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Where are we with treating Pre-Rheumatoid Arthritis?
The ability to prevent RA in individuals at risk is a holy grail in rheumatology. There is a long history dating back to the PROMPT trial of methotrexate and PRAIRIE trial of rituximab. Both otrials showed an effect, but it seemed more likely to be a delaying of RA than prevention or modulation. Framing it another way, there were better outcomes in pre-RA because we were actually treating RA as it emerged with a proven effective treatment. It is in this setting that three trials of ongoing studies in RA preventative therapy are presented at ACR.
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Are MDA criteria created equal in PsA?
Minimal Disease Activity criteria are used to evaluate PsA disease activity and response to treatment. Given that a patient only has to meet 5 of the 7 criteria, should the individual components be weighted equally?
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Gomez et al. Predictors renal flare in SLE. Adjusted models - low C3, low albumin, proteinuria. @RheumNow #ACR22 Abstr#0540 https://t.co/POfeAa9Ao9 https://t.co/a3JkSP1MkX
Richard Conway RichardPAConway ( View Tweet)
In-person meetings are tough. Virtual meetings are tough. But hybrid meetings are logistical nightmares
Would've liked better WiFi and a live poster hall, but a HUGE credit to @ACRheum on planning a great #ACR22 hybrid meeting. Really amazing job
@RheumNow
Eric Dein ericdeinmd ( View Tweet)
Getting to know the COVID-19 drugs:
◦ Pre-exposure prophylaxis: Tixagevimab and cilgavimab (Evusheld)
◦ Post-exposure treatments: Paxlovid (po), Molnupiravir (po), Sotrovimab (IV), Remdesivir (IV)
Rachael Perritt, COVID-19, #ACR22 @RheumNow https://t.co/bCwxJ9YfIU
Dr. Antoni Chan synovialjoints ( View Tweet)
Show us how you ACR! Share your favorite pictures from ACR on Twitter and tag #RheumPix and #ACR22 and we'll re-tweet our favorite ones! https://t.co/aAUyhmrLPW
Dr. John Cush RheumNow ( View Tweet)
Trend of reduced opioid use when initiating biologics and JAKi in RA though effect size small and very high baseline use (>50%) in this insurance claims database.
Residual pain and harm minimisation still areas of need.
@RheumNow #ACR22 ABST0925
https://t.co/XGHu0fIMF0 https://t.co/PutNNQiKnY
Julian Segan JulianSegan ( View Tweet)
JAK and TYK-2 inhibitors and indications in SpA:
● Tofacitinib ➣ Pan JAKi (AS, PsA)
● Baricitinib ➣ JAK1,2
● Upadacitinib ➣ JAK1 (AxSpA, PsA)
● Deucravacitinib ➣ TYK2 (PsA)
Carol Langford, Year in Review #ACR22 @RheumNow https://t.co/EMLEvptySS
Dr. Antoni Chan synovialjoints ( View Tweet)
Differences between #uveitis pattern in AS vs. PsA and IBD 👇
This is always asked to our rheum fellows during Kelley's hour 🤓
#ACR22 @RheumNow @rheumarhyme @trishiemd @RheumaRamblings @RheumaRambolMD https://t.co/gWxQ9xdb06
sheila RHEUMarampa ( View Tweet)
Jorge et al. @AprilJorgeMD Incidence SLE nephritis - 16% onset, 35% 15 years. 44.7% men vs 28.6% women at 10 years. 40% Black, 38% Hispanic, 40% Asian, 23% White. @RheumNow #ACR22 Abstr#0538 https://t.co/Nbx16jZAN7 https://t.co/BEnAtbcIHt
Richard Conway RichardPAConway ( View Tweet)
GPA pts can have dacryoadenitis (ddx 👇)
where pt's lateral eye/s can be curved due to swelling.
How to examine? Use thumb to retract eyelid & reveal lacrimal gland underneath, ask pt to look medially
#ACR22 @RheumNow @rheumarhyme @doktora_ging @PhRheumaJr #RheumTwitter https://t.co/pJYMffhYWx
sheila RHEUMarampa ( View Tweet)
Deucravacitinib (TYK2 inihibitor) already studied in PsO and PsA, has show efficacy in a phase 2 trial for treatment of SLE.
Improvement in SRI(4), BICLA, LLADS, CLASI-50 and joint count
Abs#1117 @RheumNow #ACR22 https://t.co/XElIuMmud9
Robert B Chao, MD doctorRBC ( View Tweet)
🦋Only 15% of pts with localized DLE develop SLE
Risk factors for conversion:
🔸ANA+ at BL
🔸dsDNA+
🔸Gen'd DLE
🔸Cytopenia
🔸Photosensitivity
🔸abn. UA
#ACR22 @RheumNow @rheumarhyme https://t.co/n7cKjC1oaR
sheila RHEUMarampa ( View Tweet)
Tofighi et al. VTE in SLE nephritis. 10% VTE, 5.2% VTE after SLE nephritis diagnosis. Risks - Black patients, ds-DNA+, SDI, aPL+, SLEDAI. @RheumNow #ACR22 Abstr#0541 https://t.co/G6q0qvirf7 https://t.co/B8STBTMy14
Richard Conway RichardPAConway ( View Tweet)
Prelude to a Meeting #ACR22
https://t.co/ESjDnNue1H https://t.co/EHt5tgFOn3
Links:
Dr. John Cush RheumNow ( View Tweet)
ACR Best Abstracts - Day 1
The RheumNow faculty reporters have been scouring the meeting and online presentations to find the best abstracts from ACR22. Here are some of their choice abstracts reported today on day 1 of ACR 2022 (#ACRbest).
https://t.co/ndSBqYszlo https://t.co/vOHtLTFux6
Links:
Dr. John Cush RheumNow ( View Tweet)
Across 9 trials of Upadacitinib in RA, PsA and AS, 40%–50% of patients had ≥ 2 CV risk factors, ≥ 65 years 6%–23%. Rates of adjudicated MACE and VTE with UPA were infrequent, consistent with background rates in RA, PsA, and AS Abst 0510 https://t.co/HDkQ6ELnAy #ACR22 @RheumNow https://t.co/SRJYdFFNIQ
Dr. Antoni Chan synovialjoints ( View Tweet)
New concept of sJIA to MAS as a continuum on the spectrum of disease severity. Molecular basis via impact of mTORC1 (mechanistic target of rapamycin complex 1) inhibition in Il1rn-/- mice. Looking forward to the full paper. Huang Z Abs004 https://t.co/3OtIp90PnG #ACR22 @RheumNow https://t.co/PPHQj8bYKu
Dr. Antoni Chan synovialjoints ( View Tweet)
How can we differentiate statin-assoc autoimmune necrotizing myopathy from toxic statin #myopathy?🔎
Remember this important slide👇
#ACR22 @Rheumnow #acrreview https://t.co/hKMJuGDJWt
sheila RHEUMarampa ( View Tweet)
Statin therapy may exacerbate underlying neuromuscular disorders.
‼️REMEMBER☝️The only ABSOLUTE contraindication to statins are pts who are HMGCR+
#ACR22 @RheumNow #acrreview https://t.co/A3XGHlrm0X
sheila RHEUMarampa ( View Tweet)