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How much of RA risk is attributed to lifestyle?
@Janetbirdope presents Nurse's Health Study showing 35%
BMI and smoking increase risk of RA... in patients with ACPA positivity
#RNL2023 @RheumNow https://t.co/g9DIrgc7pk
Eric Dein ericdeinmd ( View Tweet)
@Janetbirdope #RNL2023
Benefit of intra-articular jt injections in early RA
Injection of 6-12 swollen joints (!) vs systemic glucocorticoids
-- FAR better ACR20 and ACR50 with less side effects
@RheumNow https://t.co/AtgCKOd8IC
Eric Dein ericdeinmd ( View Tweet)
29 pts w/PsA Sine Psoriasis: 16F/13M, mean age 45 yrs w/ PsA ~6.2 yrs. 54% had 1st-degree relatives with PsA. 66% had DIP arthritis, 39% polyarticular, 36% oligoarticular, 25% were axial. Nail findings seen in 89%, enthesitis 59%, dactylitis 62% https://t.co/MlnIzGBzn0 https://t.co/8hHE3Yv8UE
Links:
Dr. John Cush RheumNow ( View Tweet)
Carol Langford #RNL2023 @RheumNow
Rx options for GPA showed by targeted to patient's disease characteristics of severe vs non-severe disease
CYC not for non-severe due to toxicity
MTX, MMF not for severe disease https://t.co/O3U29jmsHv
Eric Dein ericdeinmd ( View Tweet)
Carol Langford #RNL2023
Use of CYC + RTX:
Not routine upfront, but may be needed for escalating disease
Limited data to support initial usage
Higher risk of hypogammaglobulinemia, infection, and death
@RheumNow https://t.co/SHwV8o4xX1
Eric Dein ericdeinmd ( View Tweet)
Dr. Langford #RNL2023
When to use CYC over RTX for severe GPA induction?
- Severe disease with RTX intolerance
- Worsening disease despite RTX
- RGPN Cr > 4.0, mechanical ventilation? (these were excluded from RAVE trial)
@RheumNow https://t.co/twVJ81pgUK
Eric Dein ericdeinmd ( View Tweet)
Dr. Carol Langford on GPA treatment
Duration of remission maintenance therapy?
- at least 2 years, after 2 years, maintenance appropriate in many cases
- consider RTX, and other cDMARDs (MTX, MMF, AZA)
@RheumNow #RNL2023 https://t.co/VmswcnzN5v
Robert B Chao, MD doctorRBC ( View Tweet)
How to long for maintenance of GPA?
Continue for 24 months, then consider:
Relapse history? Organ damage? Toxicity? Patient wishes? Compliance? Family planning?
Dr. Langford @RheumNow #RNL2023 https://t.co/u7lqCGGeNs
Eric Dein ericdeinmd ( View Tweet)
Beyond immunosuppression, Dr. Carol Langford reviews non-med management of GPA upper airway disease. Things to consider for patients and will change the way I practice. @rheumnow #RNL2023 https://t.co/4SlYx1r5ZK
Dr. Rachel Tate uptoTate ( View Tweet)
Avacopan in GPA
- non-inferior to prednisone for induction remission
- received FDA approval for treatment of severe active GPA in combo with standard therapy and steroids
- should be used in newly diagnosed active or relapsing disease
@rheumnow #RNL2023 https://t.co/0DL1WUP177
Robert B Chao, MD doctorRBC ( View Tweet)
Dr. Langford's take home for GPA. Remember to consider disease severity (will determine tx,) maintenance tx, and non-medical management including vaccination options for pts. #RNL2023 @RheumNow https://t.co/HWdv3Fv9zK
Dr. Rachel Tate uptoTate ( View Tweet)
Limitations of IL6 and some unanswered questions in GCA ? By Dr.Robert Spiera #RNL2023 @RheumNow https://t.co/3tJpRhmFAJ
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Sirilumab ( SAPHYR trial) in PMR, By Dr.Robert Spiera #RNL2023 @RheumNow
It also improved patient reported outcomes. Great news👌 https://t.co/NDxhIwvACq
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Preterm deliveries in PsA pregnancies were more pronounced with 1- first pregnancy.
2- Discontinuation of biologic prior to pregnancy.
By Dr.Chambers #RNL2023 @RheumNow https://t.co/CxZh0ak4l0
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Neonatal outcomes:
Small for gestational age more common with an Adjusted OR off 2.42 and statistically significant.
By Dr.Chambers #RNL2023 @RheumNow https://t.co/NFMAEROEEM
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Pregnancy and #PsA
Risk of preterm delivery if
➡️first pregnancy
➡️biologic stopped pre-pregnancy
Dr Chambers at #RNL2023 https://t.co/yImZRwMuI8
Dr Gurdeep Dulay gurdeep_dulay ( View Tweet)
Why JAKinibs in PsA ?! By Eric Ruderman #RNL2023 @RheumNow
Also inflammatory bowel disease and most recently Upadacitinib for crohns disease. https://t.co/loUgJNUsKT
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Jaks are every where in Psoriatic disease domains, By Eric Ruderman #RNL2023 @RheumNow
Good news, especially with Updacitinib recently and Crohn’s disease ( full package). https://t.co/nlBWJhzpLp
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
What influences global scores to patients is different from physicians by Laura Coates #RNL2023 @RheumNow https://t.co/bTKozGeON6
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Patients definition of remission in PsA, by Laura Coates #RNL2023 @RheumNow https://t.co/kphM14SH0E
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)