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Addressing CV Risk in RA: Are we doing enough?
ORAL surveillance was a post-authorisation safety study of tofacitinib 5mg and 10mg versus TNF inhibitors, focusing on rates of adverse events, including MACE. A higher incidence of MACE was observed with the use of tofacitinib. Statins are recommended in patients with a history of atherosclerotic disease or 10 year predicted risk of MACE. But, how many patients with rheumatoid arthritis, at risk of MACE, are actually taking a statin?
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ACR 2024 - Day 2 Report
Plenary sessions began the day, followed by thousands on the abstract floor. Here are a few of my favorite presentations from day 2 at ACR 2024.
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The 🫀is muscle‼️
💥From the maestro herself @JuliePaikMD underscores why cardiac involvement in myositis can't be overlooked.
🔥Crucial insights with major implications for patient care and outcomes
#acr24 @RheumNow @HopkinsMedicine @jhrheumatology
https://t.co/mw6BvkdF2w
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Risks for HCQ cardiotoxicity:
👉>5 yrs use
👉>5 mg/kg/d (cumulative dose >500,000 mg)
👉CKD
👉use NSAID
👉preexisting heart dz
👉presence of ocular, derm, SkM toxicity
- Dr M Garschik #ACR24 @rheumnow https://t.co/LFobgls4jm
Links:
TheDaoIndex KDAO2011 ( View Tweet)
Dentition is important in RA, but it's easy to forget it's a matter of life or death.
NHANES data shows fewer teeth strongly correlates with higher mortality (esp cardiovascular).
Missing teeth = CV death HR >30
Holistic dentition is holistic RA care
#ACR24 ABST1325 @RheumNow https://t.co/Z40bSFybuS
David Liew drdavidliew ( View Tweet)
Dr. BDinneen et al reported predictors that can help screen axSpA pts w/o traditional CV RFs for carotid doppler utz:
- shorter dse duration
- no family hx of IHD
- HLAB27+
- ⬆️ dBP, WHratio, ferritin, TC, LDL and TC:HDL ratio
Small size, more data reqd
@RheumNow #ACR24 abs1440 https://t.co/3pZxFmutJz
Links:
sheila RHEUMarampa ( View Tweet)
Wallace et al. Case control study. 648 cases 1241 controls. Cumulative glucocorticoid dose and risk MACE. Dose dependent increase in risk, OR 1.01 for 10% increase GC, 1.21 for 10-fold increase GC. @RheumNow #ACR24 Abstr#1719 https://t.co/wraiWOl1dv https://t.co/feht58RDNc
Links:
Richard Conway RichardPAConway ( View Tweet)
A#1694
To get one or two lungs for lung transplant? 🫁
Autoimmune related ILD transplant outcomes?
145 single (SLT), 461 double (DLT)
Similar 1 yr mortality - HR SLT 1.19 unadjusted, 1.49 adj - not statistically significance
@RheumNow #ACR24 https://t.co/uo8WbrNFAm
Links:
Eric Dein ericdeinmd ( View Tweet)
#Gout attack is assoc w 1.5 X MI, MACE in next 30 days
@ACRheum @RheumNow #ACR24 https://t.co/7IeFbW6xW8
Janet Pope Janetbirdope ( View Tweet)
A#1693
Change in FVC @ W12 or 24 has progn value @ w52 in AI-ILD
Study SENSCIS (SSc) & INBUILD (SARD) trial PBO gps
SENSCIS: OR for ILD progression 1.9 @ w12, 2.5 @ w24
INBUILD: OR 2.2 @ w12 & w24
Early PFTs predict outcomes @ 1 yr, short trials may be feasible
#ACR24 @RheumNow https://t.co/8cICAeG0nr
Links:
Eric Dein ericdeinmd ( View Tweet)
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
Links:
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)
