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Health Literacy: the forgotten social determinant of health?
Nine out of ten adults in the USA struggle to understand basic health-related information. Across the pond, in the UK, 7.1 million adults read at, or below, the level of a nine-year-old, with 60% unable to understand health information. An increasing body of research in rheumatic diseases has sought to understand the impact of health literacy, long neglected as a social determinant of health, on clinical and non-clinical outcomes. Several abstracts at this year’s ACR Convergence focus on this topic.
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Is cognitive impairment in SLE driven by cell exhaustion or aging? Abstract 1514 shows that SLE patients with cognitive impairment had higher levels of CD8+ (cell exhaustion) and lower levels of cell senescence markers. @RheumNow #ACR24 https://t.co/SzxTQt3oNY
Akhil Sood MD AkhilSoodMD ( View Tweet)
#1350
🔬 Microbiome & RA: Impact on Disease Activity & Vascular Function
➡️ Salivary microbiome a/w arterial stiffness (AIx)(p 0.019)
➡️ Stool microbiome a/w DAS28-CRP(p 0.027)
🔴Key taxa👇identified for each; no common taxa for both disease activity & AIx.
#ACR24 @RheumNow https://t.co/54Sumzzd27
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Navigating Positive ANA: Leveraging AI for better triage
Abstract 1526: Markus et al. developed a machine learning model to predict progression to SLE, utilizing diagnoses, meds, procedures, and labs collected 2 years before and 5 years after +ANA.
@RheumNow #ACR24 https://t.co/2zzSH8Pb0e
Links:
Akhil Sood MD AkhilSoodMD ( View Tweet)
What is the impact of social connections on lupus?
Abstract #1503: In an NYC SLE cohort, greater social integration and support correlated with less pain, depression, disability, and frailty, while loneliness was linked to worse outcomes.
@RheumNow #ACR24 #SDoH https://t.co/5OCCExee06
Akhil Sood MD AkhilSoodMD ( View Tweet)
Reason for consult: aortitis- evaluate for systemic causes
Abstract 1638: Kmetova et al highlight the promising clinical utility of calprotectin as a marker for clinically isolated aortitis
@RheumNow #ACR24 https://t.co/2qPaAqWswG
Akhil Sood MD AkhilSoodMD ( View Tweet)
17S19 session on steroid free future
@LesleyJacksonMD @EBRheum @BritAdlerMD
Is a (near) steroid free future for RA, ANCA, Lupus
#ACR24 @RheumNow
Eric Dein ericdeinmd ( View Tweet)
#1456
💥In a real-world UK PsA cohort, 25% had joint erosion @ diagnosis
➡️Mean disease duration 34mo. @ diagnosis
➡️Mean disability score = mod. to severe
💥Delay in diagnosis=poor outcomes
‼️Are we doing enough to catch PsA early? ?
🔑Earlier detection key
#ACR @RheumNow
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
#1375🏋️♀️ Strength Training in RA
➡️ 12-week trial 28 ♀️
High-intensity(HIRT) v. Low-intensity+blood flow restriction(LIT-BFR)
🔴Equivalent gains:Lat-pulldown, biceps curl
🔴Knee extension:HIRT>LIT-BFR (non-significant)
✅ LIT-BFR: Alternative for RA sarcopenia
#ACR24 @RheumNow
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
John Stone
Steroid-free AAV
CYCLOPS: steroid tox like “wallpaper on room”
WGET (ETN for GCA) - taper off by 6 mos - neg trial but started tapers
RAVE - low doses 8-9 mg/d over 18 mos
LoVAS - low dose steroid equally eff
ADVOCATE - AVA one month taper, tox score
#ACR24 @RheumNow https://t.co/C7eLK5UNPM
Links:
Eric Dein ericdeinmd ( View Tweet)
It's always so dispiriting to see PMR patients rack up steroid side effects in front of your eyes.
(the intense motivation to do better than pred for our PMR patients)
#ACR24 @SattuiSEMD @RADoctor ABST0975 @RheumNow https://t.co/FTsvrTIt2F
David Liew drdavidliew ( View Tweet)
#1474
🔬Severe PsA? Guselkumab (GUS) has promise!
➡️In bionaive pts with severe disease activity,
GUS v. PBO resulted in:
🔴73% improvement in joints
🔴53% lower disease activity
🔴63% better PtGA by 2 years
➡️Rapid results by W2, sustained through W100.
#ACR @RheumNow
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Is participation in RISE assoc with improved quality of care?
➡️Enrolment assoc w ⬆️performance in several quality measures
➡️Most marked in practices with lower baseline performance
⏩Registry participation has potential to improve quality of rheum care
Ab1644 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
Biosimilar changes
ASP outpacing reimbursement making not affordable to use
Working with CMS but needs further legislation to fix this
FDA may change interchangeability status for medications to no longer require switching studies
@ACRheumDC @RheumNow #ACR24 https://t.co/daYQJvsHRG
Links:
Eric Dein ericdeinmd ( View Tweet)
What’s on tap for Trump health care agenda?
Uncertainty as to what priorities and actions will be
ACR has plans to address legislative, regulatory, and state affairs
@ACRheumDC #ACR24 @RheumNow https://t.co/a5z4RIOjRC
Eric Dein ericdeinmd ( View Tweet)
A meta-analysis of 11 randomized trials shows no significant difference in efficacy of bDMARDs for early vs. established axial spondyloarthritis (axSpA). Treating at different stages yields comparable short-term outcomes. Abstr#1468 #Spondyloarthritis #RheumatologyResearch… https://t.co/QYuTcVj2m1 https://t.co/ADzEEbCvUM
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
@ACRheumDC State Update:
No changes at executive level
Some shifts in state legislation
With political changes and new administration, states will probably take larger role in healthcare legislation
- PBM reform, copay accum, prior auth/step, reprod healthcare
@RheumNow #ACR24 https://t.co/jc77HCLxqQ
Links:
Eric Dein ericdeinmd ( View Tweet)
State Update @ACRheumDC
No executive level changes, some state legislative flips
Political changes will likely lead to more state legislative healthcare legislation
- In the works for PBM reform, copay accum, prior auth/Step, reprod healthcare
@RheumNow #ACR24 https://t.co/94KyHU0Blr
Links:
Eric Dein ericdeinmd ( View Tweet)
#1326
🔬 Predicting Imminent Inflammatory Arthritis
➡️543 anti-CCP+ at-risk (high/low) tracked
🔑Predictors for IA in high-risk:
🔴EMS≥30min(OR 11)
🔴RF+(OR 6)
🔴US PD(OR 5)
🔴smJTC (OR 5)
🔑Predictors for IA in low risk:
🔴RF+(OR 8)
🔴Anti CCP >3xULN(OR 7)
#ACR24 @RheumNow https://t.co/ou9HNcNb8X
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
What is Osteoarthritis? A downloadable patient education page from JAMA. https://t.co/pQgGfI0boe https://t.co/pd3kygUxkH
Dr. John Cush RheumNow ( View Tweet)