All News
Methotrexate: shall we split up?
Methotrexate is widely used in rheumatic diseases yet poses common tolerance issues, especially for the oral form; and bioavailability is known to be limited for doses over 15mg. In the SMART study, Prasad et al. present the first RCT comparing either single dose (25 mg) or split-dose (10 mg morning, 15 mg evening, same day) once weekly MTX for 24 weeks.
VROOM 🏎️ study
2 wks interruption of MTX just after COVID vaccine:
-Increase S1-RBD Ab response for 26 wks
-Improves Neutralizing Ab titres (Wuhan Hu-1)
-Leads to more flares wks 4 & 12
Greater effect when MTX dose>15mg
@RheumNow #ACR23 ABST1677 https://t.co/SJmaRHtbRH
Aurelie Najm ( View Tweet)
Abishek et al. 2 week break from MTX enhances response to COVID-19 vaccination, mirroring what we saw for flu. Trade off is short term worsening of disease activity. Abstr#1677 #ACR23 @RheumNow https://t.co/gguRWER81x https://t.co/1hncvDTahH
Richard Conway ( View Tweet)
There was a lower hazard ratio for incident cancer with exposure to TNFi compared to non-TNFi (RTX and ABA) and JAKi. Limits: potential for residual confounding by indication and small number of outcomes per drug class, Xavier S, Abst#1678 #ACR23 @RheumNow https://t.co/vJpFwl6Ivj
Dr. Antoni Chan ( View Tweet)
A#1403 #ACR23 @RheumNow
17% of 1st degree relatives of AS pts have MRI-defined sacroiliitis
Study of 100 subjects w FHx AS
- 13/100: new dx of AxSpA, 7 w radiographic changes
- 4/100: Sacroiliitis without back pain
- 1 periph SpA
- 12 met clinical ASAS classification but not dx https://t.co/V7LCbaDXBe
Eric Dein ( View Tweet)
OA and Syncope #ACR23
OA patient on NSAIDs presents with a peptic ulcer and GI Bleed.
https://t.co/vhRnv6dPim https://t.co/H4gsCivyxN
Dr. John Cush RheumNow ( View Tweet)
GCs Major Driver of Depression in SLE Ab#1446 #ACR23
@RheumNow
1463 pts with SLE, prospective longitudinal study GC use: 49-57% of pts Prevalence of depression at any time: 89.8%, most of time 35%!! Risk factors: - Fibromyalgia OR 2.9 - GC OR 1.85
Eric Dein ( View Tweet)
Hand movement video: more promising than photos as a computer vision concept for remote monitoring of RA disease activity.
Of course: validation, training, clinical evaluation all must happen before it is ready for your clinic
https://t.co/HyN6ElKF0F #ACR23 ABST1293 @RheumNow https://t.co/DltI9HFiFE
David Liew drdavidliew ( View Tweet)
Fatigue 😴 in RA & synovial biology
In DAS LDA pts Fatigue asso w/
-female sex
-synovial lymphocytic inflammation
In DAS moderate DA:
-female sex
-synovial lining layer
-Anxiety
Limitations: arthroplasty tissue, small sample size, no Immunohisto
@RheumNow #ACR23 ABST1630 https://t.co/4vhzvdPgyd
Aurelie Najm ( View Tweet)
PRES in SLE
A#1478 @RheumNow #ACR23
303 cases of Posterior Reversible Encephalopathy Syndrome in SLE
- Mean age 28, 91% F
- 42% HTN, HLD 15%, DM 10%
- 83% lupus nephritis. 80% dsDNA, 41% Sm, 38% aPL
- 78% seizures
- 3% mortality
- Transient in 45%, persistent in 19%, 8% sequelae
Eric Dein ( View Tweet)
#ACR23 Abstr#1636 Phase 2 crossover RCT of Dazodalibep, Anti-CD40L-i in #Sjogren pts with high disease activity showed primary endpoint, change in ESSDAI was met in DAZ vs PBO. More COVID in DAZ in Stage 1 but trial was at the start of pandemic. Phase 3 is starting soon @RheumNow https://t.co/hZcpOHumB3
Md Yuzaiful Md Yusof ( View Tweet)
Fisher et al. In high disease activity, fatigue associates anxiety and synovial lining hyperplasia, 1.57[1.01,2.5]; p=0.047) In LDA, fatigue associates chronic lymphocytic synovial inflammation, 1.92[1.09,3.57]; p=0.024) Abstr#1630 #ACR23 @RheumNow https://t.co/Gev6pU3srq https://t.co/Ys8etP36ir
Richard Conway ( View Tweet)
Do we miss RA activity in obese pts?
Pre-clinical trial entry MSK USS:
similar DAS28
but lower SJC/US scores in obese
Is it because, in obese RA patients:
we underdetect on exam?
we undertreat?
higher risk, so lower penetrance of severe dx endotypes?
#ACR23 ABST1287 @RheumNow https://t.co/3FFPdBJOpz
David Liew drdavidliew ( View Tweet)
Vasculitis in SLE
A#1443 @RheumNow #ACR23
804 SLE pts, 74% black, 9.5% h/o vasculitis
45% visceral vasculitis, 43% cutanous, 8% both
Pts w vasculitis: younger age of SLE dx- 27 v 31y
Risks: other SARD, renal dx, neuro dx, low compl
Trend to higher mortality 21 to 14% (no signif)
Eric Dein ( View Tweet)
Multimorbidity in #RA - VARA registry data- looking at 61 different biomarkers and 44 comorbidities
Chronic pain in 44%
Specific biomarkers seen in different morbidities
@rheumnow #ACR23 session#13M148 https://t.co/l6FU1ELKD3
Bella Mehta bella_mehta ( View Tweet)
Peyton et al.: 4 multimorbidity patterns in RA
-Mental health and subst abuse
-Metabolic
-CV
-Chronic pain
All associated with different sets of biomarkers.
Some are very specific of one profile while others are widespread across profiles.
@RheumNow #ACR23 ABST1631 https://t.co/VqCrLI3oyy
Aurelie Najm ( View Tweet)
Ultrasound (and specifically intima-media thickness) might not just be for diagnosis in GCA - it might be a GCA disease activity measure for monitoring:
- improves over time
- increases with flares
Valentin Schaefer #ACR23 ABST1649 @RheumNow https://t.co/QWdIVGrHbn
David Liew drdavidliew ( View Tweet)
Ross et al. Ultrasound assessed Optic nerve sheath measurement in GCA. Previously shown increased in GCA. Here decreases with treatment shown in 9 patients Abstr#1650 #ACR23 @RheumNow https://t.co/fcrS4tT6U0 https://t.co/ylnPKzdUe0
Richard Conway ( View Tweet)
In PS-matched study, no significant difference in respiratory hospitalisation or death between RA-ILD patients on non-TNFi/JAKi vs. TNFi. This finding does not support systematic avoidance of TNFi in RA-ILD, England B Abst#1582 #ACR23 #ACRBest @RheumNow https://t.co/1zVjMWNZZS https://t.co/d8TRIvGaIe
Dr. Antoni Chan ( View Tweet)
Fate of ANA+/UCTD
A#1449 #ACR23 @RheumNow
207 asymptomatic ANA+ or UCTD followed
- <10% progress to SARD, 90% did not
Progression to SLE (11 pt), Sjo (5), SSc (3), RA (1)
Progressors to SLE: arthritis (91%), low compl (45%), alopecia (36%), ulcers (27%) - milder manifestations
Eric Dein ( View Tweet)