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The Fallacy of Biologic Treatment to Prevent Rheumatoid Arthritis
The window of opportunity concept in RA shifted our focus to trying to treat disease earlier and more aggressively to improve long term outcomes. A natural development of this was to reconsider the possibility of therapeutic interventions aimed at the prevention of rheumatoid arthritis.
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Pulmonary Manifestations of Rheumatic Disease in Asymptomatic Patients
In clinical practice, pulmonary manifestations of rheumatic medical diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and peripheral spondyloarthritis (pSpA) are typically not screened for upon diagnosis of a rheumatic disease in patients without any signs or symptoms suggest
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Towards Personalised Care in Rheumatoid Arthritis
Since the millennium, we have seen an expansion in the number of advanced treatments both biologic and targeted synthetic disease modifying anti-rheumatic drugs for rheumatoid arthritis. The challenge remains on how best to characterise the subtypes of RA in order to choose the best drug to ensure optimal outcome for patients.
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Year in Review: Dr. P Seo
Novel RA therapy on the horizon:
⭐️ABBV-3373
➡️ Adalimumab (ADA) + GC receptor modulator vs ADA
➡️ Phase II, 48 pts, previously failed MTX
➡️ Wk 12: better DAS28-CRP, ACR20/70
🚩71% of responders stayed in remission after switch to PBO
#ACR23 @RheumNow
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Difficult to treat RA is not an homogeneous group!
Trajectory analysis 60months shows 4 different clusters
Cluster 2 = 1/3 of patients, do better but never reach LDA.
The ones Fibromyalgia, OA and other conditions blurring assessment?
#Abstract0382 #ACR23 @RheumNow https://t.co/dxxS7vCcMt
Aurelie Najm ( View Tweet)
Year in Review: Dr. P Seo
Novel RA therapy on the horizon:
⭐️Peresolimab
➡️ stimulates PD1
➡️ Phase II, 98 pts
➡️ tx-resistant to other therapies including biologics
➡️ Wk 12: better DAS28, ACR20, not ACR 50/70
#ACR23 @RheumNow
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
YR in Review: Dr. Seo
🚩GLORIA Trial
RA pts > 65yo: prednisolone 5 mg/d x 2 yrs vs PBO + std care
➡️decr dz activity (DAS ⬇️0.37) but 24% incr ADE
🚩Extension:
➡️Tapered off pred over 3m and..
⭐️NO ADRENAL INSUFF
But, small incr in dz activity (DAS ⬆️0.23)
#ACR23 @RheumNow https://t.co/YQbS6C8ZT5
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
It seems so simple. We should be able to use proteomics to better pick winners when it comes to b/tsDMARDs in RA.
Why is it hard? I guess:
- theory ≠ practice
- too many other factors
- it's too easy not to
Yet I hope/believe, one day we'll do better.
#ACR23 ABST0427 @RheumNow https://t.co/5VBVp3KOJN
David Liew drdavidliew ( View Tweet)
If you're >65 years old & have new RA, you start a DMARD, right? At worst, sometime in the first year?
US Medicare data 2008-17
n=33,373
only 30% have a DMARD on file
(of which bDMARD <10%)
>5% on PNL alone
Do we hate old people with RA?😔
@JihaRheum #ACR23 ABST0433 @RheumNow https://t.co/1CUXAh3fi0
David Liew drdavidliew ( View Tweet)
I underestimated how much joy not-bankrupting our healthcare system would bring me
ADA & RTX biosimilars have been wonderful; excited for IL6's to join the party
@RheumNow #ACR23 Abstr0445 https://t.co/HGwi37rZpd
Mike Putman EBRheum ( View Tweet)
Contributing Factors for Difficult-to-Treat RA using Natural Language Processing (NLP): joint erosions (OR 2.97 CI95% [2.17; 4.08], p< 0.001) , higher disease activity (median DAS28 3.16 vs 2.89) associated with D2T, Bergier Abst#0383 #ACR23 @RheumNow https://t.co/KARxoa2Z7H
Dr. Antoni Chan ( View Tweet)
COVID boosters in RA patients:
getting the job done (versus healthy controls, irrespective of non-withheld DMARDs excluding ritux)
@UChicagoMed #ACR23 ABST0416 @RheumNow https://t.co/HVRjC4dauw
David Liew drdavidliew ( View Tweet)
Can a picture tell a RA swollen joint?
(would be super useful for telehealth/remote monitor if so)
It's not prime time yet, but following with interest:
using photos to pick up on skin folds/joint swelling
Fascinating, but let's see it vs MRI, clinical
#ACR23 ABST0402 @RheumNow https://t.co/TFKiD5J4c8
David Liew drdavidliew ( View Tweet)
Year in Review by Dr. P Seo
NORD-STAR trial:
⭐️Abatacept or Certolizumab >> Tociluzumab > triple therapy in tx of 812 early RA patients based on clinical & radiographic results
➡️tx-naive, all got MTX
➡️mod-sev dz activity
➡️randomized to 48 wks therapy
#ACR23 @RheumNow https://t.co/vy2uYuyOse
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
NAFLD a real issue in RA
Does DMARD choice matter?
National Taiwanese data
newly dx RA n=41791
HCQ reduced NAFLD risk: adjHR 0.75
(other RF: obesity, NSAIDs, even low-dose PNL; but not DM, MTX)
Can HCQ improve liver health in RA?
Authors: ?adiponectin
#ACR23 ABST0396 @RheumNow https://t.co/9VMJpImFKs
David Liew drdavidliew ( View Tweet)
PROs are useful for tracking RA disease activity over time outside of the clinic setting for patients initiating new treatments without clinician-derived measures. Correlations in follow-up CDAI and PROs were 0.38 – 0.56, Nowell Abst#0380 #ACR23 @RheumNow https://t.co/LepCZ7sPY8 https://t.co/UYcZzIFEsx
Dr. Antoni Chan ( View Tweet)
Low-grade troponin rises in RA: ignore, or meaningful?
@BrighamWomens RA pts n=329
baseline hs-cTnT
Trops actually predict MACE:
HR 6.62
independent of traditional CV risk, CRP
Traditional CV RF not enough in RA
Maybe smoke does predict future fire?
#ACR23 ABST0387 @RheumNow https://t.co/33ZCgzYIl4
David Liew drdavidliew ( View Tweet)
Let’s talk about SEX! >30% of pts wished their rheums asked them about sexual health, >50% pts with sexual dysfunction have RA. The presence of menopause, younger age, and children were assc with sexual dysfunction. presenter Dr D Flores Abstr#0145, #abst#0146 #ACR23 @RheumNow https://t.co/9AdoTtEwFp
TheDaoIndex KDAO2011 ( View Tweet)
Patient reported outcomes between clinic visits: worth doing?
RA pts starting ADA/UPA, n=150
ArthritisPower/PatientSpot app for PROs between visits
52% of CDAI change explained by PROs
Maybe a helpful tool in prioritising RA clinic reviews?
@RADoctor #ACR23 ABST0380 @RheumNow https://t.co/oTttAlIxQR
David Liew drdavidliew ( View Tweet)
Join us tonight at 6pm PT/ 9pm ET for our daily #ACR23 recap. https://t.co/0RDwTdzhwS
Dr. John Cush RheumNow ( View Tweet)