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Think Before You Order: Choose Wisely
Early in medical training, we are taught diagnoses are made 90% of the time based only on the history and physical exam of the patient; laboratory tests play a minor role. When ordered, tests are used as evidence to support the diagnosis already made by the physician.
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Baker et al. Optum database study. Tofa assoc reduced incident RA-ILD. aHR 0.33 (vs ADA) @RheumNow #ACR22 Abstr#2251 #ACRbest https://t.co/R5rQ3KcHnq https://t.co/8Nq0t4zqQK
Richard Conway RichardPAConway ( View Tweet)
#Vasculitis #ACR22 highlights. #Rituximab more remission in clinical care for GPA - observational, less infections if 600 mg IV fixed q6 mo how long to continue? Abst#1084 and less flares w Rituximab maintenance in the MAINRITSAN studies abst#527 Ritux is new SoC in GPA @RheumNow
Janet Pope Janetbirdope ( View Tweet)
Aggarwal @docrota et al. ProDERM results on skin and QoL. Statistically significant improvements in CDASI (both activity and damage) and SF-36. @RheumNow #ACR22 Abstr#2239 https://t.co/vsnvYUla13
Richard Conway RichardPAConway ( View Tweet)
Let's review how GCs induce #Osteoporosis 👇(every Rheum should know this!)
💊GCs have bone cell specific effects on:
💠Osteoclasts ⬆️resorption, survival
💠Osteoblasts ⬇️🦴formation & prolif; ⬆️apoptosis
💠Osteocytes ⬆️apoptosis & skeletal fragility
#ACR22 @RheumNow @rheumarhyme https://t.co/n61OXkmRgr
sheila RHEUMarampa ( View Tweet)
Espinosa-Ortega et al. Effect of DM ab on damage (as per MDI) over time. Most damage in PM/Scl>seronegative>other abs @RheumNow #ACR22 Abstr#2241 https://t.co/g8xTRyw6NZ https://t.co/sR1tT2QmU3
Richard Conway RichardPAConway ( View Tweet)
BKZ resulted in clinically meaningful improvements in FACIT-Fatigue and pain (PtAAP) in approximately half of pts w/ active PsA who are bDMARD-naïve or TNFi-IR. Abs 2119 #ACR22 @RheumNow https://t.co/29gzmMZRlG https://t.co/qziqGNxQih
Dr. Rachel Tate uptoTate ( View Tweet)
After 1st TNFi, cycling/swapping strategies both acceptable in PsA w/ similar retention rates. Further studies needed to perform survival subgroup analysis regarding different extra-articular manifestations and PsA subtypes. Abs 2149 #ACR22 @RheumNow https://t.co/SRPhSiGeUI https://t.co/EYDULe52A3
Dr. Rachel Tate uptoTate ( View Tweet)
Luedders et al. Higher plasma MMP-7 and MMP-9 assoc development incident RA-ILD in RA patients @RheumNow #ACR22 Abstr#2252 https://t.co/woVErubytC https://t.co/r916r1AxtN
Richard Conway RichardPAConway ( View Tweet)
More PsA pts on DEUC vs PBO achieved each of the MDA components at 16 weeks. Abs 2136 #ACR22 @RheumNow https://t.co/OrrDWfvGty https://t.co/CdCQzmgOOO
Dr. Rachel Tate uptoTate ( View Tweet)
🌟 COVAX register 🌟
🦠flares of IMRD following covid vax uncommon
👉factors associated with flare:
⬆️disease activity
🙋♀️ female
💊no DMARD @ vax
💊stop/⬇️ DMARD @ vax
👉⬇️ flare assoc with:
💥young
💉RTX
@RheumNow #ACR22 Abst #2274 https://t.co/S892lKcEvS
Patricia Harkins DrTrishHarkins ( View Tweet)
Long term RZB provides durable efficacy response in PsA through 100 weeks. No new safety signals. Abs 2145 #ACR22 @RheumNow https://t.co/HfJvS1HzDW https://t.co/T67lDnxeLy
Dr. Rachel Tate uptoTate ( View Tweet)
Updated ACR GIOP guidelines:
Panel recommends doing Initial fracture risk assessment using the CLINICAL fracture risk assessment then RE-assessing while pts continue on GCs (👇)
☝️Magic nos. GC>/= 2.5mg/d for >3mos
#ACR22 @RheumNow @rheumarhyme #Osteoporosis https://t.co/7oWqHg8Tdv
sheila RHEUMarampa ( View Tweet)
Connolly @CaoilfhionnMD et al. 3 doses SARS-CoV-2 vaccine assoc reduced breakthrough infection in Omicron wave in RMD patients. @RheumNow #ACR22 Abstr#2275 https://t.co/ONXiY8JShK https://t.co/QHNYG9XuJ0
Richard Conway RichardPAConway ( View Tweet)
Wilson et al. Sputum levels of TGF-β1, TNF-α, MCP-1, and IL-4 are significantly elevated in RA-ILD and a portion of these cytokines are also increased in subclinical disease and correlated with lung physiology @RheumNow #ACR22 Abstr#2253 https://t.co/V1fG0QC9od https://t.co/d2YvVIV3Jq
Richard Conway RichardPAConway ( View Tweet)
Should You Repeat the ENA Panel?
Dr. Kathryn Dao ( @KDAO2011) discusses abstract 0725, presented at #ACR22 Convergence. Abstract 0725: Utility of Repeat Extractable Nuclear Antigen Antibody Testing- a Retrospective Audit
https://t.co/6A2ksN6yC2 https://t.co/U62Ab7jj3d
Links:
Dr. John Cush RheumNow ( View Tweet)
Strand et al PROs from SAPHYR (ping @EBRheum ) Significant improvement in SF-36 physical and mental, EQ-5D-3L. Numerical improvement in EQ VAS, FACIT-F, HAQ-DI, PtGA, and pain scores @RheumNow #ACR22 Abstr#2243 https://t.co/RffjBHkjIU https://t.co/0wbnmUhbWy
Richard Conway RichardPAConway ( View Tweet)
"A novel mode of action which has generated a degree of excitement" - Paul Emery
PD-1 agonist - peresolimab in RA
Good impact in b/tsDMARD refractory patients
"Correction of an immune state" - we're shooting for homestasis
Definitely a space to watch!
ABSTL01 #ACR22 @RheumNow https://t.co/W2lWrBgNOT
David Liew drdavidliew ( View Tweet)
McDermott @jeffsparks et al. Subpleural ILAs on CT in 16% RA vs 5% non-RA, OR 3.74. 10 year mortality 53% RA-ILA vs 23% RA non-ILA, 22% non-RA non-ILA. HR mortality 3.20 for RA-ILA vs RA non-ILA @RheumNow #ACR22 Abstr#2248 https://t.co/HZ3y8CANUl https://t.co/nfjFq2REEh
Richard Conway RichardPAConway ( View Tweet)
Figueroa Parra @zach_wallace_md @jeffsparks @AliDuarteMD RA patients have higher risk of severe COVID, especially those with ILD @RheumNow #ACR22 Abstr#2249 https://t.co/xUwStp451C https://t.co/N5A0oo1Kyk
Richard Conway RichardPAConway ( View Tweet)
