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Difficult to treat RA is not an homogeneous group!
Trajectory analysis 60months shows 4 different clusters
Cluster 2 = 1/3 of patients, do better but never reach LDA.
The ones Fibromyalgia, OA and other conditions blurring assessment?
#Abstract0382 #ACR23 @RheumNow https://t.co/dxxS7vCcMt
Aurelie Najm ( View Tweet)
Dr. Arbeeva explains how a "modern diet" can lead to MetS, intestinal dysbiosis & obesity - risk factors assoc w/ development of #osteoarthritis
Modern diet:
⬆️calorie processed food
⬇️proportion of fruits & veggies
⬆️ratio of omega-6 FA:omega-3FA
#ACR23 @rheumnow @rheumarhyme https://t.co/biVSE103S0
sheila ( View Tweet)
Year in Review: Dr. P Seo
⭐️Low dose colchicine assoc w/ ⬇️ incidence of hip/knee replacement
➡️ 5522 pts w/ stable CAD: colchicine 0.5 mg vs PBO for median of 28.6 months
➡️ Hip/knee: 2.5% vs 3.5%
➡️HR 0.69
Similar finding in 2020 CANTOS trial using Ilaris
#ACR23 @RheumNow https://t.co/PD26zoolDB
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Calling #rheumtwitter program directors! #ACR23 Plenary 0726 details considerations for developing MSUS curriculum from Canadian experts. Details below. https://t.co/VmbxkYwlcr @rheumnow https://t.co/5nrpDk0Dsc
Dr. Rachel Tate ( View Tweet)
Thinking beyond immunosuppression for SLE Nephritis management:
SGLT-2i
GLP-1RA
ERAs
@RheumNow #ACR23 https://t.co/RdmKnm08YY
Robert B Chao, MD ( View Tweet)
Love teaching about the PsA-AxSpa-IBD venn diagram of disease manifestations
Interesting idea, using fecal calprotectin to trigger colonoscopy in pts w/PsA/axSpA
~40% w/pathologic finding, 4.4% dx w/IBD
Jives w/my clinical experience
@RheumNow #ACR23 Abstr0495 #ACRBest https://t.co/rIQpJnup9v
Mike Putman EBRheum ( View Tweet)
Year in Review: Dr. P Seo
Novel RA therapy on the horizon:
⭐️Peresolimab
➡️ stimulates PD1
➡️ Phase II, 98 pts
➡️ tx-resistant to other therapies including biologics
➡️ Wk 12: better DAS28, ACR20, not ACR 50/70
#ACR23 @RheumNow
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
A possible curative therapy of an autoimmune disease via selective depletion of a TRBV-defined group of T cells. This could be potentially applicable to other HLA-B*27-associated spondyloarthropathies. Year in review, Seo #ACR23 @RheumNow https://t.co/NxxkpJhweH. https://t.co/41Po5CHid3
Dr. Antoni Chan ( View Tweet)
YR in Review: Dr. Seo
🚩GLORIA Trial
RA pts > 65yo: prednisolone 5 mg/d x 2 yrs vs PBO + std care
➡️decr dz activity (DAS ⬇️0.37) but 24% incr ADE
🚩Extension:
➡️Tapered off pred over 3m and..
⭐️NO ADRENAL INSUFF
But, small incr in dz activity (DAS ⬆️0.23)
#ACR23 @RheumNow https://t.co/YQbS6C8ZT5
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR23 Memorable Quote as reminded to us by Dr. P Seo during Year in Review:
"What you think of as a rare manifestation of a common disease is probably a common presentation of a disease you are not aware of (yet)!"
- Prof Seza Zen, MD
@RheumNow https://t.co/Xhwb1brLKG
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Yet another (mostly) reassuring report about lymphoma and DMARDS
The skin cancer signal in the CIRT trial was weird; would be worth looking into that in observational studies as well @NamrataRheum
#ACR23 Abst0438 @RheumNow https://t.co/Beg8UUe2mn
Mike Putman EBRheum ( View Tweet)
It seems so simple. We should be able to use proteomics to better pick winners when it comes to b/tsDMARDs in RA.
Why is it hard? I guess:
- theory ≠ practice
- too many other factors
- it's too easy not to
Yet I hope/believe, one day we'll do better.
#ACR23 ABST0427 @RheumNow https://t.co/5VBVp3KOJN
David Liew drdavidliew ( View Tweet)
If you're >65 years old & have new RA, you start a DMARD, right? At worst, sometime in the first year?
US Medicare data 2008-17
n=33,373
only 30% have a DMARD on file
(of which bDMARD <10%)
>5% on PNL alone
Do we hate old people with RA?😔
@JihaRheum #ACR23 ABST0433 @RheumNow https://t.co/1CUXAh3fi0
David Liew drdavidliew ( View Tweet)
Revisiting question in #painful #knee #osteoarthritis Which #steroid to inject - esp with #triamcinolone #hexacetonide shortages which is superior to #acetonide. New extended release #fluticasome #propionate > #placebo ? Is how about vs IA steroids LB04 @RheumNow @ACRheum #ACR23 https://t.co/qJazwihSe0
Janet Pope ( View Tweet)
Kudos @AlexisOgdie & co for their work in this area
Given proliferation of database research for causal inference, super important to have validated criteria to identify diseases
Many spaces (looking at you sarcoidosis) where this is almost entirely absent
@RheumNow #ACR23 https://t.co/krkgWAhjMr
Mike Putman EBRheum ( View Tweet)
#obesity is a significant RF for #osteoarthritis
Assoc'd with:
💠impairment of gut biota
💠microbial translocation
Leads to innate immune activation
#ACR23 @RheumNow @rheumarhyme https://t.co/iuEvBh3A1j
sheila ( View Tweet)
I underestimated how much joy not-bankrupting our healthcare system would bring me
ADA & RTX biosimilars have been wonderful; excited for IL6's to join the party
@RheumNow #ACR23 Abstr0445 https://t.co/HGwi37rZpd
Mike Putman EBRheum ( View Tweet)
Which to use in #EGPA? #Mepolizumab IL5i vs Benralizumab = monoclonal Ab binding to IL5Ralpha. Noninferiority RCT - both are similar. Is more Impt ? IL5 drug vs #Rituximab or #Cyclo for severe Eosinoph granuloma todos w polyangiitis 🤷 #ACR23 @RheumNow @ACRheum https://t.co/zyZeHHSsck
Janet Pope ( View Tweet)
Contributing Factors for Difficult-to-Treat RA using Natural Language Processing (NLP): joint erosions (OR 2.97 CI95% [2.17; 4.08], p< 0.001) , higher disease activity (median DAS28 3.16 vs 2.89) associated with D2T, Bergier Abst#0383 #ACR23 @RheumNow https://t.co/KARxoa2Z7H
Dr. Antoni Chan ( View Tweet)
COVID boosters in RA patients:
getting the job done (versus healthy controls, irrespective of non-withheld DMARDs excluding ritux)
@UChicagoMed #ACR23 ABST0416 @RheumNow https://t.co/HVRjC4dauw
David Liew drdavidliew ( View Tweet)