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#1748 Higher air pollution, esp PM2.5, linked to ⬆️RA disease activity and more flares in >1000 Korean patients. Each rise in PM2.5 significantly boosted DAS28, CDAI & joint counts.
Does cleaner air mean calmer joints?
@RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
US Electronic Health Record cohort 2000+pts
Incidence Heart Failure over 10 yrs 6.8%
HF asso w/
Older
Male
Lower eGFR
Hypertensive medication
Diabetes
TTMTS MTX, TNFi
Higher CRP
Probably surrogates for High Disease Activity...
How do we detect it?
Maybe not by using the https://t.co/s9SjEyk3WF
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
#1751 In early RA, higher disease activity, inflammation & older age linked to more ILD changes on machine-learning chest CT. Even subtle QCT abnormalities correlated with reduced lung function pointing to early inflammatory pathways in RA-ILD. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Serrano-Combarro et al. Abatacept in RA-ILD. 343 patients. Progressive ILD in 23%. Similar to the numbers progressing on baricitinib by same group. Previous MTX treatment appears to REDUCE risk (OR 0.45). Disease activity increases risk (OR 1.29). @RheumNow #ACR25 Abstr#2265 https://t.co/0tl0kGgm5p
Richard Conway RichardPAConway ( View Tweet)
Data from this retrospective cohort study by Alomari et al show that SLE pts on SGLT2is
⬇️rates of PulHPN (OR 0.79)
⬇️all-cause mortality (0.49)
⬇️hospitalizations (OR 0.56)
⬇️LN (OR 0.4)
vs non-SGLT2i users(p<0.001)
Impt role of SGLT2i as adjunct tx
#ACR25 @RheumNow Abs2438 https://t.co/NQJTzQwRCt
sheila RHEUMarampa ( View Tweet)
#1747 Serious infections ~2× more common in RA-LD, esp RA-ILD. Pulmonary, bacterial, viral & fungal infections all increased, underscoring need for tailored prevention and vaccination. @RheumNow #ACR25 https://t.co/soyzqLk7Vj
Mrinalini Dey DrMiniDey ( View Tweet)
#1746 In large US RA cohort, elevated GDF-15 & pentraxin-3 levels linked to prevalent RA-ILD; high GDF-15 predicted future ILD risk.
Other fibrosis-related mediators from IPF or heart failure were not associated, suggesting RA-ILD has distinct pathogenic pathways @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Mulcaire-Jones et al. Changes in PFTs over 1 year in early RA. Improved 31%, worsened 25%. No difference based on baseline disease activity, or MTX use. Those with baseline ILD were MORE likely to improve. ?due to effect of treatment @RheumNow #ACR25 Abstr#2235 https://t.co/bJeLYN9oN7
Richard Conway RichardPAConway ( View Tweet)
EGPA relapse in MANDARA including OLE
Majority of relapses are asthma / sinonasal in nature
Of non-airway:
- arthralgia/myalgia
- sensory peripheral neuropathy
@RheumNow #ACR25 Abst1769 https://t.co/cPjjzl4RWS
Links:
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Serrano-Combarro et al. Baricitinib in RA-ILD. Observational, 42 patients. Progressive ILD in 26%. More frequent in women. @RheumNow #ACR25 Abstr#2229 https://t.co/ZXfgxKoau7
Richard Conway RichardPAConway ( View Tweet)
Benson et al. Clinical features that predict CV risk in PsA. Median 3.53 year follow up. 56 CV events. 766 patients. Dactylitis emerged as key predictor in adjusted models. @RheumNow #ACR25 Abstr#2317 https://t.co/5O3G7vGYbq
Richard Conway RichardPAConway ( View Tweet)
IgG4-RD continues to present in new and unusual ways
Hasbani et al. report 9 IgG4-RD patients with coronary artery involvement
RCA and LAD most affected
Seen on CTA
Majority received RTX
7/9 pt at least partially improved imaging on f/u
@RheumNow #ACR25 Abst 2531 https://t.co/Na0gdq3dgb
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
A new genetic score for ILD prediction! 🫁
Developed in the Veterans RA cohort and Validation in a Swedish cohort
Model using classic RA-ILD risk factors and a cocktail of genetic risk
A cut off of 0.05 in this cohort would exclude 36% from HRCT or PFTs
Good performance https://t.co/6UsoSQAtyK
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Mateo Faxas et al. TriNetX study, propensity score matched. 3000 patients. Arrythmia risk is higher with IL-6i vs TNFi in diabetic RA patients. V Tachy (HR 1.4), PPM need (HR 1.4) significantly higher. AF, SVT, VF all numerically increased. @RheumNow #ACR25 Abstr#2283 https://t.co/U2Tk38Mobg
Richard Conway RichardPAConway ( View Tweet)
Effect of air pollution in RA
Prospective cohort 1000+pts w/ 12000+ visits
Higher levels of pollution
& specific size of particles PM25
asso w/
-10% higher odd of flare
-Higher DAS CRP and CDAI
Now the interesting pattern:
PM25 exposure increases 3 weeks before flares https://t.co/MOskJzk05g
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Management of cardiac and joint sarcoidosis. Use of TNFi in treatment refractory cases. Alana Nevares-Berrios @RheumNow #ACR25 https://t.co/hXOfkgQHP9
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#ACR25 Abstr#1608 10! 10! Across the board. 2-yr data from RCT + Open Label showed frequency of both airway and non-airway features of #EGPA improved with Benralizumab/Mepolizumab. Provides assurance to use more in real-world @RheumNow https://t.co/i78xXojGja
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
~1 in 6 pts with #sarcoidosis May have #cardiac involvemt
1/3 respond to #MTX + #steroids
Followed by repeat #PET
Failures get
👇
#infliximab >#adalimumab
👇
#JAKi
Better survival >yrs ago
R heart involved ⬆️risk of MTX nonresponse
#ACR25 @RheumNow @ACRheum abst#1664 #ACRbest https://t.co/kYt9JRNSVH
Links:
Janet Pope Janetbirdope ( View Tweet)
New tx for IPF/autoimmune ILD, nerandomilast (PDE4Bi)
Subgroup analysis from FIBRONEER-ILD, marginally less FVC worsening (-65mL tx grp vs -107mL plbo grp) & no clear improvements in dyspnea/fatigue/cough
But also... 6% absolute reduction in overall, persisted (small n) in https://t.co/Faf26UZuDx
Links:
Mike Putman EBRheum ( View Tweet)
England et al. Predictors of progression RA-ILD - UIP pattern (HR 1.46), current (HR 1.98) and former (HR 1.60) smoking, age (HR 1.03). @RheumNow #ACR25 Abstr#1308 https://t.co/IvQo8Istta
Richard Conway RichardPAConway ( View Tweet)
