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ACR23 – Day 1 Report
ACR 2023 is back in San Diego for its annual convergence of thousands of rheumatologists to partake, discover and learn from thousands of abstracts and hundreds of sessions and presentations. It was a big return for the Poster Hall with rows and rows of research, friends, fellows and poster tours. Below are a few of my favorite presentations from the posters, Plenary and oral sessions on day one.
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Sex bias in RA: time to stop blaming hormones?
Whether it’s RA, SLE or Sjogren’s, the increased prevalence of females affected by auto-immune diseases is well established, yet not fully understood. Often, I have heard that sexual hormones are responsible for every aspect of it. Two abstracts presented this year question this paradigm.
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#ACR23 @RheumNow #GreatDebate
Treatment for PMR by Spiera
- Plan rapid GC taper. It is OK to flare, prepare pt!
- Low threshold to introduce anti-IL-6 for GC intolerance or AEs
No need for initial biologic treatment for PMR/GCA
@philseo rebuttal upcoming... https://t.co/A0f3b0fMOr
Eric Dein ( View Tweet)
Should IL-6i be first line in GCA/PMR? Dr. Spiera says steroids work, are cheap; no evidence of using IL6i early in disease. there had been cases where pts still had active vasculitis while on IL-6i. He starts with steroids first then add IL6i #GreatDebate #ACR23 @rheumnow https://t.co/Oq5Q9HFtW3
TheDaoIndex KDAO2011 ( View Tweet)
#ACR23 #Debate Dr Spiera says NO need to up front use #glucocorticoid #sparing drugs in PMR - maybe only if flaring. Esp in PMR vs #GCA where maybe bDMARD in GCA in some Pts (my opinion) but for sure if failing #ACRbest #ACR23 @RheumNow @ACRheum https://t.co/Rt7rGZv3fW
Janet Pope ( View Tweet)
Towards Personalised Care in RA
Since the millennium, we have seen an expansion in the number of advanced treatments both biologic and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) for rheumatoid arthritis (RA). #ACR23
https://t.co/SjyfMyPyGw https://t.co/uzG72vKSpd
Dr. John Cush RheumNow ( View Tweet)
RheumNow’s expanded coverage of the #ACR23 annual meeting is sponsored in part by Novartis. All content is chosen by RheumNow & its faculty.
Dr. John Cush RheumNow ( View Tweet)
#ACR23 Abs #0844 posterior element inflammation & facet joint ankylosis on MRI uncommon in r-axSpA patients. However, when FJ inflammation is present (vs w/o) the likelihood of developing facet joint ankylosis after 1 year is over 3 x higher. https://t.co/1Kln1pNH3p @rheumnow https://t.co/BatNTFfTG2
Dr. Rachel Tate ( View Tweet)
Validation is needed, but SPARTAN + add'l stakeholders developed the first draft SPARTAN recommendations for referral of adults with chronic back pain to a rheumatologist for evaluation of axSpA! Check out #ACR23 Abs #0841 https://t.co/ISv2lgHyka @rheumnow https://t.co/Qvy8LlzOw0
Dr. Rachel Tate ( View Tweet)
When to use #belimumab and when to use #voclosporin? Dr. Dall'Era does the following:
Belimumab: GFR<45, low proteinuria, extrarenal dz, pt factors
Voclosporin: GFR>45 w/o sig chronicity, high level proteinuria (3+g/), pt preference for oral
#ACR23 #MeetExpert @rheumnow https://t.co/0SXRBtChfk
TheDaoIndex KDAO2011 ( View Tweet)
"Get rid of partial response. Why would you want to see an oncologist who say I can get risk part of your cancer? Wouldn't you want to get rid of the whole cancer!" - Dr. M Petri on how we should view lupus nephritis #ACR23 @rheumnow #MeetExpert
TheDaoIndex KDAO2011 ( View Tweet)
Proof of concept for cCAR BCMA CD19 - safely eliminated all autoabs, reset B cell/humoral immune system, & delivered long-term, med-free remission in 1 dose in LN and SLE. More studies needed! #ACR Abs 1493 @rheumnow https://t.co/sT68cN3TKe
Dr. Rachel Tate ( View Tweet)
ACR#23 Abs #1023: IgG4-RD males > likely (vs females) to have multi-organ & serological activity w/ ^ immunoglobulin concentrations. Interestingly, lower lipase levels observed in males are consistent with greater degrees of pancreatic damage. https://t.co/4hUGmzTQqX @rheumnow https://t.co/kcy5dL62Pn
Dr. Rachel Tate ( View Tweet)
UTSW Dallas study: Health literacy may be essential limiting factor for families w/ children w/ SLE. Other critical barriers to patient care include food security and living costs such as transportation, housing, and utilities. #ACR23 Abs #1029 https://t.co/jtnIgLZQfC @rheumnow https://t.co/A1zr8quSdd
Dr. Rachel Tate ( View Tweet)
RheumNow Live registration is open! Join us this January!
https://t.co/x3ilRUi1hX https://t.co/7fBLaYwIiT
Links:
Dr. John Cush RheumNow ( View Tweet)
LV mass higher in pts with SLE nephritis.Nested case-control study 48 SLE pts +/- LN. LV mass higher w/LN (66.9 g/m2) vs pts w/o LN (54.8 g/m2, p=0.035). Higher LV mass may increase risk for CV events as CHF, arrhythmias and CV mortality. @RheumNow #ACR23 abst#1447
TheDaoIndex KDAO2011 ( View Tweet)
Real World SLE Rx patterns from the SPOCS cohort. 70+% IFN high, 81% on antimalarials, 21% biologics, and 55% IS, 65% GCs. High IFN pts had more IS and steroid use. 45+% still on GCs at 12 months despite avail of new therapeutics @RheumNow #ACR23 abst#0592
TheDaoIndex KDAO2011 ( View Tweet)
Assessment of MAP kinase pathway gene expression prior to tx may aid in identification of polyarticular course JIA patients that could exhibit poor response to tofacitinib. It may be helpful in personalized tx algorithm! #ACR23 Abs #0830 https://t.co/Z8pykbG7x5 @rheumnow https://t.co/ANZr8aVrVB
Dr. Rachel Tate ( View Tweet)
STOP-JIA study data from Abs #0831 suggest improved effectiveness with early combination tx vs step up and biologic first tx at the 2-3 yr timeframe for pJIA pts. More data needed to optimize outcomes/tx for these children. https://t.co/vWL5J4FPbo #ACR23 @rheumnow https://t.co/5iJpwglhPu
Dr. Rachel Tate ( View Tweet)
Vasc Events in Danish Cohort: 3178 SLE pts matched to 60K controls. MI in SLE 2.9% vs 1.4%, cerebrovascular dz 7% vs 2.7%, & PVD 5.5% vs 1.4%. IRR ranged 1.7-7.6. Female SLE pts had 3-5X risk for CVE, Male pts 6-8X risk. @RheumNow #ACR23 abst#1442 https://t.co/PapDiJ0shJ
TheDaoIndex KDAO2011 ( View Tweet)