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Was this a Mistake? HCQ Dose Reductions per AAOS Guidelines

d Michael Putman, MD, MSCI

In the wake of the 2016 AAOS Guidelines, rheumatologists dutifully reduced the dose HCQ take by patients with SLE to some number south of 5mg/kg per day. Though I believe the ophthalmologists correctly interpreted a 2014 paper in JAMA Ophthalmology that quoted a much-higher rate of HCQ associated retinopathy than had previously been appreciated, they and subsequent guidelines published in the field of rheumatology lacked a critical piece of information: what actually happens when you do this?

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ACR 2022 Appraisal, Praise & Critique (11.18.2022)

d Jack Cush, MD

It was great to be back at an ACR annual meeting, this one in Philadelphia - Philly was great. A walking town, rich in culture, history and good places to meet and mingle. 



I loved the city, but not the convention center (not easy to navigate). 

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Methotrexate + pegloticase increases response rates in gout

d Bella Mehta, MBBS, MS

In abstract 0001 presented at ACR22 Convergence, researchers presented 12-month data from a randomized double-blind placebo-controlled trial of pegloticase with or without MTX.

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Best of

ACR Best Abstracts - Day 3

d Jack Cush, MD

The last day was jammed with important reports and research including the late breaking abstracts. 



 

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Curtis et al. Primary non-adherence to csDMARDs and b/tsDMARDs in RA/PsA/SpA. Medicare and commerically-insured patients. 20-44%! of new prescriptions not filled by 6 months. Higher for csDMARDs than b/tsDMARDs @RheumNow #ACR22 Abstr#2199 https://t.co/Pwg6GKu7Gg https://t.co/wPF0pu1UDa

Links:

Richard Conway RichardPAConway ( View Tweet)
Which is better for CV risk in RA: triple therapy DMARDs or TNFi? TARGET study n=159 using PET/CT surrogate (endpoint responsiveness👀) - either led to benefit - both equally good - benefit *not* linked to change in DAS28 A direct CV effect of RA Rx? ABST2215 #ACR22 @RheumNow https://t.co/4FPvSbfGsD
David Liew drdavidliew ( View Tweet)
Bass et al. Treatment ICI-arthritis. Tricky one. MTX alone assoc longer time to cancer progression and to arthritis control compared to combination with bDMARD. Thoughts @drdavidliew ? @RheumNow #ACR22 Abstr#1669 https://t.co/8KH8RZzcaZ https://t.co/DtpA8s4PLy

Links:

Richard Conway RichardPAConway ( View Tweet)
Are your SpA pts planning on conceiving? Be careful with NSAID use French study found age and NSAID use associated with longer time-to-conception. Factors not associated: smoking, BASDAI score, DMARD use #ACRBest Abs#1673 @RheumNow #ACR22 https://t.co/D63XTY7IB8
Robert B Chao, MD doctorRBC ( View Tweet)
Hamroun et al. Preconceptual NSAID use assoc impaired fertility in SpA, HR 3.01 for time-to-conception @RheumNow #ACR22 Abstr#1673 https://t.co/jresR9MfXF https://t.co/flyfJob9un

Links:

Richard Conway RichardPAConway ( View Tweet)
Important late breaker re:barriers to MTX post Roe decision 6% of respondents who tried to fill MTX had barriers to access; most commonly related to pharmacies/pharmacists This number should be 0%!! #ACR22 abstr#L09 @RheumNow https://t.co/dgZkJLlL25
Mike Putman EBRheum ( View Tweet)
Steroid-sparing in PMR: methotrexate most used, but what is the evidence? Christian Dejaco says: variable at best. We need a proper RCT - and it’s on its way. @Sarah_L_Mackie @profbdasgupta @DrMaxYates1 @CatherineL_Hill @drceowen #ACR22 @RheumNow https://t.co/dxaPdVcOPQ
David Liew drdavidliew ( View Tweet)
Lillegraven @SiriLillegraven ARCTIC REWIND. RA patients flare-free on half-dose csDMARD x 12 months - randomised to continue or stop. Flare 38% vs 17% over 12 months. DAS remission 96% vs 90%. Absence radiograph prog 84% vs 69% @RheumNow #ACR22 Abstr#2013 https://t.co/uOwd8Io5wZ https://t.co/SKWPE7GBrx

Links:

Richard Conway RichardPAConway ( View Tweet)
NSAIDs and CV risk in Inflammatory Arthritis Dr. Richard Conway discusses abstract 1207, being presented #ACR22 meeting. https://t.co/CjU2YbA3tk https://t.co/bHE4xw2IRF

Links:

Dr. John Cush RheumNow ( View Tweet)
Krijbolder et al. TREAT EARLIER DBRCT. MTX vs PBO for pre-RA. Treat 1 year, stop, and follow 1 year. No difference in RA development. Delay in ACPA+ or high risk. Sustained benefit in MTX group on pain, EMS, function, MRI. @RheumNow #ACR22 Abstr#1603 https://t.co/M2qQfgrhC1 https://t.co/UUeknTLx0K

Links:

Richard Conway RichardPAConway ( View Tweet)
ACR Best

ACR Best Abstracts - Day 2

d Jack Cush, MD

Day two at ACR 2022 was full of great sessions on imaging, vasculitis, lupus, vasculitis, spondyloarthritis, COVID, pregnancy, microbiome, economics and more.

Here are the RheumNow faculty selections for #ACRbest abstracts today:

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Torgutalp et al. Higher NSAID intake associated reduced spinal progression in AxSpA esp. r-AxSpA. Cox-2 may have greater effect than other NSAIDs. @RheumNow #ACR22 Abstr#1492 https://t.co/bGH6bBo7AD https://t.co/XBFV410Y2p

Links:

Richard Conway RichardPAConway ( View Tweet)
TOFA and MTX: which one to withdraw first? RCT in 100+ RA pts in remission after 1 yr, 1 yr follow-up Withdraw MTX grp: Remission 30% LDA 40% Withdraw TOFA grp: Remission 50% LDA 65% diff NS small sample 8 SAEs, 72% recovery https://t.co/tMnet32TWF Abs#1586 #ACR22 @Rheumnow https://t.co/PWnkWYdlGk

Links:

Aurelie Najm AurelieRheumo ( View Tweet)
Uggh! What would you do if your pt gets pregnant while on MTX & loses her baby, are you liable for accidental abortion? Should you advise termination if a pregnant pt’s health is deteriorating? @GreerDonley (#law professor) on theoretical risks #ACR22 @rheumnow https://t.co/L4FBWcKZnE
TheDaoIndex KDAO2011 ( View Tweet)
Stop MTX and increase folic acid to 5 mg/day for pts who find themselves with an unintentional #pregnancy. -@CuoghiE #ACR22 @rheumnow https://t.co/uChPU6zrwv
TheDaoIndex KDAO2011 ( View Tweet)
Does MTX dose matter for COVID mRNA vaccine immunogenicity in RA pts? Single-center (n=126) with one MTX dose WH post-each vaccine Similar humoral response Big error bars suggest other factors more important ABST0913 #ACR22 @RheumNow (not pretty graphs but data interesting!) https://t.co/FFfTWiNjUY
David Liew drdavidliew ( View Tweet)

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