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Abstract #0494 provides context to our continual search for better understanding of inflammatory bowel disease in patients with AS, nr-AxSpA, and PsA.
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A lot of interesting studies will be presented at the poster sessions on Sunday, November 12 and some of them address practical real-world issues such as treatment intensification and the impact of pregnancy on axSpA imaging.
Nouf Al hemmadi
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TNF AND IL17 was equally effective in Axial SpA!
#ACR23 #Reviewcourse https://t.co/oofQkvsJ3f
Paul Sufka, MD
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Takeaways from #ACR23 #ReviewCourse session on SpA Update: Radiographic and Non-Radiographic AS - Dr. Alexis Ogdie
1. Workup of inflammatory back pain: History, exam, CRP, HLA-B27, SI joint films, MRI pelvis (STIR images, no need for contrast). Response to NSAIDs not actually… https://t.co/M0W6UNsPxF https://t.co/7k3xl1RXZz
Meral K. El Ramahi, MD
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ABS0524:
⭐️Benefit of Certolizumab (CZP) over standard non-biologic tx in reducing acute anterior uveitis (AAU) flares among high risk pts w/ axSpA
➡️active dz, HLAB27+, 2 or more AAU flares
⭐️CZP reduced AAU flare rate by 87%
#ACR23 @RheumNow
#ACRBest https://t.co/rW0N18agMO
Meral K. El Ramahi, MD
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ABS0538:
⭐️Characteristics of difficult-to-treat (D2T) axSpA pts:
➡️HLAB27(-)
➡️smokers
➡️shorter symptom duration
➡️more enthesitis
➡️IBD
➡️concomitant NSAID use
➡️Co-morbidities (HTN, HLD, fibro, depress/anxiety)
#ACR23 @RheumNow https://t.co/TqEVBeaJpb
Dr. Antoni Chan
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Yield of repeated assessments of SpA features in patients with CBP suspected of axSpA was modest for the increase of new definite axSpA diagnosis at 2y. Sacroilitis on MRI, good response to NSAIDs at BL most predictive of axSpA, ML Marques #ACR23 @RheumNow https://t.co/LQ5llML11M https://t.co/PYcCDypI7c
Robert B Chao, MD
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Utility of repeating assessments in chronic back pain pts suspected of early axSpA?
2 year study found a modest increase in new axSpA diagnosis after 2 years
Yield of repeating MRI is low but can be considered in B27+ males
@RheumNow #ACR23 Abs#0845 https://t.co/TgSEztUkTm
Richard Conway
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DRESS-PS study LTE. 12 month observational extension. 114 patients PsA/AxSpA. Essentially patients TNFi tapered or not in T2T fashion. TNFi dose remained lower in tapering group but it is consistently creeping back up. Abstr#0775 @RheumNow #ACR23 https://t.co/aYoOl6Ccin https://t.co/BtMR95lIfs
Eric Dein
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Abs#518 @RheumNow #ACR23
Deodhar: TOFA in AS, by b/l CRP levels
30% nml CRP (<5 mg/L) v 70% Elevated
At wk 12, TOFA >> PBO regardless of b/l CRP
Difference in response: greater in pts w elevated CRP
Safety rates: elev. CRP c/w PBO, but nml CRP had trend of high AEs for tofa v PBO https://t.co/b9NRNkU8ub
Eric Dein
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Are Long-term NSAIDs safe in AS?
Ab#0528 #ACR23 @RheumNow
19,775 AS pts vs 59,325 controls.
Incidence of 16.9, 13.8 per 1,000 person-yrs, respectively
Long-term use of NSAIDs increased risk of CVD in non-AS control (aHR 1.64), but did NOT in AS pts (aHR 1.06)
Aurelie Najm
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2 yrs extension of DRESS-PS study
100+ pts w/ PsA and AxSPA
-70% LDA state in both Ctrl & Intervention gps
-strong recovery after relapse
No difference efficacy protocolized & routine care tapering but inferior TNFi use (52 vs. 77%) in Intervention gp
@RheumNow #ACR23 ABST0775 https://t.co/V2DqCjT0w3
Eric Dein
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Upadacitinib on wearable device-measure activity
SELECT-AXIS 2
Abs#0530 #ACR23 @RheumNow
UPA had numerically higher mean daily step counts than PBO
11% improvement v PBO at wk 14 (diff of 345 steps/day)
Sedentary pts: 22% improvement in daily step count from b/l on UPA (4% PBO) https://t.co/Gq91TmvfZC
Eric Dein
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What are effects of TNFi on Lipids in AxSpA?
Ab#0531 #ACR23 @RheumNow
320 pts w AS - retrosp cohort, first-line TNFi, not on lipid Rx
Chol and TG increase in 1st 3 mos of treatment. LDL & HDL: no signif change
Inflam markers/Lipids correlated - suspect due to anti-inflamm effect https://t.co/qT5qUEOEvO
Eric Dein
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Abs#0501 @RheumNow #ACR23
Uveitis in SpA, from Greece
AxSpA: 11.7% Uveitis. RF: HLA-B27 (OR 4.15), periperhal arthritis (OR 3.05)
PsA: 2.7% Uveitis. Ass w/ SpA FHx, Axial dis at dx, disease duration
Permanent vision loss in 16% AxSpA, 30% PsA pts, all with recurrent uveitis
Eric Dein
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EISER study: Undiagnosed IBD in SpA
Abs#0495 #ACR23 @RheumNow
559 pts, 47% PsA/53% SpA (80% r-AxSpA)
Higher mean fecal calprotectin in r-AxSpA (395 vs 305 nrAxSpA/PsA)
14.6% IBD symptoms, 23 patients (4.4% were dx w IBD)
Fecal calprotectin & history can uncover IBD
#ACRBest
Robert B Chao, MD
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Always great to see UCSD represent at #ACR23!
Pregnant women with rheumatic diseases and antiphospholipid syndrome higher a HIGHER risk for acute cardiovascular events
30% of events occurred postpartum
@RheumNow Abs#0722 https://t.co/CqZedfOlBC
Dr. Antoni Chan
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Treatment intensification was associated with a higher ASDAS cut-off (2.7) value than the recommended one (≥2.1), the recommended cut-off could be too stringent or consider other factors than disease activity, Webers, El-Din Abst#0517 #ACR23 @RheumNow https://t.co/ZtBXhufxU1 https://t.co/MzvZQoFbvw
sheila
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Analysis from the DESIR cohort reveal that pregnancy does not aggravate imaging changes in axSpA.
Stat significant changes seen on Xray of LSIJ b4 & after delivery (p=0.037) but not worsening.
Do these findings also translate to⬇️pain/improved QOL?
#ACR23 ABST0513 @RheumNow https://t.co/s6xD2CaPwn
sheila
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In a subgrp analysis of the SURPASS study by Dr @XBaraliakos et al, there was low spinal prog over 2 yrs in SEC & SDZ-ADL treated pts regardless of +/- Synd/⬆️CRP
Synd+ > CRP+ as predictor of radiog prog
Again, early dx = early tx
#ACR23 ABST0522 @RheumNow https://t.co/fGF4szPJbp
