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Where there’s smoke, there’s flare: how pollution fuels RA
Associations between air pollution and disease activity in rheumatoid arthritis have previously been demonstrated. Abstract 0978 sought to determine the association between fire smoke and other pollutant exposures with the risk of RA and RA-associated interstitial lung disease (RA-ILD).
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To stop tsDMARD / bDMARD To improve #COVIDVACCINE response in those w several previous #COVID19 #vaccinations is NOT necessary
This will change my practice!
#ACR24 @RheumNow @ACRheum https://t.co/WXeqMOEfuA
Janet Pope Janetbirdope ( View Tweet)
The anti-MCTD group strikes back
Of cohort of over 1,000 RNP+ pt, only 17 clinically diagnosed with MCTD
Majority of patients, despite potential overlap, treated for other primary rheum dz
@RheumNow #ACR24 https://t.co/vkQ6UPs34y
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Older RA patients in RISE with high disease activity show a higher incidence of hip and major osteoporotic fractures. Practice T2T and monitor bone health closely!
#ACR24 @RheumNow ABST#1748 https://t.co/7MCAIrfXhp
Jiha Lee JihaRheum ( View Tweet)
How does #race & #ethnicity impact mortality in RA?
Study in CDC national mortality database
➡️RA mortality differed by race & ethnicity
➡️Highest premature mortality in Native Americans
Findings may be used to inform resource allocation & management
Ab1747 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
A#1748
Fracture incidence in RA - RISE registry
Incidence rate of MOF, hip Fx by disease activity
50% did not have CDAI available
IR 12 per 1000py hip, 43 for MOF
High activity worst, low/mod similar, remission is best
Supports remission is better than LDA
@RheumNow #ACR24 https://t.co/78FCLemfZD
Eric Dein ericdeinmd ( View Tweet)
Ab1676 discussed an intervention to change patient mindsets about side-effects of #methotrexate. Watch my video for @RheumNow on this abstract here:
https://t.co/NxuxQ5wYda
#ACR24
Mrinalini Dey DrMiniDey ( View Tweet)
Can we do more to routinely assess fracture risk in RA?
In RA pts ≥65, hip fracture & MOF are more common in pts with active disease, worse with higher disease activity
➡️Need better and more frequent bone health assessments in our RA pts
Ab1748 #ACR24 @RheumNow https://t.co/whfnLnkpLd
Mrinalini Dey DrMiniDey ( View Tweet)
A#1747
RA mortality by race/ethnicity
Database study
>200,000 pts had RA as contributing cause of death
5.1 ASMR in American Indian >>> all other groups
No decr over time in grp, unlike other grps
Odds of death 1.67 compared to white pop
10.8x higher in pts <44
#ACR24 @RheumNow https://t.co/nXLcQkQPu4
Links:
Eric Dein ericdeinmd ( View Tweet)
A#1746 companion for RA
Like plenary for PsA, PBO response incr w time 1%/yr
More trials in less affluent countries may be related to increasing PBO response in trials
Possible reason: access to health care improves PBO in less affluent areas
@RheumNow #ACR24 https://t.co/S3LffF8vPH
Eric Dein ericdeinmd ( View Tweet)
RA patients on TOF with h/o ASCVD have 4x higher risk of MACE without statin (vs. TNFi).
Prioritize statins for heart health in RA!
#ACR24 @RheumNow ABST#1745 https://t.co/jRqXNU2T6d
Links:
Jiha Lee JihaRheum ( View Tweet)
A#1745
Post-hoc ORAL Surveillance - statin
<1/4 on a statin, only 53% h/o ASCVD on statin
Incr in LDL was less on Tofa pts on statin
Among those on b/l statins, there is no incr risk compare to TNFi, esp pts h/o ASCVD
If high risk on tofa, statin helps!
@RheumNow #ACR24 #ACRBest https://t.co/7MGgUk7tfI
Links:
Eric Dein ericdeinmd ( View Tweet)
Wallace et al. Case control study. 648 cases 1241 controls. Cumulative glucocorticoid dose and risk MACE. Dose dependent increase in risk, OR 1.01 for 10% increase GC, 1.21 for 10-fold increase GC. @RheumNow #ACR24 Abstr#1719 https://t.co/wraiWOl1dv https://t.co/feht58RDNc
Links:
Richard Conway RichardPAConway ( View Tweet)
A#1744 AI for RA to improve scheduling in UK
39% pts meet quality metric for early intervention
Input: RF, CRP, CCP, gender, age -> 51% accuracy (compare to first appt clinical accur 46%)
Focusing on highest risk -> 88% accuracy -> 50% wait time for high-risk pts
#ACR24 @RheumNow
Eric Dein ericdeinmd ( View Tweet)
Strive for remission (CDAI ≤2.8) to achieve better functional outcomes in RA
#ACR24 @RheumNow ABST#1743 https://t.co/qpsTF54rmW
Jiha Lee JihaRheum ( View Tweet)
Further evidence for risk of #MACE with cumulative GC use in RA
In a national cohort of pts with RA: ⬆️cumulative GC exposure associated with ⬆️odds of MACE, regardless of baseline MACE risk
Ab1719 #ACR24 @RheumNow https://t.co/RmxokfBXYX
Mrinalini Dey DrMiniDey ( View Tweet)
A#1743
Are there benefits of getting LDA to remission?
Remission CDAI <2.8, VLDA 2.8-6, LDA 6-10
After 1 yr f/u of LDA, 45% Rem, 40 VLDA, 16 LDA
Not in remiss - higher BMI, longer duration, higher resource utilization, worse PRO
No clear diff bw remission & VLDA
#ACR24 @RheumNow https://t.co/ut7c52JVDr
Links:
Eric Dein ericdeinmd ( View Tweet)
Frideres et al. Target trial emulation in RA-ILD. Primar outcome death or respiratory hospitialization. Abatacept (aHR 0.90), tocizilumab (aHR 0.93), tofacitinib (aHR 0.69) vs rituximab. @RheumNow #ACR24 Abstr#1713 https://t.co/fbE8xAnzQ2 https://t.co/uwzH8oAyAT
Links:
Richard Conway RichardPAConway ( View Tweet)
A#1694
To get one or two lungs for lung transplant? 🫁
Autoimmune related ILD transplant outcomes?
145 single (SLT), 461 double (DLT)
Similar 1 yr mortality - HR SLT 1.19 unadjusted, 1.49 adj - not statistically significance
@RheumNow #ACR24 https://t.co/uo8WbrNFAm
Links:
Eric Dein ericdeinmd ( View Tweet)
A retrospective analysis by Dr. ERayens et al showed that RA pts >/=50y given 2 RZV doses were less likely to develop HZ vs. unvaxxed grp
Incidence of PHN was also lower in the vaccinated group (0.2py vs.1.9py)
RZV is effective in preventing HZ & PhN
@Rheumnow #ACR25 abs0977 https://t.co/JhYBYnLmhl
sheila RHEUMarampa ( View Tweet)
