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New biomarker for atherosclerosis, cardiovascular risk and disease activity in axSpA?
Low Irisin associated with subclinical atherosclerosis, high CV risk and more severe disease activity in axSpA
@RheumNow #EULAR2022 ABST#POS0327
Robert B Chao, MD doctorRBC ( View Tweet)
Sex differences in axSpA: we’re continuing to better understand the differences in imaging findings.
Existing MRI scoring may underserve axSpA in women.
Added to therapy differences, a lot to readdress for our female axSpA patients.
from roundup #EULAR2022 @RheumNow https://t.co/8wCKx9AFcM
David Liew drdavidliew ( View Tweet)
Gut microbiome of AS patients different from healthy controls. Different bacteria communities may be associated with disease activity.
So much more to digest....
@RheumNow #EULAR2022 ABST#POS0330 https://t.co/EAvHngd6SD
Robert B Chao, MD doctorRBC ( View Tweet)
Tofacitinib had faster and larger impact on improvement of fatigue compared to placebo in treatment of ankylosing spondylitis pts.
Note 100% fatigue resolution roughly same vs. placebo
@RheumNow #EULAR2022 ABST#POS0305 https://t.co/Doep91QIRa
Robert B Chao, MD doctorRBC ( View Tweet)
Upadacitinib effective in treatment of ankylosing spondylitis pts refractory to biologic tx - phase 3 trial
Primary endpoint (ASAS40) and secondary endpoints met
No malignancy, MACE, VTE, death
@RheumNow #EULAR2022 ABST#POS0306 https://t.co/UL4hUJ0rQV
Robert B Chao, MD doctorRBC ( View Tweet)
Does treating spondyloarthritis early matter?
Systematic review showed in nr-axSpA tx with biologics may lead to better outcomes compared to established axSpA
axSpA - no difference in response between early vs. established disease
@RheumNow #EULAR2022 ABST#POS0302
Robert B Chao, MD doctorRBC ( View Tweet)
What guides treatment decisions in AxSpA? Bolt et al showed patients assessed in clinical remission, 1/3 had BASDAI >3.5. Treatment unchanged as low disease activity, awaiting effects of current Rx, complaints not related to axSpA, patient preference #EULAR2022 @RheumNow POS0303
Dr. Antoni Chan synovialjoints ( View Tweet)
Treatment of active SpA improves depressive symptoms in SpA with HADS-D score reducing. This was greatest for TNFi followed by NSAIDs and csDMARDs. TNFi reduced the proportion of patients (48% to 29%) with depressive symptoms at follow up Webers et al #EULAR2022 @RheumNow POS0304
Dr. Antoni Chan synovialjoints ( View Tweet)
Wetterslev et al showed that almost all of 108 axSpA patients in clinical remission flared during tapering,47% flared at 2/3 to ½ dose and 53% at 1/3 to discontinuation. Higher baseline physician global score was an independent predictor of flare #EULAR2022 @RheumNow POS0298 https://t.co/RELuiB3Enl
Dr. Antoni Chan synovialjoints ( View Tweet)
New in AS. Upadacitinib 15mg od was significantly more effective than placebo over 14 weeks in AS bDMARD-IR (ASAS40 45% vs 18% and the onset of effect seen by week 4), no new safety risks identified in the SELECT-AXIS 2 study by Van de Heijde et al #EULAR2022 @RheumNow POS0306 https://t.co/LCQBf38GWe
Dr. Antoni Chan synovialjoints ( View Tweet)
SELECT-AXIS 1 trial of upadacitinib in active #AS with an inadequate resp to prior biologic - pivotal phase 2/3 RCT of 420 AS pts (Dz dur 7.7 yrs; 83% B27+) showed better ASAS40 at wk 14 w/ UPA vs PBO (45% vs 18%; P<0.0001) #EULAR2022 POS0306 https://t.co/6ZBEvjRjqc https://t.co/GL0vlB34mE
Links:
Dr. John Cush RheumNow ( View Tweet)
So what diet to follow with autoimmunity in mind?
So many, all with different instructions.
Let’s concentrate on where they agree:
yes to fruits & vegetables
no to emulsifiers & processed foods
#EULAR2022 @RheumNow https://t.co/I9abweQOyZ
David Liew drdavidliew ( View Tweet)
Characteristics assoc outcomes PsO/PsA/axSpA @pedrommcmachado @rheum_covid bDMARDS, NSAIDs assoc better outcomes. Usually culprits assoc worse outcomes (age, CVD etc), and also disease activity and steroids @RheumNow #EULAR2022 OP0249 https://t.co/siLdQVj2jb https://t.co/BmdwspDhsG
Links:
Richard Conway RichardPAConway ( View Tweet)
Nossent et al Hospitalisation with opportunistic infection twice as high in RA vs AxSpA/PsA. Has IMPROVED over biologic era. To me, suggests benefits of proper disease control on infection risk
@RheumNow
#EULAR2022 OP0274 https://t.co/cqUoRti4We https://t.co/Ozz7jH3z4N
Links:
Richard Conway RichardPAConway ( View Tweet)
Michielsens et al T2T tapering of TNFi in AxSpA and PsA. 72% tapered, 28% discontinued TNFi. Month 12 LDA 69% vs 73%.Month 12 dose 53% vs 91%. Flares 85% vs 78%. Needed more NSAID 54% vs 24% and steroid 30% vs 17%. @RheumNow #EULAR2022 OP0261 https://t.co/EDBPOgg4sX https://t.co/ckPqaTdm4B
Links:
Richard Conway RichardPAConway ( View Tweet)
Increased risk of aortic regurgitation and atrial fibrillation in radiographic axSpA pts when compared to general population. No significant risk for AV block (II-III). Unclear if treatment affects cardiac risk in these patients.
@RheumNow #EULAR2022 ABST#POST0146
Robert B Chao, MD doctorRBC ( View Tweet)
COVID-19 mostly mild for majority of SpA patients.
Steroid use associated with more severe COVID-19 outcomes (OR 3.15).
TNFi found to be protective! (OR 0.26)
@RheumNow #EULAR2022 ABST#OP0254
Robert B Chao, MD doctorRBC ( View Tweet)
Perrot et al. Factors assoc severe COVID in SpA. corticosteroid intake (3.15 [1.46-6.76]), age (OR=1.06 [1.04-1.08]) while anti-TNF (OR=0.26 [0.09-0.78]) was protective @RheumNow #EULAR2022 OP0254 https://t.co/bIiEW6efQ2
Links:
Richard Conway RichardPAConway ( View Tweet)
#OP0249 #EULAR2022 Dr Machado presented pooled data >5000 pts. Poor #COVID outcomes in Pso, PsA and AxSpa were associated with the usual suspects: Age, male, high disease activity and comorbidities. No specific bDMARDs was associated. Good news for our patients @RheumNow https://t.co/itzmwqKCrH
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Ok to taper?
In PsA and AxSpA pts on TNFi, a T2T w/ tapering strategy was non-inferior to a T2T w/o tapering.
69% of tapered group remained in LDA, 73% no-taper group in LDA after 12 months.
Taper group did use more NSAIDs, cDMARDs, steroids
@RheumNow #EULAR2022 ABST#OP0261
Robert B Chao, MD doctorRBC ( View Tweet)
