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Say Goodbye to Methotrexate in PMR?
For decades, glucocorticoids (GCs) have formed the backbone of polymyalgia rheumatica (PMR) management.
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RA patients on TOF with h/o ASCVD have 4x higher risk of MACE without statin (vs. TNFi).
Prioritize statins for heart health in RA!
#ACR24 @RheumNow ABST#1745 https://t.co/jRqXNU2T6d
Links:
Jiha Lee JihaRheum ( View Tweet)
The odds of axSpA patients developing fractures was lower among those on TNFi vs DMaRDs or NSAIDs accdg to this study by NGeorge et al.
axSpA pts are at high risk of fractures & drugs that mitigate these risks are important. More robust data are needed
@RheumNow #ACR24 abs1439 https://t.co/ZSV3og5N5x
sheila RHEUMarampa ( View Tweet)
A#1745
Post-hoc ORAL Surveillance - statin
<1/4 on a statin, only 53% h/o ASCVD on statin
Incr in LDL was less on Tofa pts on statin
Among those on b/l statins, there is no incr risk compare to TNFi, esp pts h/o ASCVD
If high risk on tofa, statin helps!
@RheumNow #ACR24 #ACRBest https://t.co/7MGgUk7tfI
Links:
Eric Dein ericdeinmd ( 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)
Single cell TCR sequence study explores the limitations of TRBV9-depleting therapies in axial spondyloarthritis.
Key findings:
- Identified a clonally expanded TRBV5-5+ TCR in HLA-B27+ acute anterior uveitis.
- Alternative TRBVs may retain pathogenicity and evade anti-TRBV9… https://t.co/Aj8oslsTNX
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
📝Bimekizumab 160mg Q4 weeks in r-axSpA and nr-axSpA achieved
substantial reductions in MRI inflammation at Wk 16 maintaining to Wk 52.
-PBO‑switchers (started at week 16) reached similar levels of improvement as continuous BKZ pts at Wk 52.
Abst#1757 #ACR24 @RheumNow https://t.co/m9sdAbFqI9
Links:
Adela Castro AdelaCastro222 ( View Tweet)
A#1744 AI for RA to improve scheduling in UK
39% pts meet quality metric for early intervention
Input: RF, CRP, CCP, gender, age -> 51% accuracy (compare to first appt clinical accur 46%)
Focusing on highest risk -> 88% accuracy -> 50% wait time for high-risk pts
#ACR24 @RheumNow
Eric Dein ericdeinmd ( View Tweet)
Strive for remission (CDAI ≤2.8) to achieve better functional outcomes in RA
#ACR24 @RheumNow ABST#1743 https://t.co/qpsTF54rmW
Jiha Lee JihaRheum ( View Tweet)
In a cohort of >17,000 European pts w/ axSpA:
-bDMARD naïve pts starting TNFi or IL-17Ai were more likely to achieve LDA than TNF-experienced.
-Higher time to achieve LDA and shorter durability in pts with prior TNFi use.
Abst#1756 #ACR24 @RheumNow
Adela Castro AdelaCastro222 ( View Tweet)
Further evidence for risk of #MACE with cumulative GC use in RA
In a national cohort of pts with RA: ⬆️cumulative GC exposure associated with ⬆️odds of MACE, regardless of baseline MACE risk
Ab1719 #ACR24 @RheumNow https://t.co/RmxokfBXYX
Mrinalini Dey DrMiniDey ( View Tweet)
Study revealing the Uterine-Joint Axis in female axial spondyloarthritis, highlighting dysbiosis and subclinical uterine inflammation as key factors in disease pathogenesis.
Key findings:
- Distinct microbiota profiles in AxSpA patients vs. healthy controls.
- Significant genital… https://t.co/Cl12ELdjI2
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
A#1743
Are there benefits of getting LDA to remission?
Remission CDAI <2.8, VLDA 2.8-6, LDA 6-10
After 1 yr f/u of LDA, 45% Rem, 40 VLDA, 16 LDA
Not in remiss - higher BMI, longer duration, higher resource utilization, worse PRO
No clear diff bw remission & VLDA
#ACR24 @RheumNow https://t.co/ut7c52JVDr
Links:
Eric Dein ericdeinmd ( View Tweet)
Frideres et al. Target trial emulation in RA-ILD. Primar outcome death or respiratory hospitialization. Abatacept (aHR 0.90), tocizilumab (aHR 0.93), tofacitinib (aHR 0.69) vs rituximab. @RheumNow #ACR24 Abstr#1713 https://t.co/fbE8xAnzQ2 https://t.co/uwzH8oAyAT
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)
BE MOBILE 1 & 2: Bimekizumab resulted in improvement of SIJ MRI inflammation & structural lesions particularly after 16 wks of treatment and continued on until wk. 52.
Supports addtl evidence of BKZ's winning streak in #axSpA
@RheumNow #ACR24 abs1757 https://t.co/EUntQIuQC8
sheila RHEUMarampa ( View Tweet)
A picture is worth a thousand words—and so are the four abstracts behind it! At #ACR24, I highlight the benefits and risks of apremilast in #PsA.
@RheumNow
https://t.co/ospR0qEIsd
Akhil Sood MD AkhilSoodMD ( View Tweet)
Chevet et al. What happens when you withdraw tocilizumab after 6 months in PMR? Follow up of SEMAPHORE study. 80.8% relapsed! Median time to relapse 15 weeks. @RheumNow #ACR24 Abstr#1698 https://t.co/9pJ88C05V2
Richard Conway RichardPAConway ( View Tweet)
Choose Rheum!
Hart & Kumar interviewed trainees about picking rheumatology... major themes:
▶️ exposure prior to medical training
▶️ mentorship/sponsorship
▶️ long-term self-reflection
▶️ chance!
How can we optimize first 3 to build our workforce?
@RheumNow #ACR24 Abst 1738
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Is 6M TCZ treatment enough to induce lasting remission in PMR?
➡️cohort of pts in SEMAPHORE trial
➡️among pts in remission after 6M TCZ, 1/4 were relapse-free after TCZ discontinuation
⏩6M treatment not enough to withdraw TCZ
Ab1698 #ACR24 @RheumNow https://t.co/wTRTfX1fWq
Mrinalini Dey DrMiniDey ( View Tweet)