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Why are older RA patients getting mistreated? Most rheums would say that every RA patient should be started on a DMARD. So I'm shocked that, in a US Medicare 20% sample dataset b/w 2008-17, less than 30% of new RA patients aged 66+ have a DMARD initiated. https://t.co/VFp3oz8wGK https://t.co/60Jn6ShmDs

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Dr. John Cush RheumNow ( View Tweet)
Do We Stop or Continue Treatment? Remission had been a dream, an elusive concept. But then, with the introduction of biologics, conventional synthetic and targeted synthetic DMARDS, patients are able to live longer and with a better quality of life. https://t.co/qSgfuDvAQb https://t.co/eUzIaC35tl

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Dr. John Cush RheumNow ( View Tweet)
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Here’s what will change my practice in Rheumatoid Arthritis

d Janet Pope, MD, MPH, FRCPC

Here's what I learned at ACR23 that will change the way I practice in rheumatoid arthritis. 

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The SMART Study: Split Dose Oral Methotrexate Dr. Jack Cush discusses abstract 1583 presented at the 2023 ACR Convergence meeting in San Diego. https://t.co/Blg4EUe5rX https://t.co/0svgLAZ1as

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Dr. John Cush RheumNow ( View Tweet)
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Withdraw DMARDS after remission?

d Aurelie Najm, MD, PhD

The possibility of withdrawing DMARDs after patients achieve remission has been in our minds for a while. Yet when our patients ask whether it is a good idea to taper or stop their DMARD when they are doing well, most of us don’t have a black or white answer for them.

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Race to the top: how high will treatment response rates in RA reach?

d Antoni Chan, MD, PhD

We have become accustomed to the 60/40/20% rule for the outcome of ACR 20/50/70 respectively for biologics and targeted synthetic DMARDs.

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Plotting Future ACR Convergence Meetings (11.24.2023)

d Jack Cush, MD

In this week's podcast, Dr. Jack Cush reviews the ACR Convergence 2023 meeting and proposes how to best learn at your next large medical meeting.

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TNFi and RA-ILD – The Pendulum Swings Again

d Richard Conway, MBBChBAO, PhD

TNF inhibitors revolutionised the treatment of rheumatoid arthritis. While highly effective for the joint manifestations of the disease, a note of caution was sounded regarding the potential for worsening of ILD with these agents. Within this framework, a study by England et al presented at ACR23 was highly relevant.

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elderly hands

Why are older RA patients getting mistreated?

d David Liew, FRACP

Most rheumatologists, if asked, would say that every rheumatoid arthritis patient should be started on a DMARD of some sort - if not at diagnosis, then pretty soon after. So I am genuinely shocked that, in a large United States Medicare 20% sample dataset between 2008-17, less than 30% of new RA patients aged 66 years or older have a DMARD initiated.

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Early aggressive treatment in SLE: are we there yet?

d Md Yuzaiful Md Yusof, MRCP(UK), PhD

Early treatment with DMARDs has revolutionised the outcomes of patients with rheumatic arthritis. However, this concept has not been fully extrapolated to other autoimmune rheumatic diseases such as systemic lupus erythematosus.

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Methotrexate: shall we split up? Methotrexate (MTX) 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. https://t.co/yxvI9Q0B9m https://t.co/MxPQ4DAGsj

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Dr. John Cush RheumNow ( View Tweet)
Rheumatology,Roundup,2023

Rheumatology Roundup - ACR 2023

d Jack Cush, MD

Drs. Jack Cush and Arthur Kavanaugh discuss highlights and key takeaways from ACR 23.

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As per #ACR23 ABST0433, what % of RA patients on US Medicare are on a DMARD within 1y of diagnosis? I'm not talking your choice of b/tsDMARD. I'm talking any cs/b/tsDMARD of any sort. Hear from @JihaRheum to skip to the answer: https://t.co/lI2M20JWKC Truly stunning. @RheumNow

David Liew drdavidliew ( View Tweet)

rare

Here at Last: Treatment Options for VEXAS

d Michael Putman, MD, MSCI

We have known about the VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome for nearly 3 years, but there has been relatively little to say about how to treat it. To date there have been over twice as many publications about VEXAS (263 publications) as there have been patients described with respect to treatment strategies (116 patients). One of the late breaking abstracts may finally have rectified this imbalance.

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#ACRbest Yrin Preview @ACRheum J Bathon Take home Symptomatic #Rx of ACPA+ people WITH #DMARD is too late to alter risk of #RA when drug is d/c AI to read joint erosions on X-ray May be ‘too little too late’ #Steroids in #RA increase #MACE even after d/c #ACR23 @RheumNow

Janet Pope  ( View Tweet)

Peng et al. 146 IgG4-RD in remission on immunomodulators+GC. 18 month follow-up. Withdraw IM+GC - 52% flare. Withdraw GC + continue IM 14.2% flare. Continue both 12.2% flare. Clear message that ongoing IM is the way Abstr#L16 #ACR23 #ACRbest @RheumNow https://t.co/3CAQhyTYqq https://t.co/qr1GOSvJYg
Richard Conway  ( View Tweet)
L16 #ACR23 @RheumNow W/d of Immunosuppr and Low-dose steroid in IgG4RD Gr1: W/d GC+IM, G2: IM alone, G3: Maintain Relapse rate: G1 52%, G2 14%, G3 12% https://t.co/xe6NLVxUov
Eric Dein  ( View Tweet)
Withdrawing immunosuppression and steroids in IgG4-RD Maintaining immunosuppression with or without steroids associated with low relapse rate 52% of pts who withdrew steroids +immunosuppression relapsed @RheumNow #ACR23 Abs#L16 https://t.co/xJyDiCkMVD
Robert B Chao, MD  ( View Tweet)
Withdrawal of Immunosuppressant and Low-dose Steroids in IgG4-RD Patients with Stable Disease 146 pts - 3 Grps 1: withdraw GC+IM 2:withdraw GC but maintain IM; 3: maintain GC+IM The maintenance of IMs, with or without low-dose GC, superior to withdraw #ACR23 @rheumnow #abstL16

Bella Mehta bella_mehta ( View Tweet)

#ACR23 Late-Breaking Abstr#L19 IA steroid can help osteoarthritis knee pain but effect & duration are variable. Phase 3 RCT: improvement in ADP & WOMAC pain favouring TLC5999 (liposomal modification of DEX) vs PBO at all timepoints inc. after repeated injection @RheumNow #ACRBest https://t.co/xUhoFHPExr
Md Yuzaiful Md Yusof  ( View Tweet)

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