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Playing it Safe with RA? JAK vs. TNF Debate
Reported safety signals, at odds with the efficacy of these medications, have left rheumatology clinicians in a difficult position when considering when during a patient’s treatment course and in which patients, specifically, JAKi should be used. Two abstracts from ACR convergence 2024 further contribute to our understanding of this potential risk profile.
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VACIMRA Study showed timing matters for Methotrexate and Pneumococcal Vaccine in RA.
RA patients vaccinated with PCV13 1 month before MTX initiation had higher responder rates at 1 month:
88% (ELISA) vs. 75%
96% (OPA) vs. 88%
At 12 months, responses remained stronger in… https://t.co/bSbIazsRtG
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Weinblatt et al. AMPLIFIED trial. No difference in response rates of RA to adalimumab or abatacept based on dual seropositivity/shared epitope status. Fits with my priors and refutes a previous pilot study. @RheumNow #ACR24 Abstr#2671 https://t.co/OUwnlsP6jU https://t.co/RBN6ivSKDr
Links:
Richard Conway RichardPAConway ( View Tweet)
Dumoulin et al. 4 year results of TREAT EARLIER trial of 1 year MTX in CSA. In high risk ACPA- group, reduced risk of RA development, 8.6% vs 29%, HR 0.27. No difference at 4 years in ACPA+ or low risk ACPA- @RheumNow #ACR24 Abstr#2672 #ACRbest https://t.co/S2yJm196UV https://t.co/bJ9JySteUs
Links:
Richard Conway RichardPAConway ( View Tweet)
In the AMPLIFIED study (phase 3, single-blind RCT) ABA not superior to ADA in patients with dual seropositive early RA and HLA Class II
#ACR24 @RheumNow ABST#2671 https://t.co/VSorAiJUIe
Jiha Lee JihaRheum ( View Tweet)
Is Pregnancy Truly the Solution for RA?
Pregnancy is perhaps the oldest treatment in rheumatoid arthritis (RA) and has been associated with a natural improvement in disease control in 50-75% of patients. Others, however, are not as successful with unchanged disease activity or… https://t.co/MesVIUl0fC https://t.co/760i5znmeu
Dr. John Cush RheumNow ( View Tweet)
Conversation with @RheumKay on his #ACR24 biosimilar talk for @RheumNow
https://t.co/LzAIGIG4wu https://t.co/CqSYLpJYAh
Eric Dein ericdeinmd ( View Tweet)
@drceowen @TheLancetRheum @RheumNow Efficacy in newly diagnosed & established PMR is not necessarily interchangeable
different treatment paradigm
?different immunologically
Many other diseases have different Rx for induction vs maintenance, early dx vs established.
Having said that: doesn't look great for MTX. https://t.co/89lByaYdYq
David Liew drdavidliew ( View Tweet)
If your pt with #rheumatoid #arthritis is
#exhausted - there is a reason
#Meta-analysis of 70000 RA Pts
#Insomnia is ⬆️4X vs gen population
Due to
▶️#pain
▶️#inflammation
▶️#depression
🤷♀️
#ACR24 @RheumNow @ACRheum abst#0480
Janet Pope Janetbirdope ( View Tweet)
Paraoxonase-1: Possible Biomarker for Progression to RA
Dr. Jonathan Kay discusses abstract 0464, Increases in Paraoxonase-1 Activity over Time Associates with Reduced Risk of Incident Inflammatory Arthritis in an Anti-Citrullinated Protein Antibody-Positive Population,… https://t.co/yhcCrrvjxH https://t.co/caf5dUvrOQ
Dr. John Cush RheumNow ( View Tweet)
JAK-pot! How fast do DMARDs work?
Dr. Mike Putman interviews Dr. Kim Lauper about abstract 0501, How Fast Do JAK-inhibitors, TNF-inhibitors, Abatacept and IL-6 Inhibitors Act in Rheumatoid Arthritis? An International Collaboration of Registers of Rheumatoid Arthritis Patients… https://t.co/GO9EwyrVpV https://t.co/lELE5SJW5i
Dr. John Cush RheumNow ( View Tweet)
RheumNow Day 3 Recap: ACR Convergence 2024 Highlights https://t.co/jFIATPKlp7
Links:
Dr. John Cush RheumNow ( View Tweet)
What factors are assoc with uptake of newer meds in RA?
➡️Incr use of b/tsDMARDs over 10yrs
➡️Use of newer drugs lower in older ppl, socioeconomic deprived & Asian/Black ppl
Could this indicate disparities in access to meds? How can we best address this?
Ab2608 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
Subsets of lupus arthritis. Kenneth Kalunian @RheumNow #ACR24 https://t.co/ZmHui126zr
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
How often do you ask about #fatigue, #depression & #anxiety in pts with RMDs?
Study of >1000 pts found anxiety symptoms in 1/3 pts and significant association between fatigue & anxiety and depression
Highlights importance of regular review of MH symptoms
Ab2657 #ACR24 @RheumNow https://t.co/0zMOMybrCI
Mrinalini Dey DrMiniDey ( View Tweet)
A#2652
NEWTON study 🇫🇷 Retrosp cohort
51% relapse. Median @8.7 mos, dose 9mg pred
Rf: limb art involv- HR 1.9
Pred taper speed not risk for relapse
Most relapse -> incr GCs
Toci 1/3 at dx, 50% stopped
-61% d/c due to remission, 39% SEs
-1/3 relapse after d/c
@RheumNow #ACR24 https://t.co/NP0wieDmvo
Eric Dein ericdeinmd ( View Tweet)
How do you manage DMARDs when giving the recombinant #zoster #vaccine (#RZV)?
➡️75 pts with ARDs
💉2-week #MTX discontinuation after each dose of RZV
⏩Significant boost in immune response without difference in flare rates
Ab2612 #ACR24 @RheumNow https://t.co/o4iqj3e1Be
Mrinalini Dey DrMiniDey ( View Tweet)
A re-evaluation of lupus arthritis. Old dogma is RA is erosive and SLE non-erosive. With better imaging, lupus arthritis can be erosive. Vivianne Malstrom. @RheumNow #ACR24 https://t.co/JEqVPLGNfu
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Did you know?
#Lupus arthritis have clinical and US classifications.
On MRI, findings will show:
- periarticular hyperplastic tissue
- capsular swelling
- edematous tenosynovitis
@RheumNow #ACR24 @rheumarhyme @theactiverheum https://t.co/EoKh2Q3V9Z
Links:
sheila RHEUMarampa ( View Tweet)
A systematic review & meta-analysis by Dr. JBCorrea et al show that the ff immune-mediated dses are assocd w/⬆️ ocurrence risk after covid19 infection 👇
Behcets
SpA
SS
SLE
PMR
Pso
RA
Sjogrens
T1DM
Vasculitis
IBD
Ask prior covid infexn in pts history
@RheumNow #ACR24 abs2614 https://t.co/TIEglPrmvL
sheila RHEUMarampa ( View Tweet)
