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ACR21 Best Abstracts - Day 2
The RheumNow faculty reporters have been scouring and reporting on the best abstracts from the ACR. Here is a sampling of their choice abstract presentations reported during ACR 2020 Day 2 (#ACRbest).
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Steroids can cause co-morbidities which increase CV risk, but can PNL directly increase CV event (MACE) risk in RA?
30d PNL➡️15% increase in MACE in next 30d
(independent of underlying CV risk, RA dx activity)
PNL actively confers risk!
@BethIWallace #ACR21 ABST1428 @RheumNow https://t.co/cuL69n7cx3
David Liew drdavidliew ( View Tweet)
Plenary Abs#1428 #ACR21
👉🏼Long-term #steroid use is common in RA incl in pts with high risk of #MACE
👉🏼30days of steroids ➡️ 15% increased odds of MACE
@RheumNow
https://t.co/fCM3m04ruS https://t.co/FWGmAatYu5
Mrinalini Dey DrMiniDey ( View Tweet)
26K Veterans data with RA #ACR21 plenary abst#1428
30 days on glucocorticoids - ⬆️15% odds of Major Adverse Cardiovascular events @RheumNow @BethIWallace https://t.co/BOram4o2rp
Bella Mehta bella_mehta ( View Tweet)
Plenary Abs#1427 #ACR21
👉🏼#Statins assoc w/ reduced #CVD & all-cause mortality, outweighing
modest #T2DM risk increase in RA pts
👉🏼Reduction in all-cause mortality greater in RA than gen population
👉🏼Incr in T2DM risk is NOT greater in RA compared to gen population
@RheumNow https://t.co/WcF11B0C2s
Mrinalini Dey DrMiniDey ( View Tweet)
Statins in RA - plenary at #ACR21 UK Clinical
Practice Research Datalink 1989-2018 @RheumNow
Reduction in CVD risk, All cause mortality
INCREASE in Type 2 DM risk🧐 - need to make sure we look into it for RA patients!
Great work @UNMC_Rheum by Gulsen Ozen! https://t.co/YmTO0xcdjj
Bella Mehta bella_mehta ( View Tweet)
RA and CVD: take your statins!
Obs UK study
Statins ⬇️CVD HR=0.46
⬇️All cause death HR=0.68
w/ mild ⬆️ T2DM risk HR=1.33
(but not more than in general population)
⭐️NNT to prevent CVD 102
⭐️NNT to prevent death 46
⭐️NNH 127
#ACR21 #Abst1427 @RheumNow https://t.co/v6TinuklNv https://t.co/r0rD4jMmuh
Aurelie Najm AurelieRheumo ( View Tweet)
Fautrel describes a series of 13 #AOSD (Stills) pts with Pulmonary arterial HTN (cath confirmed) - seen exclusively with women, 85% and all were on DMARDs - 31% MTX, 69% IL-1i, all on steroids- 5 deaths, 3 yr Survival 74% (same as PAH) #ACR21 Abstract 1100 https://t.co/qR21MdYG3A https://t.co/WN38ifgtT6
Links:
Dr. John Cush RheumNow ( View Tweet)
#ACR21 #Abstr1100 Pulmonary Hypertension is a rare complication of AOSD. What can we learn from case-series of N=13🧐 💠All were female 💠Severe at diagnosis: mean PAP 41mmHg; 85% had NYHA III&IV 💠38.5% mortality rate So, plz be aware of PAH @RheumNow https://t.co/gmXF3AzH2n https://t.co/s5CXrHYUor
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
AS and PsA: Mortality vs Gen Pop (meta-analysis)
AS:
👉⬆️All-cause
👉⬆️CVD
PsA:
👉All-cause not higher
👉⬆️CVD, Respiratory, and Infectious etiologies
Important to consider CVD and other comorbidities.
https://t.co/9K4qNpYvMb
#ACR21 Abst#0569 @RheumNow
Pedro Castillo _Castillo_Pedro ( View Tweet)
Ethnic disparities in pts with RA & CVD - paucity of evidence in published lit
Need to improve study inclusion, diversity to improve quality of care
#ACR21 https://t.co/sWKcHugU9W
Rheum Cat rheum_cat ( View Tweet)
Aware of COPA syndrome?
➡️Rare cause of immune-mediated lung dz
➡️Mimics RA-ILD, SLE, & vasculitis
➡️Adult-onset cases reported
Abst#0529 determined that mutations in the COPA gene underlie some cases of severe pulmonary fibrosis.
#ACR21 @RheumNow https://t.co/mCx3eT7Pv8
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Abst#0572: In US veterans w/ RA followed for 17 yrs, several cytokines+chemokines
⭐️Associated w/ ↑ risk of incident MACE independent of typical CVD RF & RA activity
&
⭐️Predicted MACE even if in LDA/remission
WOW! We need to do better @ CVD risk strat!
#ACRBest @RheumNow https://t.co/J74rRa9EQE
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
*️⃣CT-P13=1st monoclonal biosimilar to infliximab (IFX)
⭐️ReFLECT: 1370 French pts (142 RA, 411 axSpA, 96 PsA)
→2 groups: IFX-naïve starting CT-P vs switching from IFX to CT-P
*️⃣CT-P13 induced improvement in IFX-naïve & maintained dz in pts switched
Abst#0817 #ACR21 @RheumNow https://t.co/bASmGvhuIS
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Great talk by @saadhealth #ACR21 & interesting to compare myocarditis irAEs to inflamm arthritis irAEs:
similar:
- importance of confirming dx well
- cautious adoption steroid-sparing Rx
different:
- clear benefit hard/early Rx
- dx metrics aided by tech
#ACR21 7S404 @RheumNow https://t.co/mFjM3ZlZaP
David Liew drdavidliew ( View Tweet)
#ACR21 #Abstr0871 📢Argument against HCQ<5mg/kg dose from cardiac perspective in #lupus. A retrospective study N=296 pts, 13% developed CV events.⬇️28% in risk of heart failure, arrhythmia/cardiac death per mg/kg of HCQ in non-smokers @RheumNow #ACRBest https://t.co/6ssd2159R1 https://t.co/tllPWLnFFj
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
ORAL Surveillance MACE conclusions:
So this is fair: tofacitinib acts as a CV risk factor, there are many others, we need to address CV risk in RA pts.
Nevertheless, in terms of MI risk, tofa vs TNFi, if I had one CV risk factor, I know what I'd do.
#ACR21 ABST0958 @RheumNow https://t.co/4Z79XtTzl9
David Liew drdavidliew ( View Tweet)
Let's look at MI first.
Well, the numbers don't look great for tofa here.
fatal MI very small numbers
non-fatal MI - well that doesn't look good
(do we have combined both tofa doses vs TNFi?)
HR > 2 seems less than ideal - this would represent a substantial RF
#ACR21 @RheumNow https://t.co/5HSXFrMJCu
David Liew drdavidliew ( View Tweet)
ORAL Surveillance: MACE events higher in TOFA vs TNFi. Independent risk factors: smoking, aspirin use, age ≥ 65 yrs, and male sex; TOFA vs TNFi tx in these pts assoc'd w/ numerically higher MACE incidence. Plenary Abs 0958 #ACR21 #ACRbest @RheumNow https://t.co/44af1KujqP
Dr. Rachel Tate uptoTate ( View Tweet)
Do you order EKGs in everyone starting HCQ? Do you avoid HCQ in patients with heart failure? Will these abstracts impact your practice? Click on link to read more....#ACR21 @rheumnow #HCQ https://t.co/fvUZAvNWa8
TheDaoIndex KDAO2011 ( View Tweet)
