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Can Neural Networks Answer Important Diagnostic Dilemmas in Rheumatology?
An interesting study presented at ACR22 looked at whether neural networks can distinguish seropositive rheumatoid arthritis (RA+), seronegative RA (RA-), and psoriatic arthritis (PsA) using hand MRI data based on the structural inflammation patterns.
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One of my personal highlights. History lesson with intersection of medicine. The hilarious @adamjbrown
@RheumNow #ACR22 #rheuminations #factsperminute https://t.co/vDoKLsVfhB
Julian Segan JulianSegan ( View Tweet)
Abst0327 #ACR22 SMART-SLE Monitoring
Some SLE patients with +dsDNA have persistent positivity, others have fluctuations
Anti-dsDNA in persistently positive HR 1.56 for flare risk
Change (up or down!) in dsDNA more than 2x prior visit for fluctuating patients: HR 1.43
@RheumNow https://t.co/YwDPTYWPLu
Eric Dein ericdeinmd ( View Tweet)
Abst0324 #ACR22
How close are we to measuring Interferon Signature in clinical practice?
NCounter and BioFire assays studied - correlated well we each other
Genes: IFI27, IFI44L, IFIT1, RSAD2
SLE higher than RA or FMS, but does not correlate with SLE activity
@RheumNow https://t.co/izpFtj9Pcd
Eric Dein ericdeinmd ( View Tweet)
Abst0326 #ACR22 Anti-Mitochondrial Ab in SLE
Whole mitochondrial (AwMA), AmtDNA or AmtRNA - higher in SLE compared to controls
AwMA predictive of death, AmtDNA and AmtRNA predictive of nephritis
@Rheumnow https://t.co/d98HSHnJVE
Eric Dein ericdeinmd ( View Tweet)
Abst0328 #ACR22. Predicting UCTD to CTD Meta-Analysis
Factors for SLE transition: younger age, serositis, dsDNA
SSc transition: puffy finger, NFC, or SSc antibodies
No studies wo moderate or high risk of bias
Limited studies on biomarkers for SLE, need more studies
@Rheumnow https://t.co/GofGF8TkCx
Eric Dein ericdeinmd ( View Tweet)
All monster stories end with an unexpected award: A new order
@cuttingforstone at #ACR22 tells the monster story of #covid
“How will history review our story?”
The science will get an A+, but we failed to learn the lessons of history
All was predictable through history
@RheumNow
Eric Dein ericdeinmd ( View Tweet)
Year in Review #ACR22
GLORIA
Low steroid usage: lower DAS28, reduced joint damage
BUT 24% increased adverse effects
@RheumNow https://t.co/vYTAhoQEqr
Eric Dein ericdeinmd ( View Tweet)
Ab1012 #ACR22
@AlexisOgdie Opioid Use & Healthcare Utilization in PsA and AS
21% PsA pts on opioids, 27% AS on opioids
Opioid users - more co-morbidities, 🚬, worse disease
Tended to higher use of anti-rheumatic drugs
Higher health care utilizations, medical $$
@RheumNow
Eric Dein ericdeinmd ( View Tweet)
@RheumNow Panel felt that weight and smoking recs were adequately covered by general health recommendations
BUT, this misses a HUGE opportunity to stress that inflammatory arthritis pts have higher risks and need greater emphasis on modifiable risk factors than gen pop
#ACR22 @RheumNow
Eric Dein ericdeinmd ( View Tweet)
CASIPSA results: CT SIJ characteristics from PsA pts similar to age- and sex-matched controls, but w/ higher prevalence of erosions, found in 18% of PsA patients. Abs 1012 #ACR22 https://t.co/jdUSUoUUbf https://t.co/2NQOhncYFc
Dr. Rachel Tate uptoTate ( View Tweet)
Look at these graphs and try and tell me that sex and gender doesn't matter in RA.
We have seen in study after study after study - sex and gender matters.
ABST0241 @erasmusmcintl #ACR22 @RheumNow https://t.co/GQnKrAp0eB https://t.co/MxHRy2kwDN
David Liew drdavidliew ( View Tweet)
New IgG4-RD therapeutic avenues,
mechanistically driven (B cell-CTL interaction):
inebilizumab: registered for NMO, ph3 now
obexelimab: novel dual MOA ?safer, ph3 now
rilzabrutinib: BTKi, ph2 now
elotuzumab: targets SLAMF7, MM registered, NIH study
John Stone #ACR22 @RheumNow https://t.co/lx4bnCutlS
David Liew drdavidliew ( View Tweet)
Pre-RA studies: a summary by Dr. Deane #ACR22 @RheumNow https://t.co/HU8JWmYM8H
David Liew drdavidliew ( View Tweet)
One of the nicest, smartest, and hardest working young rheumatologists you will meet, and I'm sure is destined for great things. My hat off to you @SattuiSEMD, congratulations!
#ACR22 @RheumNow https://t.co/dzHXeahsHT
David Liew drdavidliew ( View Tweet)
Is channelling bias a risk, because of treating clinicians 'protecting' pre-existing autoimmune dx pts: maybe?
Certainly in practice, these pts might get less combo immunoRx; this @mcgillu data would suggest so
Much more to understand across tumor streams
ABST0760 #ACR22 https://t.co/z1rhAJZ9gj
David Liew drdavidliew ( View Tweet)
What imaging modality is best in GCA?
Dutch study: n=42
?GCA got all three of USS, PET/CT, MRI
Overall performance basically the same between all three.
Important details in 🧵
but reasonable to say you can be happy with whatever you’ve got!
ABST1617 #ACR22 #ACRBest @RheumNow https://t.co/HGt0vW9Z38
David Liew drdavidliew ( View Tweet)
To propose early intervention in pre-clinical PsA we need to first identify pts!
Eder et al. PRESTO Prediction of Psoriatic Arthritis Tool
Dvlped 600+ Pso
M stiff, PASI, nails, fatigue pain severity
Sens 61% Spe 77% for 5% proba PsA onset w/in 5yrs
Abs#1612 #ACR22 @Rheumnow https://t.co/QYOIKe3nui
Aurelie Najm AurelieRheumo ( View Tweet)
Tapryal et al. Diagnostic delay of >6 months contributes to poor PROs in PsA. @RheumNow #ACR22 Abstr#1507 https://t.co/dkaNhXUAeD https://t.co/6G7X7V1aRI
Richard Conway RichardPAConway ( View Tweet)
Data like this make us think even in the setting of a controlled clinical trial in #gout, non-white patients much less likely to achieve target serum urate!
Black pts 70% less likely to reach target compared to whites!
#ACR22 @RheumNow abst#1583 https://t.co/dYet7pk2l5
Bella Mehta bella_mehta ( View Tweet)