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Two new studies presented this year tackle a key question: can our initial treatment choices influence who ends up in the difficult-to-treat category?
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Here are 3 abstracts that caught my eye on Day 2 at ACR25. Notably these have takeaway messages that should support your current practices.
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CAR T-cells have been a revolutionary development in rheumatology. We have seen a population of patients with severe refractory autoimmune conditions almost overnight presented with the prospect of not just improvement, but of a cure.
Aurelie Najm
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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
Mike Putman
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RESET-RA, RCT of vagus nerve stim (device that zaps pts in neck)
Marginal improvements in ACR20 at wk 12; trend in to improvement in unblinded part of study fwiw
Have never seen result that is more likely to be driven by plbo effect & unblinding 🤪
@RheumNow #ACR25 Abstr#2278 https://t.co/BlR570nv7k
Richard Conway
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Hindosh et al. Semaglutide associated with reduced synovitis, joint pain and swelling, in RA. @RheumNow #ACR25 Abstr#2286 https://t.co/6Xs4um5l32
Richard Conway
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Bremer et al. Earlier initiation of biosimilar adalimumab (vs csDMARDs) may result in cost-savings. Reduced cost of tests, consultations, and hospitalisations. @RheumNow #ACR25 Abstr#2271 https://t.co/lHaSiX3WLd
Jiha Lee
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Semaglutide isn’t just for weight loss?
In RA, users had 20–40% lower risk of synovitis, stiffness & swelling up to 1 year vs matched controls.
GLP-1 agonists may offer anti-inflammatory benefit beyond metabolism.
@RheumNow #ACR25 Abstract#2286
Richard Conway
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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
Aurelie Najm
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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
Richard Conway
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Higashida-Konishi et al. RA. Insomnia and fatigue in >80%, depression in 13%. RA disease activity is associated with depression, fatigue, and insomnia. @RheumNow #ACR25 Abstr#2254 https://t.co/7SibPW6BBw
Jiha Lee
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Can AI predict who stops their RA meds?
In older adults on b/tsDMARDs, interpretable ML found frailty, comorbidity & age top the list for nonadherence risk.
@RheumNow #ACR25 Abstract#2287
Richard Conway
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Girolami et al. VA study. Safety of DMARDs in RA following melanoma. 644 patients. 3 year all cause mortality. No significant difference, but graph sure looks like b/tsDMARDs are better. No melanoma specific mortality/recurrence data however. @RheumNow #ACR25 Abstr#2237 #ACRBest https://t.co/IN4LDkioT7
Aurelie Najm
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Is RA-ILD associated with/ higher risk of infection?
Retrospective US cohort study
151 RA-ILD
980 matched controls
79% higher risk of any and pulmonary infections in RA-ILD
Pathogen type: bacterial, viral and fungi
Some of these infections are preventable!
Take Home: https://t.co/fPmRjLL7Po
Aurelie Najm
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A prediction model for RA-ILD in RA pts: is it possible?
Not quite yet!
Veterans Affairs RA registry 2700+ pts
5% of prevalent ILD
Associated w/
-GDF-15
-Pentraxin 3
No prediction for Incident disease
Needs more work to understand implications for practice
@RheumNow #ACR25 https://t.co/CmW72nybcQ
Mrinalini Dey
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#1724 MAIT cells central in RA pathogenesis. These innate-like T cells accumulate in synovial fluid, driving fibroblast activation, cytokine release & joint damage. Blocking MAIT activation or deleting MR1 reduces arthritis in mice- a potential new target in RA. @RheumNow #ACR25
Nouf Al hemmadi
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SLGT-2 and GLP-1 in RA: More than Weight Loss https://t.co/SRKMHNlHZo
Future of rheumatology is bright , Shreya Sakthivel discussed her work on TriNetX database , looking specifically for effect of SLGT-2. GLP-1 on RA flare incidence.
@RheumKay
@RheumNow
#acr25
Nouf Al hemmadi
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New Paradigms in RA Treatment https://t.co/CqpI2znglE
@jeffsparks Highlights new trials in RA
1-Neuro immune modulation ( Vagal nerve stimulation).
2-Targeting pathogenic T cells
3-T reg CAR-T ( Peace maker).
@RheumNow
#ACR25
Aurelie Najm
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How many patients do you need to treat to prevent one RA conversion in at-risk individuals?
APPIPRA and ALTO Interception studies, long term data
Number Necessary to Treat to prevent 1 RA conversion across time:
1yr = 4
2yrs = 7
3, 4, 5 yrs = 9
6 yrs = 11
#ACR25 #ABSTRACT1678 https://t.co/GBzUJG8jVk
David Liew
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So who with inflamm arthralgias might benefit from abatacept, in terms of delaying RA onset?
ALTO study (APIPPRA continuation)
1y abatacept then follow
If autoAb x5 (RF, ACPA IgG, IgA, anti-CarP, AAPA): sustained delay of RA
If not: benefit only on Rx
#ACR25 ABST1678 @RheumNow https://t.co/3Pc5ZLzVf6
