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Proof-of-concept study: when PsA pts w/Achilles enthesitis & +US findings underwent pain induction, they showed ⬆️activity in the OBF gyrus, ant cing, left PCG, SMG, STG an left PC lobule vs. US- grp.
PsA pts w/+US process pain differently than US-
#ACR23 ABST1388 @RheumNow https://t.co/ScXA17LHPa
sheila ( View Tweet)
#GreatDebate #ACR23 @RheumNow
Advanced Rx 1st line in PMR/GCA
@philseo
IL-6 research in RA (STREAM, MOBILITY): safety of toci, sarilumab - compares to ADA
Ifn risk driven by GCs
GUSTO: TCZ w/ only 3d GC pulse - 13/18 in remission 24, 52w
PMR: "its not just a little bit of pred" https://t.co/sAlQ0pttcq
Eric Dein ( View Tweet)
@RheumNow https://t.co/WmHt6c12TG
TheDaoIndex KDAO2011 ( View Tweet)
Taiwanaise study of factors associated with 5 year mortality in patients after their first biological b,ts DMARDS
A highter risque mortality in RTX and lower in tsDMARD vs TNFi @RheumNow @Janetbirdope @Yuz6Yusof https://t.co/rjpo08Tg46
Dellal ( View Tweet)
#GreatDebate #ACR23 @RheumNow
Advanced Rx 1st line in PMR/GCA?
@philseo: Yes
"Biologics work. Steroids suck" https://t.co/mQfbiaTsRV
Eric Dein ( View Tweet)
#ACR23 Great debate: should we use biologics at PMR/GCA onset?
Dr Spiera (Cons)
-Need to agree on clin important diff & flares
-No evidence as disease modifying in GCA
- No need for disease modifying in PMR
-Most pts can be treated with steroid & rapid taper
-Cost @RheumNow https://t.co/ptM8E7EQzF
Md Yuzaiful Md Yusof ( View Tweet)
Plants For Joints continuation data poster was meant to be this am #ACR23 - but withdrawn.
Makes me sad!
Intervention: plant-based diet, exercise, stress Rx for 16w
Abstract reports 1y follow-up:
sustained DAS improvement, despite BMI reductions rebounding
Enticing
@RheumNow https://t.co/4adYf5BTtt
David Liew drdavidliew ( View Tweet)
Coming soon - the great debate!
Should PMR and GCA be treated with Advanced Therapies at disease onset?
@ACRheum @RheumNow #ACR23
Eric Dein ( View Tweet)
Pt w/ refractory SCLE, wants to get pregnant. Dr. Petri's approach is: counsel patient and review meds (e.g PPI's can induce SCLE). She also asks: Where's your hat and sunblock? Get HCQ blood levels b/f starting anifrolumab or belimumab #ACR23 @rheumnow #MeetExpert
TheDaoIndex KDAO2011 ( View Tweet)
Difficult SLE skin dse?
Dr. Mosca reminds us to engage pts in the treatment process including adherence to preventive measures & lifestyle mods (sun protection, smoking)
Other considerations:
+ antimalarials
early use of newer tx? - Anifrolumab
#ACR23 @RheumNow https://t.co/kz8YfcBB2d
sheila ( View Tweet)
#ACR23 Great Debate @ACRheum @RheumNow
Should you start with upfront bDMARD in #PMR and #GCA?
Janet Pope ( View Tweet)
Frailty in PMR @DrTrishHarkins >1/3 are frail or pre-frail. Frailty correlates with PROs - worse mood, pain, fatigue, and QoL. Abstr#1201 #ACR23 @RheumNow https://t.co/pH5yG4AscU https://t.co/QuHmOgpLbi
Richard Conway ( View Tweet)
Telemedicine tools with central evaluation of clinical and imaging (+/- MRI SIJs) information may be helpful in the diagnostic process for patients with suspected axSpA. This reduces the risk of overdiagnosis, Poddubnyy D, Abst#1392 #ACR23 @RheumNow https://t.co/kYEMdqmQF8 https://t.co/2lRg2byGjK
Dr. Antoni Chan ( View Tweet)
Pooled safety analysis of 48 phase II/III/IV trials on secukinumab for tx of PsO, PsA and axSpA
Well tolerated
No new long term safety signals
IBD, malginancy, MACE remain low
@RheumNow #ACR23 Abs#1436 https://t.co/6dzdO5Vpuc
Robert B Chao, MD ( View Tweet)
The Great Debate #ACR23 - and it’s a cracker.
Is early steroid-sparing therapy justified in GCA/PMR? I don’t know, but Rob Spiera and @philseo will battle it out to tell us.
(and ably moderated by the always eloquent @SattuiSEMD)
I’ll put some highlights here ⬇️🧵
@RheumNow https://t.co/ASpuglyENv
David Liew drdavidliew ( View Tweet)
Should #filgo be fil-gone in North America?
Unfortunately #filgotinib is not in NA, but is elsewhere & expanding into other diseases #IBD, IA, etc. Safety at >8yrs is similar to other #JAKi. #CDAI in MTX-IR at 1 yr in 200mg is impressive. @ACRheum @RheumNow #ACR23 1323, 1325 https://t.co/3iAZRcSeq6
Janet Pope ( View Tweet)
Baseline vascular ultrasound predicts clinical outcomes @ 3 months. Subclinical GCA = relapse 37% vs 15%. Higher cumulative steroid dose. @sharoncowley01 @DrTrishHarkins Abstr#1565 #ACR23 @RheumNow https://t.co/b35CkFS0lz https://t.co/suBGR1ByDK
Richard Conway ( View Tweet)
So firstly the no case, and Rob Spiera takes up the case, dictated by the electronic coin toss.
No-one disagrees that we need steroid-sparing options, or that IL-6Ri work in PMR and GCA. But it’s the strategy questions which remain in play:
#ACR23 @RheumNow https://t.co/I2QDU7l6DE
David Liew drdavidliew ( View Tweet)
@RheumNow #ACR23 #GreatDebate
Use Advanced Rx for GCA 1st line?
Spiera: No
No ev for disease modification with early Rx
Lose only reliable biomark of dis activity w IL-6 inhib
No evid of reduced major GC AEs
$$
GCA: treat by GC alone, taper off by 6 m, low threshold to escal https://t.co/QxgAlVKitd
Eric Dein ( View Tweet)
@RheumNow So what might early steroid-sparing therapy in PMR/GCA achieve?
Cure? Superior disease activity control? Minimize damage? Improve QoL/function?
Well, sadly we have a long way to go in defining a lot of this:
#ACR23 @RheumNow https://t.co/QeidAHHm8x
David Liew drdavidliew ( View Tweet)