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RA-ILD:
💡Lifetime prevalence seems low but ~40% can have subclincal.
💡Screen early in symptomatic pts.
💡RA disease control decreases ILD progression and mortality.
💡RA-ILD UIP pattern seems to respond to immunosuppression.
#ACR24 @RheumNow https://t.co/q3iACMeYVU
Links:
Adela Castro AdelaCastro222 ( View Tweet)
When you stop 🛑 #TCZ #tocilizumab at
6 months of #Rx in #PMR
RELAPSES are V high
DON’T stop #Toci in PMR too
Early
Rapid and frequent flares
#ACR24 @RheumNow @ACRheum #1698 https://t.co/IX5EJOcIY5
Janet Pope Janetbirdope ( View Tweet)
A#1692
Single cell RNA-seq identifies double-negative-2 (DN2) B-cell population ass w progressive SSc-ILD
IgD- CD27- cluster is highest risk
CD21 low B cells are distinct subset associated with sclerosis, pHTN
DN2 B cells as potential biomarkers for SSc-ILD
@RheumNow #ACR24 https://t.co/IbnOGS8C3t
Eric Dein ericdeinmd ( View Tweet)
Subgroup data from SELECT GCA, overall reinforces overall message
I was curious to see pts previously treated with TCZ; wonder if that selects for refractory phenotype - seems not to be the case
Take home: encouraging data, no subgroup issues
#ACR24 @RheumNow Abstr#1695 https://t.co/5iCLE6T4u3
Links:
Mike Putman EBRheum ( View Tweet)
This will change my practice!
#RCT #MMF + #MTX
superior to
#Cyclophosphamide then #Azathioprine
In
#Tayakasu’s #arteritis N=150
RCT ~1g BID #mycophenolate + 15mg/wk #Methotrexate
Vs #cyclo ➡️100mg #azathioprine
All got #glucocorticoids
#ACR24 @RheumNow @ACRheum #1696 https://t.co/OpRep1vsmx
Janet Pope Janetbirdope ( View Tweet)
Which subsets of GCA pt might benefit most from upadacitinib?
Sub-analysis from SELECT-GCA presented today:
💥Both relapsing and refractory disease
💥Pt w hx of PMR
💥Non-smokers
💥No hx ischemic eye dz
In general, most subgroups still favor UPA
@RheumNow #ACR24 Abst 1695 https://t.co/pX5hcX4TmR
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
A#1690 fibroblast activation protein inhibitor (FAPI)-PET in SSc ILD
Introduces FAPI quantification algorithm
FAPI uptake predicts greater rate of FVC decline. Trend for DLCO, not statistically signif
FAPI volume & intensity both predict accel lung decline
#ACR24 @RheumNow https://t.co/YA2ptLDaMy
Links:
Eric Dein ericdeinmd ( View Tweet)
Sun et al. MMF+MTX vs CYC/AZA in Takayasu. Overall response rates week 28 58.1% vs 32.4%, week 52 55.4% vs 32.4%. So MMF+MTX>CYC/AZA. But I'm not sure what to do with these results. How does it compare to toc or ada? @RheumNow #ACR24 Abstr#1696 https://t.co/Jr6S2c6AKs https://t.co/L8pMFJ5hnj
Links:
Richard Conway RichardPAConway ( View Tweet)
Safer and less relapses in
#Takayasu’s #arteritis
In
#MTX + #MMF
Vs
#Cyclo ➡️ #azathioprine
@RheumNow #ACRBest @ACRheum abst#1696
WOW 😮 Amazing! https://t.co/y3BDjdAa6P
Janet Pope Janetbirdope ( View Tweet)
Can we use MTX+MMF to treat active #TAK rather than CYC?
➡️MTX+MMF vs CYC/AZA over 52W
MTX+MMF had:
⬆️Better efficacy in inducing & maintaining remission
❕Comparable safety to CYC/AZA
⏩This combination may prove preferable to using CYC
Ab1696 #ACR24 @RheumNow https://t.co/S0A8YNk3qL
Mrinalini Dey DrMiniDey ( View Tweet)
A#1691
Biomarkers for Rx response SSc ILD?
92 SSc-ILD pts, 19 had progressive pulm fibrosis (PPF)
KL-6 - incr in PPF, decr in those w/o PPF
CXCL-4 decr across cohort - non-signif trend for more w/o PPF
Specifically in MMF: CRP, KL6, CXCL4 are predictive
#ACR24 @RheumNow https://t.co/9fG6atcLmK
Links:
Eric Dein ericdeinmd ( View Tweet)
#Methotrexate is a dud in #PMR for benefit above #glucocorticoids !
#RCT MTX25mg/wk + Pred 15
Mg/d tapered to 0 at 1 yr vs #Prednisone + placebo same taper
NO BENEFIT from #MTX
#1697 #ACR24 @ACRheum @RheumNow
As FYI
Poster at #EULAR observed
#Leflunomide better than #MTX https://t.co/RepBmOKIsA
Links:
Janet Pope Janetbirdope ( View Tweet)
Abstract 1686: Urinary proteomics reveals potential markers (MMP-13, M-CSF receptor, CD163, ALCAM, FOLR2) and pathways (neutrophil degranulation, ECM, tissue remodeling) involved in lupus nephritis Class II.
@RheumNow #ACR24 https://t.co/kufd2zl9yc
Akhil Sood MD AkhilSoodMD ( View Tweet)
@kekuchinad A#1689 PFT ref equations -> inequities in SSc ILD Predict FVC uses age, ht, sex & race - higher % pred values -> underdx Race-specific v neutral equations: More black pts meet trial eligibility (69/57%), immunos (56/40), lung t, (14/9) @RheumNow #ACR24 #ACRBest https://t.co/40PFmdk3Xv
Links:
Eric Dein ericdeinmd ( View Tweet)
Is there a less invasive approach to evaluate lupus nephritis?
Abstract 1683 highlights the potential role of 68Ga-FAPI PET imaging in evaluating for lupus nephritis. FAPI uptake ↑ in pts with lupus nephritis vs HC. Correlated with IFN -α and IFN-γ pathways.
@RheumNow #ACR24
Akhil Sood MD AkhilSoodMD ( View Tweet)
Very neat simulated model of GC regimens in AAV pt on fixed RTX by @zach_wallace_md and co
Over 5 years:
- No difference in relapse btwn standard GC vs. minimal GC + avacopan
- Higher DMII rates in standard group
Adds to trial + real world data
@RheumNow #ACR24 Abst 1598
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Will my patient with lupus nephritis respond well to induction therapy?
Abstract 1685: Aundhia et al demonstrate the promising utility of RAIL to predict complete renal response in patients with lupus nephritis (Class III or IV +/- V)
@RheumNow #ACR24 https://t.co/JBldrrwUhN
Akhil Sood MD AkhilSoodMD ( View Tweet)
#1689: race-neutral 🫁 function equations in SSc improve equity:
🔹 Race-specific equations underestimate disease severity in Black patients.
🔹 Switching to race-neutral reclassified 45% of Black patients to more severe, 16% of White patients to less severe
@RheumNow #acr24 https://t.co/BfK2PsCMX5
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Belimumab, anifrolumab and voclosporin exhibited an increase in claims from 2017-2022 for #SLE
Belimumab ~ 600% increase!!
@RheumNow #ACR24 abst#1259 https://t.co/norl1xk2KF
Bella Mehta bella_mehta ( View Tweet)
#SLE treatments #ACR24:
Compared efficacy & safety of belimumab vs. telitacicept (targets B-lymphocyte stimulator (BLyS) and proliferation-inducing ligand(APRIL))
Both improved disease activity with no difference in efficacy
Belimumab had lower infection rates
@RheumNow abst1544
Bella Mehta bella_mehta ( View Tweet)