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Taking AI Out of AutoImmunity: Predicting disease before it develops
the predictive value of a positive ANA test—especially in the absence of other clinical symptoms—remains a challenge. A positive test often leads to further testing, yet it does not necessarily indicate whether a patient truly has an underlying autoimmune disease. The development of AI and machine learning algorithms presents an opportunity to interpret autoantibody tests and predict autoimmune diseases. Here are three studies looking at this issue.
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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)
A#2530
ANA reactive CD4 cells: elevated B cell help activation in SjD
Unique autoreactive T cell cluster in SSc shows CD4+ TRAIL+ IFN type I - unique to SSc
Leads to decrease activation of APCs, decrease CD4 T effector fxn
@RheumNow #ACR24 https://t.co/4JnA3SpVM8
Eric Dein ericdeinmd ( View Tweet)
#2259 💊 Anti-Obesity Meds in RA 📊 152 RA patients on semaglutide/tirzepatide 🔑 Findings 💥Significant ⬇️weight, BMI, ESR, CRP, lipids, pain VAS 💥Improved CVD risk ⛔ 15% GI side effects, 27% discontinued 🔎Study of impact on RA outcomes needed #ACR24 @RheumNow #ACRBest https://t.co/6LCTZl5173
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Cool study investigating differences in nailfold capillaroscopy, jives w/my clinical experience
Compared to SLE, pts with DM 🔼nailfold changes, 🔼 loop dilation, 🔼hemorrhages
#ACR24 @rheumnow Abstr#2404 https://t.co/8N7KNRZet8
Mike Putman EBRheum ( View Tweet)
Dr. @karen_kc123 discusses the results of the VITAL study.
- Long term use of Vit D3 2000IU was safe and decreased the incidence of all autoimmune dses by 22%.
- It took a while to work but the effect dissipates once discontinued.
@RheumNow #ACR24
@rheumarhyme https://t.co/mnwRsdZ06N
Links:
sheila RHEUMarampa ( View Tweet)
Will be covering some TAK pearls and pitfalls from today’s session!
Renal dz stratified by location of vessel inflammation:
- TAK = proximal (off aorta)
- FMD = mid-section, beading
- PAN = distal arterial branches
@RheumNow #ACR24 https://t.co/zu6qJ6DXcF
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
A call for ANA stewardship?
Abstract 1931: Educating clinicians on wise ANA ordering via EMR Alert plus removing the comprehensive ANA panel -->
- ↓ ANA testing (outpatient 15.9%→7.4%, inpatient 25.5%→6.4%)
↓ costs ($440k→$130k)
#ACR24 @RheumNow
Akhil Sood MD AkhilSoodMD ( View Tweet)
Study of 25K+ patients using TrinetX on immune checkpoint inhibitors shows no significant mortality difference between those with pre-existing autoimmune disease (AID) and those without.
Mortality rates:
AID: 39.8%
Non-AID: 40.2%
Large-scale evidence supports ICIs in AID… https://t.co/BI5jK9jsoM
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
A#2531 @AlisaMueller
CRISPR deletion of fibroblasts, gave cytokine activation to mimic inflamm
Are there gene depletions that affect inflamm pathways?
👉SIX1 reduces inflamm potentiation
👉NFIL3 deletion promotes inflamm, degradation
@RheumNow #ACR24 https://t.co/Nqghb5UaBR
Links:
Eric Dein ericdeinmd ( View Tweet)
A#2532
Pre-existing AID for immunoRx?
Excluded from trials
4 prior studies showed no diff in mortality w AID
Propensity-matched cohort study
Followed median 250 days
Hazard ratio: 1.07 (unmatched), 0.97 (matched) - no diff. Mortality about 40% in grps
@RheumNow #ACR24 https://t.co/zyVCPts6s6
Links:
Eric Dein ericdeinmd ( View Tweet)
#ACR24 Guidelines #LupusNephritis for refractory dz @RheumNow https://t.co/LlSixkggKK
TheDaoIndex KDAO2011 ( View Tweet)
Imaging in TAK Diagnosis
@KQuinnRheum @RheumNow
⭐ Take homes ⭐
👉location of renal artery stenosis (RAS) key to making Dx with proximal RAS in TAK
👉FDG PET -focal uptake in TAK vs diffuse in GCA
👉MRI good surrogate for disease activity where PET unavailable
#ACR24 https://t.co/UWxTAZScIt
Links:
Patricia Harkins DrTrishHarkins ( View Tweet)
Mental health, sex, and comorbidities are key factors in determining recalcitrant psoriatic arthritis (PsA).
Key findings:
- 21.7% of patients required ≥4 biologic/targeted synthetic DMARDs.
- Female patients and those with depression were more likely to be recalcitrant.
- No… https://t.co/I9YYoRnLwh https://t.co/VtnPceVLOZ
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#ACR24 - Featured Industry Presentations
Many of the great presentations for this meeting come from industry sponsored clinical trials and reports. Often these become the pivotal studies for regulatory approval and the annual congresses are their first look.… https://t.co/I6LMQ5xMUx https://t.co/UzTeqWUSdo
Dr. John Cush RheumNow ( View Tweet)
The precise mechanism of action of GIOP is not known. Decrease in osteocyte LCN is observed. Abstr#2528 @RheumNow #ACR24 https://t.co/fazUUy03fQ
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
In earlier studies of Vit D, there were conflicting evidence as to whether it reduced or increased the risk of RA and #SLE
@RheumNow #ACR24 @rheumarhyme https://t.co/PvjjmhHaOd
sheila RHEUMarampa ( View Tweet)
A Bayesian Network Meta-analysis Phase II/III/IV, placebo-controlled, randomised clinical trials and long-term extension studies of JAKi and TNFi, in adults with RA, PsO, PsA, axial
spondyloarthritis axSpA and IBD showed the following:
- TNFi was associated with a significantly… https://t.co/FWHgemEAvG https://t.co/3D0nldwmwA
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Gottenberg et al. A positive RCT in pSS! DAHLIAS study. Phase 2. 163 patients. Nipocalimab, anti-neonatal Fc receptor (FcRn) mAb. @RheumNow #ACR24 Abstr#2527 https://t.co/M7li4ZoKeY https://t.co/gV9MGnswdR
Links:
Richard Conway RichardPAConway ( View Tweet)
Nipocalimab, an anti-neonatal Fc receptor (FcRn) mAb, reduces circulating IgG including specific autoantibodies (AAb), by selectively blocking IgG–FcRn interactions.
DAHLIAS, the first study of a FcRn blocker in SjD, showed that nipocalimab led to significant improvement vs PBO… https://t.co/zl1tEsEMAj https://t.co/qrkOD2Ccc3
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)