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#RNL2024 @RheumNow SPA spectrum Q and A 🔥 - @lihi_eder 👏advocating for #POCUS #mskus and enthesitis - we agree @CrusSurc - confirming the concept of #pocus as an extension of the clinical exam and to be kept in the hands of the clinician - doesn't seem an area yet for AI 🤖
CRUS-SURC CrusSurc ( View Tweet)
Dr. @lihi_eder approaches enthesitis both clinically and with imaging *highly recommended.
NSAIDs and local steroids may be useful with caution. Advanced tx strongly recommended if initial tx fails/other domains involved.
#RNL2024 @RheumNow https://t.co/SKrWmp115M
Dr. Rachel Tate uptoTate ( View Tweet)
Advanced therapies in enthesitis. Don't believe the spin, they all work, no clear evidence that any agent is better than others. @lihi_eder @RheumNow #RNL2024 https://t.co/FwLMUmmClB
Richard Conway RichardPAConway ( View Tweet)
@JointMD updates us on nomenclature. "AS" is out and "AxSpA" is in.
#RNL2024 @RheumNow https://t.co/gdmZeuMNpW
Dr. Rachel Tate uptoTate ( View Tweet)
#RNL2024 @RheumNow
@lihi_eder on enthesitis
- ~1/3 PsA, SpA
- Enthesitis precedes onset of PsA in PsO, high u/s score ass. w/ RFs (BMI, nail dyst)
- Exam: tenderness (non-specific), as swelling uncommon. U/s helpful, but non-specif
- Marker of severity, higher risk of damage
Eric Dein ericdeinmd ( View Tweet)
Dr. @lihi_eder recommends enthesial evaluation with POC ultrasound if available in addition to her clinical evaluation. #RNL2024
@RheumNow https://t.co/LQiyFK5VB1
Links:
Dr. Rachel Tate uptoTate ( View Tweet)
AS v nr-AxSpA for TNFi - no diff in response
@JointMD @RheumNow #RNL2024
ADA: ASAS20 AS 58%, nr-AxSpA 52%, ASAS40 AS 39%, nr 36% (ATLAS, ABILITY-1)
ETN: ASAS 20 59%/52%, ASAS50/40 44%/33% in p3 AS study v EMBARK
CZP: RAPID-AxSpA - no diff bw AS & nr-AxSpA response in same trial https://t.co/Rau2CDYbY4
Eric Dein ericdeinmd ( View Tweet)
#RNL2024 @RheumNow
@JointMD on AxSpA
SPEED study: roughly 1/2 AS have AxSpA, 1/2 have nr-AxSpA
Are they similar:
- Yes, but r-axSpA less F and more abnml CRP
= Low progression of nr-AxSpA to AS - only 26% progressed in mean 10.6 yrs https://t.co/Vwf5HaMcgu
Links:
Eric Dein ericdeinmd ( View Tweet)
Disease activity indices may perform differently in man and women.
@lihi_eder
#RNL2024
@RheumNow https://t.co/8G1D0pGKe8
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Diagnostic delay in SpA
2.3 years longer delay in diagnosis in women with PsA.
@lihi_eder
#RNL2024
@RheumNow https://t.co/d9ao8vvpa5
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Amazing talk by @lihi_eder on sex differences in PsA.
#RNL2024
@RheumNow https://t.co/PW5fYLYmu5
Links:
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Dr. Lihi Eder discusses the differences between sex and gender.
Sex is a biologically-based construct defining differences between male and female
Gender has socio-cultural aspects of being a man, woman, or other AND has effect on social norms/expectations
BOTH are important to… https://t.co/iceTS0w5LY https://t.co/slSQMwF91J
Links:
Dr. Rachel Tate uptoTate ( View Tweet)
BASDAI tends to be higher in women while there is no appreciable difference in ASDAS scoring in men compared to women.
Dr. L. Eder believes this could be due to the pain scoring in both indices.
#RNL2024 @RheumNow @lihi_eder https://t.co/i7XPenrmGG
Dr. Rachel Tate uptoTate ( View Tweet)
With regard to SpA patient journey:
On average, women are diagnosed 2.3 years later than men.
Additionally, women tend to have more visits to rheumatology to reach diagnosis of PsA, AS, and RA!
Remember your inherent bias along with sex/gender disparities.
Dr. L. Eder… https://t.co/o0Hv3NrXpB https://t.co/vsMN3HkSv6
Links:
Dr. Rachel Tate uptoTate ( View Tweet)
My volume of referrals for OCI or degenerative disease (or sometimes completely normal SI joints) read as "sacroiliiitis" really does seem to have been increasing lately @lihi_eder @RheumNow #RNL2024 https://t.co/vksNCaADck
Richard Conway RichardPAConway ( View Tweet)
The different outcomes and response to treatment in males and females are related to sex differences in pain mechanisms and gender roles. Women report a higher BASDAI level, the ASDAS is equal in both sexes, Lihi Eder #RNL2024 @RheumNow https://t.co/7jjkgmmUg8
Links:
Dr. Antoni Chan synovialjoints ( View Tweet)
Picking the right tools to measure disease activity may be difficult because these tools may perform differently in men and women. The ASDAS show to differences between sexes but the BASDAI was significantly higher in women than in men. – Dr. Eder #RNL2024 @rheumnow https://t.co/KSBMrxio5P
TheDaoIndex KDAO2011 ( View Tweet)
Potential board question: be able to differentiate between osteitis condensan ilii vs sacroiliitis. With osteitis condensan, the SI joint is normal, with no irregularity, erosions, or loss of joint space. Sclerosis is predominantly on the iliac bone @rheumnow #RNL2024 @rheumnow https://t.co/mimcdoufEE
TheDaoIndex KDAO2011 ( View Tweet)
Dr. Eder on gender differences – we need to move from gender blind to gender specific approach to treating our patients. There are biological, cultural, and social differences between males and females. #RNL2024 @rheumnow https://t.co/gnzU6FKIPR
TheDaoIndex KDAO2011 ( View Tweet)
“TNFi, IL17i, JAKi--- note that these are the only classes of drug that work for axial spondyloarthritis!” – Dr.
@AlexisOgdie noted ustekinumab, apremilast, and abatacept do not work for inflammatory back pain.
@rheumnow #RLN2024 https://t.co/BHV6qCUdYi
TheDaoIndex KDAO2011 ( View Tweet)
