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Health Literacy: the forgotten social determinant of health?

d Mrinalini Dey, MD

Nine out of ten adults in the USA struggle to understand basic health-related information. Across the pond, in the UK, 7.1 million adults read at, or below, the level of a nine-year-old, with 60% unable to understand health information. An increasing body of research in rheumatic diseases has sought to understand the impact of health literacy, long neglected as a social determinant of health, on clinical and non-clinical outcomes. Several abstracts at this year’s ACR Convergence focus on this topic.

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Quaack etlal. PreCARA study (vs PARA, historical control). T2T in RA improves fertility - time to pregnancy 84 days vs 196 days. T2T strategy also led to less NSAIDs and prednisolone. @RheumNow #ACR24 Abstr#1647 #ACRbest https://t.co/vYCCUqpCLo https://t.co/PUHJOxgGbL

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Richard Conway RichardPAConway ( View Tweet)
#2282 🔬 Personalised Approach to TNFi in RA 📊 N=50👇; 43 responders 🔑 Findings 💥TNFR2 rs1061622 polymorphism linked to TNFi response 💥 MR/RR alleles ⬆️ 10X odds non-response v. MM allele (OR = 10.1,p=0.04) 🎯Genotyping may guide personalized RA therapy. #ACR24 @RheumNow https://t.co/MQKZUCEPxj

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Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
#1330 🔬F-Calprotectin in Early RA ➡️ New-onset RA pts(n=104) had ⬆️ F-calprotectin vs controls(n=50)(71 v. 17µg/g; p<0.001) 🔑Higher F-calprotectin linked to ⬆️ DAS28 & NSAID use ⬇️levels @ 6 months Rx ❓Role of subclinical gut inflammation in early RA #ACR24 @RheumNow

Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)

GILZ is a negative regulator of the GC receptor, a potential steroid sparer target. Dr. Miceli et al identified an E3 ligase of GILZ "E3-X" where deficiency leads to ⬆️ GILZ & ⬇️ inflammation. More studies needed but a promising steroid sparer option. @Rheumnow #ACR24 abs1646 https://t.co/GuVMkgOTXT

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sheila RHEUMarampa ( View Tweet)
#1165 📊 PBMCs of IIM patients with myocarditis(n=4) showed distinct gene expression v controls(n=4) v IIM alone(n=4)👇 💥 B-cell dysregulation may drive myocarditis in IIM 🎯Key immunological insights into🫀involvement in IIM #ACR24 @RheumNow @JuliePaikMD @jhrheumatology https://t.co/PceZUS929S

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Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Plenary II: pregnancy in RA When a treat to target approach is used to achieve remission, pregnancy rates nearly similar to general population! Time to pregnancy less than half that of non-T2T comparators @RheumNow #ACR24 https://t.co/B9F9M8t9Kt

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Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Infertility in women with RA 2x higher Risk factors - age - disease activity - use of NSAIDs - use of pred >7.5mg/day With T2T aiming for remission, fertility improves and becomes similar to the general population #ACR24 @RheumNow ABST#1647 https://t.co/B2Tx4dju4Z

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Jiha Lee JihaRheum ( View Tweet)
Does psoriasis (Pso) affect radiographic progression in ankylosing spondylitis (AS)? A study comparing radiographic spine assessment in AS patients with and without Pso reveals no significant differences in structural lesions. Male gender is a key factor in structural… https://t.co/z34FjHtjEJ

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)

Is cognitive impairment in SLE driven by cell exhaustion or aging? Abstract 1514 shows that SLE patients with cognitive impairment had higher levels of CD8+ (cell exhaustion) and lower levels of cell senescence markers. @RheumNow #ACR24 https://t.co/SzxTQt3oNY

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Akhil Sood MD AkhilSoodMD ( View Tweet)
#1350 🔬 Microbiome & RA: Impact on Disease Activity & Vascular Function ➡️ Salivary microbiome a/w arterial stiffness (AIx)(p 0.019) ➡️ Stool microbiome a/w DAS28-CRP(p 0.027) 🔴Key taxa👇identified for each; no common taxa for both disease activity & AIx. #ACR24 @RheumNow https://t.co/54Sumzzd27

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Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Navigating Positive ANA: Leveraging AI for better triage Abstract 1526: Markus et al. developed a machine learning model to predict progression to SLE, utilizing diagnoses, meds, procedures, and labs collected 2 years before and 5 years after +ANA. @RheumNow #ACR24 https://t.co/2zzSH8Pb0e

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Akhil Sood MD AkhilSoodMD ( View Tweet)
What is the impact of social connections on lupus? Abstract #1503: In an NYC SLE cohort, greater social integration and support correlated with less pain, depression, disability, and frailty, while loneliness was linked to worse outcomes. @RheumNow #ACR24 #SDoH https://t.co/5OCCExee06

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Akhil Sood MD AkhilSoodMD ( View Tweet)
Reason for consult: aortitis- evaluate for systemic causes Abstract 1638: Kmetova et al highlight the promising clinical utility of calprotectin as a marker for clinically isolated aortitis @RheumNow #ACR24 https://t.co/2qPaAqWswG

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Akhil Sood MD AkhilSoodMD ( View Tweet)
17S19 session on steroid free future @LesleyJacksonMD @EBRheum @BritAdlerMD Is a (near) steroid free future for RA, ANCA, Lupus #ACR24 @RheumNow

Eric Dein ericdeinmd ( View Tweet)

#1456 💥In a real-world UK PsA cohort, 25% had joint erosion @ diagnosis ➡️Mean disease duration 34mo. @ diagnosis ➡️Mean disability score = mod. to severe 💥Delay in diagnosis=poor outcomes ‼️Are we doing enough to catch PsA early? ? 🔑Earlier detection key #ACR @RheumNow

Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)

#1375🏋️‍♀️ Strength Training in RA ➡️ 12-week trial 28 ♀️ High-intensity(HIRT) v. Low-intensity+blood flow restriction(LIT-BFR) 🔴Equivalent gains:Lat-pulldown, biceps curl 🔴Knee extension:HIRT>LIT-BFR (non-significant) ✅ LIT-BFR: Alternative for RA sarcopenia #ACR24 @RheumNow

Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)

John Stone Steroid-free AAV CYCLOPS: steroid tox like “wallpaper on room” WGET (ETN for GCA) - taper off by 6 mos - neg trial but started tapers RAVE - low doses 8-9 mg/d over 18 mos LoVAS - low dose steroid equally eff ADVOCATE - AVA one month taper, tox score #ACR24 @RheumNow https://t.co/C7eLK5UNPM

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Eric Dein ericdeinmd ( View Tweet)
It's always so dispiriting to see PMR patients rack up steroid side effects in front of your eyes. (the intense motivation to do better than pred for our PMR patients) #ACR24 @SattuiSEMD @RADoctor ABST0975 @RheumNow https://t.co/FTsvrTIt2F

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David Liew drdavidliew ( View Tweet)
#1474 🔬Severe PsA? Guselkumab (GUS) has promise! ➡️In bionaive pts with severe disease activity, GUS v. PBO resulted in: 🔴73% improvement in joints 🔴53% lower disease activity 🔴63% better PtGA by 2 years ➡️Rapid results by W2, sustained through W100. #ACR @RheumNow

Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)

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