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Cost-Effective Use of Biological and Targeted Synthetic DMARDs
An international task force of 13 European experts have developed evidence-based points to consider regarding the cost-effective use of biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in the treatment of inflammatory rheumatic diseases (including rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis).
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NSAIDs in Pregnancy (3.3.2023)
Dr. Jack Cush reviews the lastest journal articles, news, and FDA announcements from the past week on RheumNow. This week, the importance of IFNa, Subclinical PsA and NSAID safety during Pregnancy.
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Is AS transmission to offspring more common from the mother or father?
- hard to say, some studies (including Swiss and UK studies) show mothers play a larger role
- other studies show fathers do
@RheumNow #RNL2023 https://t.co/Vr1qUy5Y6b
Robert B Chao, MD doctorRBC ( View Tweet)
AxSpA is primarily a genetic disease
- clusters in families, especially HLA-B27+ first degree relatives
- genetic testing for asymptomatic relatives not recommended
@RheumNow #RNL2023 https://t.co/vhBlNlXMHR
Robert B Chao, MD doctorRBC ( View Tweet)
Awareness increased for this disease , BY Atul Deodhar #RNL2023 @RheumNow https://t.co/MSBrYU5Pb4
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
#RNL2023 @RheumNow
Atul Deodhar:
Prevalence of AS is increasing!
Is it truly more? Or likely better recognized and diagnosed, as well as increased recognition of nr-AxSpa https://t.co/qNwUg5RtaG
Eric Dein ericdeinmd ( View Tweet)
Atul Deodhar's "3-4-5" Rule for MRI Sacroiliac Jts (SIJ)
Erosion in 3+ SIJ quadrants
Bone marrow edema 4+ SIJ quadrants
Fat lesion in 5+ SI joint
@Rheumnow #RNL2023 https://t.co/AHZUhhEmmC
Eric Dein ericdeinmd ( View Tweet)
Dr. Deodhar reminds us of his "3,4,5 rule" for diagnosing AS.
*Erosions in 3 or more SIJ quadrants
*BME in 4 or more SIJ quadrants
*Fat lesions in 5 of more SIJ quadrants
#RNL2023 @RheumNow https://t.co/2m8TmkQo0A
Dr. Rachel Tate uptoTate ( View Tweet)
Dr. Atul Deodhar on AxSpA
- 5-40% of nr-axSpA progress to r-axSpA over 2-10 years
- is non-radiographic axSpA a misnomer?
@RheumNow #RNL2023 https://t.co/bhwlbg6eWN
Robert B Chao, MD doctorRBC ( View Tweet)
Risk factors for radiographic progression:
Men ♂️
Smoking 🚬
Active inflammation🔥
Blue collar workers 💪
HLA-B27+ 💉
Pre-existing syndesmophyte 🩻
Atul Deodhar at #RNL2023 @RheumNow https://t.co/9ibHTEhi9k
Eric Dein ericdeinmd ( View Tweet)
No significance difference in radiographic progression in patients with IL17-TNF , BY Atul Deodhar #RNL2023 @RheumNow https://t.co/S3NQ4mWgjt
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
SURPASS: SEC vs ADA for axSpA
Outcome: %pts with no radiographic progression
Not benefit- Secukinumab not better than adalimumab
Though negative study, in all groups the progression was very low (<1 mSASS) - both interventions did well!
@RheumNow #RNL2023 https://t.co/Vt58jSXCMd
Eric Dein ericdeinmd ( View Tweet)
First Head-to-Head bDMARD study in axSpA to assess radiographic progression
- secukinumab vs. adalimumab biosimilar
- 66% of either arm prevented radiographic progression
- no difference between two arms but good news is radiographic progression is low!
@RheumNow #RNL2023 https://t.co/xq8GhN7kzr
Robert B Chao, MD doctorRBC ( View Tweet)
Late breaking ACR abstract '22 SURPASS study (H2H TNFi vs IL17 in AS radiographic progression.) Primary endpoint was not met.
However, Dr. Deodhar's take away: spinal radiographic progression over 2 years is very low despite high disease activity in both txs! #RNL2023 @RheumNow https://t.co/TsukRs29pC
Dr. Rachel Tate uptoTate ( View Tweet)
Bimekizumab is a dual IL-17A and IL-17F inhibitor, for nr-axSpA and AS
- it works but is it different from existing IL-17i?
- appears to work well in TNFi-inadequate responders
- are TNFi-IR pts immunologically different? niche category for IL-17A and F use?
@RheumNow #RNL2023 https://t.co/dWkakahHAi
Robert B Chao, MD doctorRBC ( View Tweet)
Dennis Poddubnyy #RNL2023
MRI sequences for axSpA:
Semi-coronal- T1 weighted, T2 STIR, T1 weighted w fat suppression
Semi-axial- T2 STIR
@RheumNow https://t.co/ySk4hU5lMY
Eric Dein ericdeinmd ( View Tweet)
To differentiate mechanical from inflammatory lesion:
1-Site matters
2-Structural changes matter
Denis Poddubnyy #RNL2023 @RheumNow https://t.co/iQ1gHPnkqO
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
@RheumNow's review of new drug approvals during 2022 at #RNL2023 https://t.co/IgndlG6lOI
Dr. Rachel Tate uptoTate ( View Tweet)
Dr. Stanley Cohen on JAKinibs:
Very concise and informative timeline on the multiple JAKinibs approved for multiple conditions
@RheumNow #RNL2023 https://t.co/3ZZHr0akrR
Robert B Chao, MD doctorRBC ( View Tweet)
Swedish registry of Axial SpA pregnancies, 1580 births (matched 1:10), saw improved Preg outcomes & incr biologic use. SpA pts had signif. incr in preterm (RR 1·43), preeclampsia (1·44), C-Sect (1·59), infant SIE (1·29) - Each decreased by annually 0.5% https://t.co/EAUwxNsgzH https://t.co/tmNi3dQtMK
Links:
Dr. John Cush RheumNow ( View Tweet)
