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Are we really treating Psoriatic disease if we only address active disease domains and T2T?
It’s widely accepted that Psoriatic disease has multi-system, multi-domain potential that can lead to life altering complications if left untreated or undertreated. Rheumatologists have shifted the way we discuss treatment options and disease state expectations with patients. Two #ACR22 abstracts stood out to me regarding the Psoriatic disease patient experience and will, ultimately, add to what I do in clinic.
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Dr. John Cush RheumNow ( View Tweet)
What if my #myositis patient gets pregnant?
Abstract #0952 #ACR22 @RheumNow
🫁10 pregnancies ➡️ 1 miscarriage
-2 preterm
-3 low birth wght
-1 HELLP
-Mean gestational age 36w
🫁 Higher disease activity ➡️ more adverse pregnancy outcomes
Catherine Sims, MD DrCassySims ( View Tweet)
Application of 2022 adult-based AAV ACR/EULAR classification criteria to a large cohort of pediatric vasculitis patients resulted in different classification of one-third of patients compared to the EMA classification algorithm. Abs 0456 #ACR22 @RheumNow https://t.co/AWk4RijJLP https://t.co/nX96xTf7KW
Dr. Rachel Tate uptoTate ( View Tweet)
JAKi appear to be an effective and safety therapy in refractory GCA to cDMARDs and/or bDMARDs. Abs 0464 #ACR22 @RheumNow https://t.co/0ZjI8uTgnY https://t.co/OgxND7HrXj
Dr. Rachel Tate uptoTate ( View Tweet)
Mortality increased by 50% in GCA pts compared to matched controls during first year of follow up after dx. Main cause of this early excess mortality appears to be CVD. Abs 0467 #ACR22 @RheumNow https://t.co/TEV0qSlJuQ https://t.co/U8gv2SXhdQ
Dr. Rachel Tate uptoTate ( View Tweet)
Death rate is higher in the first year after AAV diagnosis and remains elevated in long-term follow up. Primary cause of death is the vasculitis itself. Abs 0448 #ACR22 @RheumNow https://t.co/z7qBnefTbR https://t.co/PRaUeK2XXd
Dr. Rachel Tate uptoTate ( View Tweet)
@alberta_hoi @RheumNow @seminarthrheum Indeed! Thanks Alberta
I think:
- they're not as separate as some might think
- it's possible beta-blockers could prevent damage-related remodelling
- at the least, couldn't they be additive?
Whatever the case, if it's real I want to use it. Big signal needs testing? #ACR22
David Liew drdavidliew ( View Tweet)
International survey finds induction therapy patterns for severe ANCA-associated vasculitis differ based on physician specialty, expertise, and practice setting. Abs 0442 #ACR22 @RheumNow https://t.co/gB6QhYnbp5 https://t.co/Io2hA9EZiW
Dr. Rachel Tate uptoTate ( View Tweet)
🦵Heel enthesitis on physical exam predictive of ⬇️ likelihood of low disease activity and ⬆️ scores in Global VAS, BASDAI, ASDAS and BASFI on 2yr follow up in r-axSpA
# The Achilles heel of r-axSpA!
Abst#0375
#ACR22 @RheumNow
Patricia Harkins DrTrishHarkins ( View Tweet)
@rheum_cat et al Abs 0415 TNFi initiation early in AS dz course (compared to no initiation) showed higher risk of incident CVD, stroke & MACE individually! Residual confounding by indication cannot be excluded. Were TNFi tx pts sicker? #ACR22 @RheumNow https://t.co/ERoDhS2yOY https://t.co/8tto5AIUSP
Dr. Rachel Tate uptoTate ( View Tweet)
🤕 Late onset PsA associated with
⬆️ structural damage
💪🏻UL > LL arthritis
⬆️ BASFI
🙋♂️ males
⬇️ enthesitis/ sacroilitis
Abst# 0377
#ACR22 @RheumNow
Patricia Harkins DrTrishHarkins ( View Tweet)
Can I use BASDAI to asses disease in #pregnant AS patients?
Abstract #0374 #ACR22 @RheumNow; 50 women
🫃Back pain and fatigue beyond 4.5 months = not reliable
🫃BASDAI in 3rd trimester = not reliable
🫃Morning stiffness remains reliable marker of disease in pregnancy
Catherine Sims, MD DrCassySims ( View Tweet)
Abs 0478 at #ACR22 study indicates that a single screening US of temporal and axillary arteries accurately identified 83.3% of patients with subclinical GCA in an inception PMR cohort. It may not change tx but possibly timeline for tx, IMO. @RheumNow https://t.co/bEBVfxDNir https://t.co/UQ1EdniGk5
Dr. Rachel Tate uptoTate ( View Tweet)
Wanna know more about SpA in female patients? Just ask @Sineadm15! Check out my interview with her at #ACR22 @RheumNow https://t.co/NSM4pJeb6g
Dr. Rachel Tate uptoTate ( View Tweet)
👁 What causes worse outcomes in our SpA uveitis pts? 👁
🚬 smoking Hx
🦴 ax + peripheral disease
✏️ BASDAI >4
👩🔬 HLA B27 +ve
🙋♀️ females
🧪CRP ⬆️
👁 bilat eye involvement
Abst#0373
#ACR22 @RheumNow
Patricia Harkins DrTrishHarkins ( View Tweet)
IL-17A/F inhibition with Bimekizumab in active nr-axSpA Wk 16 ASAS40 vs PBO
• Rapid improvement 47.7 vs 21.4%
• TNF naive 46.6 vs 22.9%
• TNFIR 60 vs 11.8%
• Wk 24 >50% ASDAS <2.1
• Improved MRI
• Serious TEAE 0.4%
Deodhar Abs0544 https://t.co/q9dbQP5oLD #ACR22 @RheumNow https://t.co/VCJgo56JrA
Dr. Antoni Chan synovialjoints ( View Tweet)
QD Clinic - How to Treat Erosive OA (abstract #L05)
61yoWM with bilateral pain/swelling in DIPs. Labs normal, seronegative and Xrays shows evidence of DIP erosive OA.
But what works in EOA? #ACR22
https://t.co/tbIoTg6kxA https://t.co/YcW7TON0En
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Dr. John Cush RheumNow ( View Tweet)
Adding MTX to Pegloticase for 52 wks in gout
◦ Improved response rate by 30%
◦ Reduced discontinuation rate by 40%
◦ Greater resolution of tophi by 20%
◦ Similar safety profile in MTX vs non-MTX groups
Botson J, MIRROR RCT https://t.co/ifXLdvOv0K #ACR22 #ACRBest @RheumNow https://t.co/le9ggUa2Xk
Dr. Antoni Chan synovialjoints ( View Tweet)
Abs 0412 by @Spondy_MD et al at #ACR22: BKZ tx showed meaningful improvements in physical function and HRQoL in nr-axSpA and AS pts with consistent responses. @RheumNow https://t.co/diGqpQKfpS https://t.co/1pdGi47IJM
Dr. Rachel Tate uptoTate ( View Tweet)