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What Worries You, Masters You (7.1.2022)
Dr. Jack Cush reviews recent news, regulatory and guideline updates from the past week on RheumNow.com. Studies on methotrexate use, COVID vaccination, Supplements and vitamins, and arthrocentesis despite anticoagulation are discussed.
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HCQ for RA: Not a Great Idea?
MedPage Today
Hydroxychloroquine (HCQ) appeared less safe from a cardiovascular standpoint than methotrexate in older patients with rheumatoid arthritis (RA), analysis of Medicare data indicated.
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CV risk factors not equal when considering magnitude of risk
What can we learn from Oral Surveillance?
The Oral Surveillance trial has almost become a household word for rheumatologists.
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It's time to exonerate methotrexate in causing or exacerbating fibrotic interstitial lung disease in #RA patients https://t.co/AuEIWn8Pc4 https://t.co/razVTF6fFX
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Dr. John Cush RheumNow ( View Tweet)
450 axSpA pts followed 2868 Pt-yrs, 48% on TNFis. TNFi Rx pts had reduced CV risk (HR 0.30; 0.10–0.85), but no longer signif after adjustment for CRP, ESR (HR 0.37, 0.12–1.12, p = 0.077). Reduced CV risk, may not be specifically due to TNFi use https://t.co/mVHYn3PteL https://t.co/bgKWreBL8z
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Dr. John Cush RheumNow ( View Tweet)
CV risk factors not equal when considering magnitude of risk
What can we learn from Oral Surveillance?
The Oral Surveillance trial has almost become a household word for rheumatologists.
https://t.co/LHZTVZh4AK https://t.co/2SlxrG7UpQ
Links:
Dr. John Cush RheumNow ( View Tweet)
New biomarker for atherosclerosis, cardiovascular risk and disease activity in axSpA?
Low Irisin associated with subclinical atherosclerosis, high CV risk and more severe disease activity in axSpA
@RheumNow #EULAR2022 ABST#POS0327
Robert B Chao, MD doctorRBC ( View Tweet)
Redondo-Rodriguez et al. Abatacept in RA-ILD. Prospective study 38 patients. 73.6% improved/stablised with abatacept at median 17 month follow-up @RheumNow #EULAR2022 POS0654 https://t.co/D2du0hAXIy
Richard Conway RichardPAConway ( View Tweet)
Associations with RA-BR (n=57 cases) compared to RA-no lung disease controls (n=36)
⬆️⬆️⬆️RF level (OR 4.4)
⬆️⬆️ ACPA level (OR 3.5)
⬆️older age at RA onset (OR 1.37 per 10 years)
⬇️ BMI (OR 0.94 per kg/m2) (i.e., higher risk in underweight)
🚫 associations: sex, smoking pk-yrs
Jeffrey Sparks MD MMSc jeffsparks ( View Tweet)
Alsing et al. Dutch study. Persistent excess stroke risk in RA in biologic era. @RheumNow #EULAR2022 OP0277 https://t.co/oLmsrniKw6 https://t.co/2zDkuUzq0S
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Richard Conway RichardPAConway ( View Tweet)
Szekanecz et al. ORAL Surveillance. Geographic differences in MACE largely driven by history CVD and high baseline risk in North America and ROW. @RheumNow #EULAR2022 POS0110 https://t.co/cR6a7N2KP5
Richard Conway RichardPAConway ( View Tweet)
Was ORAL Surveillance really a surprise?
Let's look post-hoc at all the other tofacitinib RCTs (ph 1-3b/4 +LTE)
Cardiovascular risk-enriched pts were always in the same MACE ballpark with tofa
ORAL Surveillance was worse, but clues were always there
OP0264 #EULAR2022 @RheumNow https://t.co/rB5SwVX2oc
David Liew drdavidliew ( View Tweet)
#OP0251 #EULAR2022 Any data to support association of RA-ILD with poor #COVID outcomes? A study is US >500 pts (9% ILD) showed ILD as well as poor RA status (RF+ & erosion) increased risk. Detailed analysis inc Radiographic + PFT cd help stratify risk further @RheumNow https://t.co/E89dd38GQS
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
CTD associated ILD 🫁:
lncRNA ENST00000604692 detected in PBMCs is associated with CTD-ILD and can distinguish SSc-
ILD and RA-ILD vs. non ILD patients with AUC 0.79.
As many lncRNA, unknown if biomarker only or has a pathogenic role.
@RheumNow OP0114 #EULAR2022 https://t.co/sR4GmaMkXD
Aurelie Najm AurelieRheumo ( View Tweet)
Vadillo et al. Clinical course in IPAF (ping @leticiakawano ) . Most frequent females in 60s. Arthritis, raynauds most common features. Most NSIP. 50% PFT deterioration 16 months. UIP, baseline fibrosis, mod/high ANA titre assoc progression @RheumNow #EULAR2022 POS1427 https://t.co/qk9zK90Wuk
Richard Conway RichardPAConway ( View Tweet)
Rojas-Gimenez et al After adjusting for age, smoking, ACPA. Male sex (OR 4.2) and longer time of having RA (OR 1.08) associated with ILD @RheumNow #EULAR2022 POS0619 https://t.co/kzG76Qwe52
Richard Conway RichardPAConway ( View Tweet)
Comorbidity in AS from @rheum_cat , Karmacharya et al. Clustering of comorbidities. Depression and hypertension clusters assoc worse disease activity and function @RheumNow #EULAR2022 OP0154 https://t.co/jGQXayAYs9 https://t.co/SnVDhVYQq5
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Richard Conway RichardPAConway ( View Tweet)
RABBIT registry data on CV events with JAKi. Incidence rate low 0.41/100PY. No increase compared to TNFi RR 0.94 (0.39-2.38). No increase in high-risk group RR 0.90 (0.37-2.17). Reassuring with wide CI's. @RheumNow #EULAR2022 OP0135 https://t.co/vBSsnfeBoR https://t.co/iYDZsNwMye
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Richard Conway RichardPAConway ( View Tweet)
#EULAR2022 OP0136:
PROTECT-RA Cohort - 150 pts established RA
Cholesterol loading capacity (CLC) on macrophages
⭐️High CLC correlates with CV events
⭐️bDMARD use affects CLC
@RheumNow https://t.co/9ngaH9yUI7
Eric Dein ericdeinmd ( View Tweet)
#EULAR2022 OP0071
Association between long-term exposure to air pollution (fine particulate matter) and immune-mediated disease in Italy
⭐️⬆️ risk of autoimmune disease, esp RA as well as CTD, IBD
⭐️Every 10 ug/m3 increase in PM, associated with incremental 7% risk
@RheumNow https://t.co/x57CXUHSHb
Eric Dein ericdeinmd ( View Tweet)
