular risk vary with #ACPA & #biologics in #RA?
⬆️BMI assoc with ⬆️MACE risk in ACPA+ pts
In ACPA- pts, BMI inversely assoc with MACE risk among pts on biologics
Further evidence to consider ACPA, BMI & MACE as part of RA management
Ab0870 #ACR24 @RheumNow https://t.co/UkkC146DWS
Mrinalini Dey DrMiniDey ( View Tweet)
Cross-sectional study finds metabolic dysregulation in RA-ILD is indicative of poor prognosis- FGF-21 assoc w. poor survival.
Another link btwn CV risk factors, metabolic syndrome & RA? Should we be doing more to manage metabolic risk factors in RA-ILD?
Ab0803 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
Don’t miss the “window of opportunity” for aggressive treatment in early RA!
with active RA, risk of ILD 6x and RA-related lung disease 4x higher
#ACR24 @RheumNow ABST#0802 https://t.co/yxlfInte6A
Jiha Lee JihaRheum ( View Tweet)
How often should #scleroderma #ILD pts have #PFTs? 🤷♂️
Data from SENCIS RCT of SSc-ILD
25% worsened FVC by 6/12
Are we UNDER a ordering PFTs in an ILD #SSc population
👇
Because if worsening we would consider a change in background #immunesuppression
@RheumNow #ACR24 #678 https://t.co/a9ybO3FwDd
Janet Pope Janetbirdope ( View Tweet)
Results from MANDARA- #EGPA pts treated with benralizumab or mepolizumab
Eosinophil-targeting biologics rapidly control airway- & non-airway-related manifestations
Few pts had worsening of disease that progressed to organ damage over 52W
Ab0828 #ACR24 @RheumNow https://t.co/hIn9iyNVWQ
Mrinalini Dey DrMiniDey ( View Tweet)
What's the assoc between RA disease activity & ILD?
Results @MassGenBrigham show early active RA is assoc with
➡️6x incr risk of #ILD
➡️4x incr risk of RA-related lung disease
Early DMARDs are vital to reduce articular & extra-articular manifestations!
Ab0802 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
McDermott @jeffsparks et al. SAIL-RA prospective study. 172 early RA patients. RA lund disease in 16%, RA-ILD in 11%. Disease activity strongest predictor RA lung disease, HR 4.89, and RA-ILD, HR 6.17. @RheumNow #ACR24 Abstr#0802 #ACRbest https://t.co/ia0koG64mL https://t.co/U1KdgcUfOy
Links:
Richard Conway RichardPAConway ( View Tweet)
