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Who gives a ‘JAK’ why and how they work, as long as they do!
Several abstracts have studied the mechanism of action of JAK inhibitors (JAKi) in various diseases. JAKi alter many other mediators affected by the JAK STAT pathway. For instance, T cell signature in blood that is proliferative was associated with a response in RA.
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Towards Personalised Care in Rheumatoid Arthritis
Since the millennium, we have seen an expansion in the number of advanced treatments both biologic and targeted synthetic disease modifying anti-rheumatic drugs for rheumatoid arthritis. The challenge remains on how best to characterise the subtypes of RA in order to choose the best drug to ensure optimal outcome for patients.
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Need to improve our conversations with young adults on methotrexate about alcohol and sexual activity. They are often uncomfortable and/or dishonest about telling. Great work from @McMasterU by undergrad Matthew Sholdice #transition @drgrainnemurray #ACR23 https://t.co/wwyZLQVA51
Catherine Hill CatherineL_Hill ( View Tweet)
Takeaways from #ACR23 #ReviewCourse session on SpA Update: Radiographic and Non-Radiographic AS - Dr. Alexis Ogdie
1. Workup of inflammatory back pain: History, exam, CRP, HLA-B27, SI joint films, MRI pelvis (STIR images, no need for contrast). Response to NSAIDs not actually… https://t.co/M0W6UNsPxF https://t.co/7k3xl1RXZz
Paul Sufka, MD psufka ( View Tweet)
ABS0538:
⭐️Characteristics of difficult-to-treat (D2T) axSpA pts:
➡️HLAB27(-)
➡️smokers
➡️shorter symptom duration
➡️more enthesitis
➡️IBD
➡️concomitant NSAID use
➡️Co-morbidities (HTN, HLD, fibro, depress/anxiety)
#ACR23 @RheumNow https://t.co/TqEVBeaJpb
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Yield of repeated assessments of SpA features in patients with CBP suspected of axSpA was modest for the increase of new definite axSpA diagnosis at 2y. Sacroilitis on MRI, good response to NSAIDs at BL most predictive of axSpA, ML Marques #ACR23 @RheumNow https://t.co/LQ5llML11M https://t.co/PYcCDypI7c
Dr. Antoni Chan ( View Tweet)
Colchicine - what a fascinating medicine.
From a rheum point of view, interesting to see it play out for secondary prevention coronary artery disease, lot of patients. Great we can share our collective clinical confidence with it with cardiology
#ACR23 @US_FDA session @RheumNow https://t.co/Q7zLtyby8l
David Liew drdavidliew ( View Tweet)
Are Long-term NSAIDs safe in AS?
Ab#0528 #ACR23 @RheumNow
19,775 AS pts vs 59,325 controls.
Incidence of 16.9, 13.8 per 1,000 person-yrs, respectively
Long-term use of NSAIDs increased risk of CVD in non-AS control (aHR 1.64), but did NOT in AS pts (aHR 1.06)
Eric Dein ( View Tweet)
Ab#498 Does DMARD for PsO and PsA decrease MACE?
#ACR23 @RheumNow
Retrospective database Israeli study.
PsO, PsA on MTX or bDMARD: lower MACE compared to health matched controled (HR 0.45-0.68, p<0.001)
Pts on topical Rx had marginally Increased MACE (HR 1.14, p <0.001) https://t.co/0uRgjzYbFp
Eric Dein ( View Tweet)
Systemic anti-inflammatory treatments for PsO and PsA including methotrexate and biologics provided cardioprotective effects
Potential cardiovascular benefits of IL-17i and IL-12/23i compared to TNFi
@RheumNow #ACR23 Abs#0498 https://t.co/Np7PSNvFd6
Robert B Chao, MD ( View Tweet)
Difficult to treat D2T-axSpA (failure > 3 biologics), affects one in five patients exposed to b/tsDMARDs in this national registry. D2T is more common in women, presence of peripheral involvement, psoriasis, depression, Fakih O Abst#0514 #ACR23 @RheumNow https://t.co/OoymZzzQST https://t.co/EpTqS1C61A
Dr. Antoni Chan ( View Tweet)
Yet another (mostly) reassuring report about lymphoma and DMARDS
The skin cancer signal in the CIRT trial was weird; would be worth looking into that in observational studies as well @NamrataRheum
#ACR23 Abst0438 @RheumNow https://t.co/Beg8UUe2mn
Mike Putman EBRheum ( View Tweet)
It seems so simple. We should be able to use proteomics to better pick winners when it comes to b/tsDMARDs in RA.
Why is it hard? I guess:
- theory ≠ practice
- too many other factors
- it's too easy not to
Yet I hope/believe, one day we'll do better.
#ACR23 ABST0427 @RheumNow https://t.co/5VBVp3KOJN
David Liew drdavidliew ( View Tweet)
If you're >65 years old & have new RA, you start a DMARD, right? At worst, sometime in the first year?
US Medicare data 2008-17
n=33,373
only 30% have a DMARD on file
(of which bDMARD <10%)
>5% on PNL alone
Do we hate old people with RA?😔
@JihaRheum #ACR23 ABST0433 @RheumNow https://t.co/1CUXAh3fi0
David Liew drdavidliew ( View Tweet)
Year in Review by Dr. P Seo
NORD-STAR trial:
⭐️Abatacept or Certolizumab >> Tociluzumab > triple therapy in tx of 812 early RA patients based on clinical & radiographic results
➡️tx-naive, all got MTX
➡️mod-sev dz activity
➡️randomized to 48 wks therapy
#ACR23 @RheumNow https://t.co/vy2uYuyOse
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Interesting question... but feels like some time related bias or perhaps confounding?
Seems implausible that MTX & biologic would be protective for PsO & harmful for PsA
@RheumNow #ACR23 Abstr 0498 https://t.co/pSRoLHRTAm
Mike Putman EBRheum ( View Tweet)
NAFLD a real issue in RA
Does DMARD choice matter?
National Taiwanese data
newly dx RA n=41791
HCQ reduced NAFLD risk: adjHR 0.75
(other RF: obesity, NSAIDs, even low-dose PNL; but not DM, MTX)
Can HCQ improve liver health in RA?
Authors: ?adiponectin
#ACR23 ABST0396 @RheumNow https://t.co/9VMJpImFKs
David Liew drdavidliew ( View Tweet)
Join us tonight at 6pm PT/ 9pm ET for our daily #ACR23 recap. https://t.co/0RDwTdzhwS
Dr. John Cush RheumNow ( View Tweet)
#ACR23 Abs #0505 found use of IL-17 inhibitors and oral DMARD alone were associated with a decreased likelihood of achieving MDA in PsA. Small sample size, but interesting finding nonetheless. https://t.co/CAZGykwxRT @rheumnow https://t.co/8ptF8aTIFu
Dr. Rachel Tate ( View Tweet)
Did you know about Tubulointerstitial nephritis uveitis (TINU) syndrome? Usually younger pts; uveitis may not be concurrent with the TIN. Risks: NSAID/abx, infx, genetics. Nice systematic review of this entity (link below). #boardquestion @rheumnow #ACR23 https://t.co/HDqLDHyGM6
TheDaoIndex KDAO2011 ( View Tweet)