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Addressing CV Risk in RA: Are we doing enough?

Mrinalini Dey, MBBChir, MA(Hons) Cantab., MRCP, FHEA Nov 18, 2024

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

Jack Cush, MD Nov 17, 2024

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.

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

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

https://x.com/drdavidliew/status/1858484801650790676/photo/1

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

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

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

#Gout attack is assoc w 1.5 X MI, MACE in next 30 days @ACRheum @RheumNow #ACR24 https://t.co/7IeFbW6xW8

https://twitter.com/nellziade/status/1858212544118222855

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

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

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

#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

https://x.com/CaoilfhionnMD/status/1858213164443119768/photo/1

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

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

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

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

https://x.com/EBRheum/status/1858185076560830717/photo/1

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

https://x.com/i/web/status/1858182057098367025

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

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

https://x.com/AkhilSoodMD/status/1858171739508814279/photo/1

🫁RP-ILD a/w high morbidity and mortality How to Predict RP-ILD Development? ➡️AutoAb: anti-MDA5, anti-ARS, anti-Ro52 ➡️Biomarkers: CRP, LD, Ferritin, KL-6 ➡️CT: Lower consolidation/GGO #ACR24 @RheumNow https://t.co/OIrHfVTZcM

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Addressing CV Risk in RA: Are we doing enough?

ACR 2024 - Day 2 Report

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