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✨Localized #Scleroderma Pearls✨
#EULAR2022
Eosinophilic Fasciitis
👉Contractures wrists/ankles, rarely fingers
👉Mimics- #Lipodermatosclerosis #Panniculitis
👉GCs+MTX 1st line (IV in refractory🧐),MMF 2nd line
✅I add IVIg+/-UVA1 (pending logistics and insurance coverage!) https://t.co/ZErfLxgdxd
Ashima Makol MD AshimaMakol ( View Tweet)
Hellamand et al. Sex differences in first TNFi response in AxSpA. Treatment efficacy (RR 0.85) and retention (58% vs 72% month 24) rates lower in females. @RheumNow #EULAR2022 OP0020 https://t.co/2IL88K7q40 https://t.co/hSJds5EJFK
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Richard Conway RichardPAConway ( View Tweet)
TOFFIFE RCT in colchicine-resistant FMF. Tocilizumab normalises SAA and CRP/ESR with PGA response in 20-25%. Maybe response criteria too strict, or maybe TCZ only effective for subgroup of patients @RheumNow #EULAR2022 OP0043 https://t.co/kNs8DMzXFB https://t.co/QMDk1IUkjx
Links:
Richard Conway RichardPAConway ( View Tweet)
Adami et al on risk of RMDs with air pollution. Mainly RA - OR 1.4 for PM10, 1.6 for PM2.5 @RheumNow #EULAR2022 OP0071 https://t.co/zDr2jMsIWv https://t.co/f0Y2rQxWRD
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Richard Conway RichardPAConway ( View Tweet)
Can you train #dermatologists to do ultrasound to detect #PsA if pt has joint pain. POCUS of up to 3 painful joints. US ⬆️derm suspicion of PsA- but this is not feasible in busy offices and no reimbursement @RheumNow #EULAR2022 @eular_org OP0029 https://t.co/9a3gDgIBp0
Janet Pope Janetbirdope ( View Tweet)
#EULAR2022 TREAT-EARLIER OP0700
Arthralgia + subclinical inflammation in MRI without RA, treated with MTX + depo steroid injection
▶️In High risk patients, delayed development of synovitis, but does not prevent in long-term
▶️Reduction in disease burden on MTX Rx
@RheumNow https://t.co/SKlqMQQTui
Eric Dein ericdeinmd ( View Tweet)
Zhao et al. Infection risk is ⬆️ in incident AAV. aHR 3.8 for first infection and 3.8 for infectious mortality. 3.2 fold increase in number infections. @RheumNow #EULAR2022 OP0093 https://t.co/LSe4vJqZym https://t.co/tNqI2m30SD
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Richard Conway RichardPAConway ( View Tweet)
MIRACLE (love it!) study. High (max tolerated up to 25mg) vs low dose (6-8mg) MTX in combo with ADA in MTX-IR. Low dose non-inferior with better safety. Japanese population so may not be generalisable. @RheumNow #EULAR2022 OP0062 https://t.co/l3CfzzM7mi https://t.co/lkjuoqLY56
Links:
Richard Conway RichardPAConway ( View Tweet)
Krijbolder et al on MTX to prevent RA in clinically suspect arthralgia. No effect on arthritis free survival (80 vs 82%). Some delay in RA onset in high-risk group. But there was a sustained improvement in symptoms in MTX group @RheumNow #EULAR2022 OP0070 https://t.co/0CPIP51yQd https://t.co/kWNmw1YzrH
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Richard Conway RichardPAConway ( View Tweet)
Bimekizumab (dual 17A/17F inhibitor) RCT in AS. ASAS40 45% vs 23% at week 16. All secondary clinical and imaging endpoints also + @RheumNow #EULAR2022 OP0019 https://t.co/RiZ7Divap3 https://t.co/ushogL5TaX
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Richard Conway RichardPAConway ( View Tweet)
How do we treat fatigue in our PsA patients? Guselkumab PsA trials showed systemic disease activity/function, joint manifestations, and skin involvement accounted for 62% of variability in fatigue. How do we account for the other 38%?
@RheumNow #EULAR2022 ABST#OP0025
Robert B Chao, MD doctorRBC ( View Tweet)
Early RA - does the biologic matter?
NORD-STAR: largely seropos, high CRP early RA
Perhaps unsurprising abatacept shone vs TNFi or TCZ
One of the few pt subgroups with plausible rationale & some data for comparative advantage. Shame it’s less & less common?
#EULAR2022 @RheumNow https://t.co/CrOILKVpIp
David Liew drdavidliew ( View Tweet)
Combined Nordic registry data on demyelination and inflammatory neuropathy with TNFi. Demyelination 2-3 times higher in SpA vs RA. No difference between ETN and monoclonals. @RheumNow #EULAR2022 OP0060 https://t.co/SK9s7aVaZk https://t.co/hZ5VaoTe4X
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Richard Conway RichardPAConway ( View Tweet)
#ClinicalPearl Update on @eular #rheumatoid #arthritis guidelines. Reassuringly not much of an update. Very reasonable discussion of #JAKi safety. @RheumNow Day 1 of #EULAR202 T2T, shared decision making, limit #glucocorticoids to shortest time. Change MOA or not, after failure.
Janet Pope Janetbirdope ( View Tweet)
#POS0190 #EULAR2022 Disappointing news. Despite +ve Phase 2 RCT, Results from Phase 3 RCTs of Baricitinib in #lupus is inconclusive
💠SRI4 was met in BRAVE1 but not BRAVE2 despite identical study
💠BILAG MSK & Skin improved in BRAVE1 only
BICLA wasn’t reported @RheumNow https://t.co/IfJRYEwFY8
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Combined nordic registers study: 🧠 demyelinating and inflammatory neuropathies in 50000+ patients starting TNFi
📍DML SpA > RA
📍INP SpA = RA
📍ETA = Other anti TNFi
But no csDMARDs control group
OP0060 #EULAR2022 @RheumNow https://t.co/LYqUW22rMg
Aurelie Najm AurelieRheumo ( View Tweet)
#Bestinclass #EULAR2022 #PsA @RheumNow #OP0027 #CVE #MACE with #Tofacitinib in #psoriatic #arthritis and #PsO with median 3 to 4 yrs Rx. 40% metabolic syndrome which is high. There was no comparison. As expected hose with ⬆️MACE risks had more outcomes. https://t.co/sTjFHsUxzi
Janet Pope Janetbirdope ( View Tweet)
The amazing @SuAnnYeoh1 oral presentation showing terminally differentiated T effector memory re-expressing CD45RA are associated persistent disease activity in TNF non-responders (but not other bDMARDs) ?role in driving disease @RheumNow #EULAR2022 OP0011 https://t.co/OFradjuGvo https://t.co/flpFmcvixO
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Richard Conway RichardPAConway ( View Tweet)
Dr Fabian Proft @ProftDr present CONSUL open label RCT of effect of adding NSAIDS to TNFi on structural outcomes. Bottom line, no significant difference in mSASSS. However new syndesmophytes in 11% vs 25%. @RheumNow #EULAR2022 OP0018 https://t.co/OcYH6oKbJQ https://t.co/kxH5vUdibe
Links:
Richard Conway RichardPAConway ( View Tweet)
178,000 cells from knee synovium studied to eval diff in RA vs PsA transcriptomes. With RA:
👉synov Tcells ⬆️TGFB1 express'n
👉⬆️FAP+ THY1+ synovial fibroblasts
👉receptor ligand network➡️synovial T cell & macrophage synergy
👉IL-1b & TGFb synergy #EULAR2022 OP0067 @rheumnow https://t.co/0uaFyqZqBg
TheDaoIndex KDAO2011 ( View Tweet)