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Meeting audience conference

EULAR 2022 – Day 1 Report

d Jack Cush, MD

It’s good to be back into full, big meeting mode.

Highlights included a EULAR Recommendation Session, where updated guidelines were presented for the management of a) ANCA-associated Vasculitis, b) ASAS/EULAR recommendations for axSpA and c) RA. Here are a few of my favorites from Day 1.

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TYK2i

Are TYK2 inhibitors ‘ticked’ to be part of the JAK family?

d Janet Pope, MD, MPH, FRCPC

Are TYK2 inhibitors JAK inhibitors? Are they effective in PsA? Are they safer than JAKi? Read on to learn more.

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Back Pain

JAKi for nonradiographic axSpA

d Robert Chao, MD

One area of continued interest for many rheumatologists is the field of non-radiographic axial spondyloarthritis. Furthermore, the question of the utility of JAK inhibitors for the treatment of axial spondyloarthritis has been on the rise. 

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RA.Ow02.jpg

A Big Leap in Modulating Rheumatoid Disease

d Richard Conway, MBBChBAO, PhD

Intervention in individuals predisposed to develop rheumatoid arthritis (RA), with a holy grail of prevention of RA, has long been a hot topic. It is well known that seropositivity for rheumatoid factor and antibodies to cyclic citrullinated peptides (ACPA) can precede RA disease by many years. Many, but by no means all, patients also seem to go through a pre-RA arthalgia phase of varying duration characterised by the presence of increasing joint pain without frank arthritis.

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ASRI @Gillianfitzger1 @bososhea @Sineadm15 Current smoking is associated with lower risk of uveitis and arthritis in males with axSpA. I wonder why this would be? @RheumNow #EULAR2022 POS1001 https://t.co/3bKmyvI606
Richard Conway RichardPAConway ( View Tweet)
Sanchez-Bilbao et al. TCZ for large vessel GCA. Has been a concern due to limited LVV/imaging in RCTs 196 patients. Seems to work well. 20% sustained remission month 6, 60% month 12. Clinically significant reduction steroid doses as shown in figure. @RheumNow #EULAR2022 POS0802 https://t.co/Z0HEVal6RI
Richard Conway RichardPAConway ( View Tweet)
Dermatologists doing ultrasound (US) for earlier diagnosis of PsA? Grobelski et al showed in this study of 140 PsA patients, pre-US sensitivity/specifity was 81%/55%, post-US this changed to 62%/91%. Targeted US improved accuracy of referrals for PsA #EULAR2022 @RheumNow OP0029 https://t.co/iajqMuPqcd
Dr. Antoni Chan synovialjoints ( View Tweet)
Sex differences may affect the response to first line TNFi in AxSpA. Hellamund et al EuroSpA study showed the TNFi 6/12/24 month retention rate was lower in females (58%) compared to males (72%). Females had lower CRP level and higher PROs at baseline #EULAR2022 @RheumNow OP0020 https://t.co/ANgRYMxpat
Dr. Antoni Chan synovialjoints ( View Tweet)
MIRACLE study: High or Low dose MTX w/ ADA in eRA? ✨ LOWd (6-8mg/w) 38.4% non-inferior to HIGHd (>10mg/w) 44.8% ✨But safety profile looks better 9.1% vs 22.1% 👀 Are you already looking for minimal dose of MTX in patients treated w/ biologics? #OP0062 @Rheumnow #EULAR2022 https://t.co/dq0EIKSnOe
Aurelie Najm AurelieRheumo ( View Tweet)
RA patients close to the equator (i.e. ‘Global South’) get RA earlier in life than the temperate world. Is it patient-level characteristics like smoking? No. It’s country-level factors e.g. socioeconomic status. Are rich world and poor world RA the same? #EULAR2022 @RheumNow https://t.co/tAzGHzaZGe
David Liew drdavidliew ( View Tweet)
#POS0114 #EULAR2022 Can we identify #lupus patients better in electronic health records? Barbero et al. used machine learning and developed a model to distinguish SLE diagnosis vs "near-misses". AUC: 0.90. Further validation can help future epidemiological studies @RheumNow https://t.co/vpLH8SWlWm
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Upadacitinib shows promising response in the treatment of nr-AxSpA in the SELECT-AXIS 2 study. Deodhar et al showed the ASAS40 response rate for UPA was twice vs placebo (45% vs 23%). 12/14 of the secondary endpoints were also met #EULAR2022 @RheumNow OP0016 https://t.co/dOWVJdLRtG
Dr. Antoni Chan synovialjoints ( View Tweet)
Updated #EULAR2022 AxSpa Recc: The Algorithm @rheumnow https://t.co/fu46QJ3jmQ
TheDaoIndex KDAO2011 ( View Tweet)
ANCA vasculitis guidelines make sense. Less use of cyclophosphamide was already the case, rituximab can be for induction & maintenance, I am reluctant though in severe disease to stop maintenance Rx at 1 or 2 yrs and go longer as at least 1/3 will relapse beyond 2 yrs. @RheumNow https://t.co/3xRHWya2Uq

Links:

Janet Pope Janetbirdope ( View Tweet)

Occupational and non occupational silica exposure in RA increases ILD. At home exposure was higher in women due to cleaning - talc, laundry detergents, etc. Maybe some items should be banned or people protected - ? Masks. V interesting #OP0006 @RheumNow #EULAR2022 @eular_org

Janet Pope Janetbirdope ( View Tweet)

Kading et al reports axial disease in 1/3 of patients with PsA, 55% females, 45% HLA-B27+, in 20% there was spinal but no SI joint involvement. Starts to define the Axial PsA patient as more female, less HLA-B27+ and may have only spinal inflammation #EULAR2022 @RheumNow OP0026

Dr. Antoni Chan synovialjoints ( View Tweet)

Botson et al. 152 patient RCT. MTX combo with pegloticase (to decrease antidrug abs). 6-month response (sUA<6 mg/dL) 71% vs 39%. Infusion reactions 3% vs 31%. @RheumNow #EULAR2022 OP0171 https://t.co/N29kYT3xkR https://t.co/Z4dUMD4Tt3

Links:

Richard Conway RichardPAConway ( View Tweet)
GR2 cohort prospective study of pregnancies in 126 pts w/ SpA over 15 years -Rx exposure 23% steroids, 11% NSAIDS, 55% biologics - 116 live births, 7 miscarriages, 3 stillbirths - 36.5% had unfavorable pregnancy outcomes - 19% SGA - 4.8% preterm birth #EULAR2022 @rheumnow POS1000

TheDaoIndex KDAO2011 ( View Tweet)

Important to capture MDA in the first year! Failure to achieve MDA in 1st year after PsA diagnosis associated with worse quality of life persisting despite intensified treatment. @RheumNow #EULAR2022 ABST#OP0028 https://t.co/FrO569J10S
Robert B Chao, MD doctorRBC ( 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)

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