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Methotrexate and hepatic fibrosis: we must be doing something right
Methotrexate may be a rheumatologist’s best friend, but a key part of counselling any patient about its use has always been the risk of hepatotoxicity.
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Plenary Abs#1428 #ACR21
👉🏼Long-term #steroid use is common in RA incl in pts with high risk of #MACE
👉🏼30days of steroids ➡️ 15% increased odds of MACE
@RheumNow
https://t.co/fCM3m04ruS https://t.co/FWGmAatYu5
Mrinalini Dey DrMiniDey ( View Tweet)
26K Veterans data with RA #ACR21 plenary abst#1428
30 days on glucocorticoids - ⬆️15% odds of Major Adverse Cardiovascular events @RheumNow @BethIWallace https://t.co/BOram4o2rp
Bella Mehta bella_mehta ( View Tweet)
Role of GC on MACE in RA:
US database analysis 26000+pts
23% on GC >90d/6mo
Each 30days of GC dispensed ⏭15% increase in odds of MACE in the following 6month period!
Adjustment on several confounders but not disease activity.
#Abts1428 #ACR21 @RheumNow https://t.co/prdA7D5fLz https://t.co/F3wCcRAfuf
Aurelie Najm AurelieRheumo ( View Tweet)
Plenary Abs#1427 #ACR21
👉🏼#Statins assoc w/ reduced #CVD & all-cause mortality, outweighing
modest #T2DM risk increase in RA pts
👉🏼Reduction in all-cause mortality greater in RA than gen population
👉🏼Incr in T2DM risk is NOT greater in RA compared to gen population
@RheumNow https://t.co/WcF11B0C2s
Mrinalini Dey DrMiniDey ( View Tweet)
Statins in RA - plenary at #ACR21 UK Clinical
Practice Research Datalink 1989-2018 @RheumNow
Reduction in CVD risk, All cause mortality
INCREASE in Type 2 DM risk🧐 - need to make sure we look into it for RA patients!
Great work @UNMC_Rheum by Gulsen Ozen! https://t.co/YmTO0xcdjj
Bella Mehta bella_mehta ( View Tweet)
RA and CVD: take your statins!
Obs UK study
Statins ⬇️CVD HR=0.46
⬇️All cause death HR=0.68
w/ mild ⬆️ T2DM risk HR=1.33
(but not more than in general population)
⭐️NNT to prevent CVD 102
⭐️NNT to prevent death 46
⭐️NNH 127
#ACR21 #Abst1427 @RheumNow https://t.co/v6TinuklNv https://t.co/r0rD4jMmuh
Aurelie Najm AurelieRheumo ( View Tweet)
PsO pts not on biologics had a ⬆️ risk of PsA compared to those on biologics
⭐️HR 1.39
⭐️retrospective cohort study w/ >1300 cases
Abs#1355
#ACR21
#ACRBest
@RheumNow
https://t.co/tL37we3lwc https://t.co/SAexvn9HMb
Robert B Chao, MD doctorRBC ( View Tweet)
In PsA patients with low baseline CRP treated with IXE or ADA, a favorable reduction in pain was observed for IXE-treated
patients, irrespective of controlled or non-controlled inflammation, as
measured by CRP or SJC improvement @RheumNow #ACR21 Abst#1341 https://t.co/Nl78oASmf5 https://t.co/2qSXQr2sQS
Dr. Antoni Chan synovialjoints ( View Tweet)
To statin or not to statin?
UK cohort study 22,000 RA pts eval CV risk/diabetes w/statins
Statins:⬇️CV events by 32%, ⬆️DM-2 by 33%, ⬇️all cause mortality by 54%
NNT 102➡️prevent CV events
NNT 42➡️prevent all cause mortality
NNH 127➡️cause DM-2
absr#1427 #plenary @rheumnow https://t.co/QAt6Ie4qa7
TheDaoIndex KDAO2011 ( View Tweet)
Can’t have it all! In #RheumatoidArthritis statins when prescribed by primary care ⬇️CV mortality but sl ⬆️in type II #diabetes - just like in general pop’n-DM onset ⬆️with statins in gen pop’n #ACRBest #ACR21 @RheumNow abst#1427. https://t.co/FJ3L5w49y4
Janet Pope Janetbirdope ( View Tweet)
Abst 1128
Nelson & colleagues performed clustering analysis between collagen biomarkers and different phenotypes of multiple joint #OA
#ACR21 @RheumNow https://t.co/J9jcSUzh7M
Akhil Sood MD AkhilSoodMD ( View Tweet)
@BethIWallace on MACE risk with GC use in 26,239 veterans with RA. GC (>30 days in 6 months) associated 15% ⬆️in MACE. Abstr#1428 #ACR21 @RheumNow https://t.co/InXPiuO1GY
Richard Conway RichardPAConway ( View Tweet)
#ACR21 Abs#1428. Retrospective cohort VA study
▶️45% of patients got >30 days of GC use in a 6-month period - high # of pts!
▶️3% MACE events during study period
⭐️30 days of glucocorticoids = 15%⬆️ in odds of MACE in RA pts!
@Rheumnow https://t.co/m5bl9Ho163 https://t.co/v8hdzi1Vrb
Links:
Eric Dein ericdeinmd ( View Tweet)
Achieving MDA in PsA results in improvements in disease activity measures, PROMs and maintenance of therapy. It may help increased work productivity
and reductions in lost wages in PsA @RheumNow #ACR21 Abst#1344 https://t.co/KR1DPXt7jh https://t.co/3bfeiXxN54
Dr. Antoni Chan synovialjoints ( View Tweet)
Multinational web survey (UPLIFT) showing patients with PsA➕ active PsO associated with - more active disease; 🔼prevalence comorbidities ; depression
⭐️Positive depression screen associated with overall disease impact as measured by PsAID
Abst#1351 #ACR21 @RheumNow https://t.co/w1JETzNao9
swethaann23 swethaann23 ( View Tweet)
#ACR21 #Abstr1425 Interim AURORA2 (Extension of original RCT to 2 years) showed #lupus nephritis patients on voclosporin maintained meaningful low uPCR and stability of eGFR at 2yrs. No unexpected safety signals @RheumNow https://t.co/aclJZNOGc5 https://t.co/ENl9SzMHN3
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
How much PNL do you need with TCZ in GCA, to avoid early risks of visual loss?
GiACTA: 26w. Can we do better?
GUSTO: 3d pulse IVMP. Not enough.
Is 8w the sweet spot?🤔
sustained remission off PNL at 52w: 20/27
no visual loss/ischaemia
@MGHrheumatology #ACR21 ABST1413 @RheumNow https://t.co/IV9MorvTeW
David Liew drdavidliew ( View Tweet)
#Voclosporin still going strong in LTE in #lupus nephritis AURORA 2. No new safety signals, stable GFR. Cost may be problem! Abst#1425 #ACR21 #ACRBest @RheumNow https://t.co/biEptZbJoz
Janet Pope Janetbirdope ( View Tweet)
#ACR21 Abs#1426 - VEXAS!
Predictors of mortality:
▶️p.MetVal41 genotype (HR 3.5)
▶️Absence of ear chondritis (HR 3.8)
▶️Transfusion dependence (HR 2.6)
@Rheumnow https://t.co/m5bl9Ho163 https://t.co/LSNcF6EZHv
Links:
Eric Dein ericdeinmd ( View Tweet)