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Where are we with treating Pre-Rheumatoid Arthritis?
The ability to prevent RA in individuals at risk is a holy grail in rheumatology. There is a long history dating back to the PROMPT trial of methotrexate and PRAIRIE trial of rituximab. Both otrials showed an effect, but it seemed more likely to be a delaying of RA than prevention or modulation. Framing it another way, there were better outcomes in pre-RA because we were actually treating RA as it emerged with a proven effective treatment. It is in this setting that three trials of ongoing studies in RA preventative therapy are presented at ACR.
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Don't forget the power of NSAIDs! (esp COX2i)
10 year study from Germany.
NSAID intake associated with lower radiographic progression in axSpA patients (esp r-axSpA)
COX2i may have stronger effect
#ACRBest #ACR22 @RheumNow Abs#1492 https://t.co/vPIaCahmiW
Robert B Chao, MD doctorRBC ( View Tweet)
Meng et al. ESR/CRP and steroid associated increased risk of MACE in IA. NSAIDs/COX-2 and MTX associated reduced risk of MACE in IA. @RheumNow #ACR22 Abstr#1207 https://t.co/OvjNZkpWpy https://t.co/9NMIJPcV9G
Richard Conway RichardPAConway ( View Tweet)
Singh @NamrataRheum et al. 27,421 RA patients, 8225 on b/tsDMARD. b/tsDMARDs did not increase risk of lymphoma. IR 1.68/1000PY (95% CI 1.5-1.9) on csDMARD vs IR 1.73/1000PY (95%CI 1.4-2.1) on b/tsDMARD. @RheumNow #ACR22 Abstr#1210 https://t.co/3Uvz3mvsGM https://t.co/6k3Vqb21KF
Richard Conway RichardPAConway ( View Tweet)
Filho et al. Retrospective Brazilian study. ADA vs LEF in Takayasu arteritis. Comparable renission, relapses, steroid dose, ESR, CRP, imaging over median 15 weeks. More AEs in LEF but non-severe. @RheumNow #ACR22 Abstr#1553 https://t.co/499dUNmpUD https://t.co/AEk5cG7dc4
Richard Conway RichardPAConway ( View Tweet)
Exposure to DMARDs prior to ICI treatment was not associated with 2-year crude mortality rates. Abs 0764 #ACR22 @RheumNow https://t.co/WvTy84Si7u https://t.co/X4RvYAVSMC
Dr. Rachel Tate uptoTate ( View Tweet)
#abs0948 #acr22 @rheumnow perception on fertility&ART in pts w/rheum Dx: 60% believe their Dx affects fertility/25% believe meds do: most cited MTX, steroids, TNFi, HCQ, NSAIDs. 92% heard of ART but unsure if safe or successful w/their Dx. Hx of infertility 29%/only 52% go w/ART https://t.co/lmaM773gP5
Olga Petryna DrPetryna ( View Tweet)
In non-renal SLE, BEL associated w/ a lower risk of severe infection and hospitalizations due to severe infection compared to MTX, AZA, MMF. Abs 0349 #ACR22 @RheumNow https://t.co/0EBpCMPOqF https://t.co/vdxKVJSaZA
Dr. Rachel Tate uptoTate ( View Tweet)
How to prescribe methotrexate in a post-Roe era:
Abstract #L09
💊 6% of > 1,700 patients reported access issues to MTX
-63% had a delay in filling script
🤰Excessive questions about possibility of pregnancy
🧑⚕️Pharmacy refused to fill
#ACR22 #ACRbest @RheumNow
Catherine Sims, MD DrCassySims ( View Tweet)
Broder et al. HCQ alone vs steroid alone as maintenance in ESKD due to SLE. HCQ less cardiac events, less infection. @RheumNow #ACR22 Abstr#0539 https://t.co/mb3Eof2Uiv https://t.co/3i3ZTY25ru
Richard Conway RichardPAConway ( View Tweet)
ACR Best Abstracts - Day 1
The RheumNow faculty reporters have been scouring the meeting and online presentations to find the best abstracts from ACR22. Here are some of their choice abstracts reported today on day 1 of ACR 2022 (#ACRbest).
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HCQ tx thresholds study by Prof Garg:
🔸HCQ >=500ng/ml: good threshold to detect adherence
🔸HCQ 750-1000ng/ml: effective thresholds to prevent flares
🔸CKD>=2: 4x ⬆️odds of HCQ>1500ng/ml (supraTx! dose adj.)
Interesting data.
Game changing?🧐
#ACR22 @RheumNow ABST#0344 #ACRBest https://t.co/GxlucrTeE5
sheila RHEUMarampa ( View Tweet)
Adding MTX to Pegloticase for 52 wks in gout
◦ Improved response rate by 30%
◦ Reduced discontinuation rate by 40%
◦ Greater resolution of tophi by 20%
◦ Similar safety profile in MTX vs non-MTX groups
Botson J, MIRROR RCT https://t.co/ifXLdvOv0K #ACR22 #ACRBest @RheumNow https://t.co/le9ggUa2Xk
Dr. Antoni Chan synovialjoints ( View Tweet)
NSAIDs plus TNFi (celecoxib and golimumab) therapy in ankylosing spondylitis did not show significant decrease in radiographic progression compared to TNFi monotherapy.
*Numerical reduction in syndesmophytes 11% vs. 25%
Abs#0546
@RheumNow #ACR22
#ACRBest https://t.co/pG5F3xdsh9
Robert B Chao, MD doctorRBC ( View Tweet)
Khanna @sclerodermaUM. SLS-III MMF+Pirfenidone vs MMF alone in SSc-ILD. Underpowered due to COVID (51 vs 150). No difference FVC 18 months ?more rapid improvement in combo. Better HRCT, PROs in combination. Need another study! @RheumNow #ACR22 Abstr#0520 https://t.co/K2Ne6PSHkS https://t.co/P6A7OJpzCf
Richard Conway RichardPAConway ( View Tweet)
#ClinicalPearl #Methotrexate is recommended for Rx in all EXCEPT…#ACR22 @RheumNow
Janet Pope Janetbirdope ( View Tweet)
#ACR22 Plenary 1. Abstr#0001 Another important use of #methotrexate. MIRROR RCT showed greater response in pegloticase + MTX vs pegloticase + PBO and lower infusion reaction. Be interesting to define MTX dose and ?other DMARDs esp in patients with CKD @RheumNow #ACRBest https://t.co/xkP6ZZGQfu
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Abst#0001 MIRROR RCT at #ACR22 #plenary
Pts with gout on #pegloticase and #gout
sustained higher urate lowering response in pts cotreated with #MTX
benefit beyond 6 months
@rheumnow https://t.co/rTZ3fPaFJS
Bella Mehta bella_mehta ( View Tweet)
Excellent start to the first plenary session!
MIRROR study - MTX coadministration with pegloticase for gout treatment
- doubling of efficacy and 7x decrease in infusion reactions
- less anti-PEG abs
@RheumNow #ACR22 Abs#0001 https://t.co/V1HIYypmpO
Robert B Chao, MD doctorRBC ( View Tweet)
MIRROR results showed 12-month safety/efficacy support MTX co-therapy w/ pegloticase. No IRs after 6mo of tx and increased resolution of tophi at wk 52. I use MTX in my gout pts on Pegloticase. Are you #rheumtwitter? Abs 0001 #ACR22 @RheumNow https://t.co/FLwOmAYrS4
Dr. Rachel Tate uptoTate ( View Tweet)