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Think Before You Order: Choose Wisely
Early in medical training, we are taught diagnoses are made 90% of the time based only on the history and physical exam of the patient; laboratory tests play a minor role. When ordered, tests are used as evidence to support the diagnosis already made by the physician.
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Thinking Outside the Box: Novel Strategies for Early Detection of AxSpA
Strategies to identify patients with suspected inflammatory back pain in the general population is critical for timely and proper diagnosis.
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Wilson et al. Sputum levels of TGF-β1, TNF-α, MCP-1, and IL-4 are significantly elevated in RA-ILD and a portion of these cytokines are also increased in subclinical disease and correlated with lung physiology @RheumNow #ACR22 Abstr#2253 https://t.co/V1fG0QC9od https://t.co/d2YvVIV3Jq
Richard Conway RichardPAConway ( View Tweet)
Should You Repeat the ENA Panel?
Dr. Kathryn Dao ( @KDAO2011) discusses abstract 0725, presented at #ACR22 Convergence. Abstract 0725: Utility of Repeat Extractable Nuclear Antigen Antibody Testing- a Retrospective Audit
https://t.co/6A2ksN6yC2 https://t.co/U62Ab7jj3d
Links:
Dr. John Cush RheumNow ( View Tweet)
Strand et al PROs from SAPHYR (ping @EBRheum ) Significant improvement in SF-36 physical and mental, EQ-5D-3L. Numerical improvement in EQ VAS, FACIT-F, HAQ-DI, PtGA, and pain scores @RheumNow #ACR22 Abstr#2243 https://t.co/RffjBHkjIU https://t.co/0wbnmUhbWy
Richard Conway RichardPAConway ( View Tweet)
"A novel mode of action which has generated a degree of excitement" - Paul Emery
PD-1 agonist - peresolimab in RA
Good impact in b/tsDMARD refractory patients
"Correction of an immune state" - we're shooting for homestasis
Definitely a space to watch!
ABSTL01 #ACR22 @RheumNow https://t.co/W2lWrBgNOT
David Liew drdavidliew ( View Tweet)
McDermott @jeffsparks et al. Subpleural ILAs on CT in 16% RA vs 5% non-RA, OR 3.74. 10 year mortality 53% RA-ILA vs 23% RA non-ILA, 22% non-RA non-ILA. HR mortality 3.20 for RA-ILA vs RA non-ILA @RheumNow #ACR22 Abstr#2248 https://t.co/HZ3y8CANUl https://t.co/nfjFq2REEh
Richard Conway RichardPAConway ( View Tweet)
Figueroa Parra @zach_wallace_md @jeffsparks @AliDuarteMD RA patients have higher risk of severe COVID, especially those with ILD @RheumNow #ACR22 Abstr#2249 https://t.co/xUwStp451C https://t.co/N5A0oo1Kyk
Richard Conway RichardPAConway ( View Tweet)
#ACR22 Abs 2144: JAK inhibition induced different gene profile in circulating immune cells w/prominent downregulation of pro-inflammatory pathways in CD4+naïve T cells AND a shift in their metabolic signaling towards a more quiescent state. @RheumNow https://t.co/qYmr6A3zvS
Dr. Rachel Tate uptoTate ( View Tweet)
Dual Energy CT Study in 32 #gout pts on #allopurinol escalated over 2 yrs to achieve Uric acid <6
- tophus urate volumes and tophus soft tissue volumes reduced
- chronic inflammatory soft tissue within the tophus is slower to respond than crystals
@RheumNow #ACR22 abst#2203 https://t.co/dtHQqg9iFR
Bella Mehta bella_mehta ( View Tweet)
BD-2 novel, PsA-specific predictive biomarker of clinical arthritis response to SEC. Pts w/ high levels of BD-2 at baseline reach and sustain higher rates of clinical response after tx w/ SEC. Abs 2148 #ACR22 @RheumNow https://t.co/9ZJz2C0Pep https://t.co/5gf2O7B0c5
Dr. Rachel Tate uptoTate ( View Tweet)
Abstr #2193 studies invasive fungal infxn in Autoimm/Rheum dx
- PJP most common (41.5%)
- Mortality highest among fungemia (48.7%) and invasive aspergillosis (38.3%) vs PJP (26.1%)
- Older age, cirrhosis, high dose GC assoc w ↑ mortality
@RheumNow #ACR22
Akhil Sood MD AkhilSoodMD ( View Tweet)
Monday: ACR 2022 Daily Recap https://t.co/AKYrkLTPJe
Dr. John Cush RheumNow ( View Tweet)
We'll be going live with our #ACR22 daily recap at 5pm ET. Find us on Twitter, LinkedIn, Youtube and Facebook. https://t.co/hjAyOOynZM
Dr. John Cush RheumNow ( View Tweet)
Aggarwal @docrota et al. RCT abatacept in IIM - 52 week results. IMACS DOI, FI-2, HAQ-DI, CDASI, TIS, MRC response all numerically better, some statistically significant. There looks like a real effect across all subtypes. @RheumNow #ACR22 Abstr#2237 https://t.co/NdkH8BnSEw https://t.co/l7ufagjniX
Richard Conway RichardPAConway ( View Tweet)
Kim et al. After first episode VZV in RA or UC treated with JAKi, continued JAKi use does not increase reactivation compared to cessation. @RheumNow #ACR22 Abstr#2220 https://t.co/zx96xgkySU https://t.co/KdniDGCUgI
Richard Conway RichardPAConway ( View Tweet)
#ACR22 Abstr#1656 Promising therapy for #lupus. Cenerimod, S1P1 modulator, controls lymphocyte trafficking out of lymph nodes into blood. Phase 2 dose-ranging RCT didn't meet primary endpoint (adjusted for multiple testing) but mSLEDAI-2K reduced in 4mg dose vs PBO @RheumNow https://t.co/YnENTkqClk
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Abstr #2194- What is my risk of flare after COVID vaccine?
- Up to 3 wks s/p vaccination, no significant assn w/ risk for flare (aIRR 0.89 95% CI 0.8-.098) including after 1st, 2nd, and 3rd dose
- No significant assn by disease, hx of COVID infxn, vaccine type
@RheumNow #ACR22
Akhil Sood MD AkhilSoodMD ( View Tweet)
Some RA patients do well.
Some do badly, and get frail even before the age of 65 (6% of pts).
These are the ones that get hit by infections with b/tsDMARDs: see below from MarketScan data. These are the patients we need to watch & protect!
ABST2217 @NamrataRheum #ACR22 @RheumNow https://t.co/DXZjFDnCcn
David Liew drdavidliew ( View Tweet)
Nakafero et al. Self-controlled case series analysis. No increased risk RMD flare with SARS-CoV-2 vaccination. In fact reduced risk! aIRR 0.89(0.80-0.98). No evidence in any of multiple subanalyses either @RheumNow #ACR22 Abstr#2194 https://t.co/r5pOkdjnR1 https://t.co/YpwMkJ3WVe
Richard Conway RichardPAConway ( View Tweet)