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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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#ILD in #rheumatic diseases. When to use #glucocorticoids and immune suppressive sand anti fibrotic. V clear but harder in real world! @RheumNow #ACR21 #ACRBest https://t.co/R4V5ZggRsu
Janet Pope Janetbirdope ( View Tweet)
Steroids can cause co-morbidities which increase CV risk, but can PNL directly increase CV event (MACE) risk in RA?
30d PNL➡️15% increase in MACE in next 30d
(independent of underlying CV risk, RA dx activity)
PNL actively confers risk!
@BethIWallace #ACR21 ABST1428 @RheumNow https://t.co/cuL69n7cx3
David Liew drdavidliew ( View Tweet)
#ACR21 Abs:#1429: ALPN-303: Dual BAFF/APRIL antagonist for SLE:
⭐️Encouraging immunomodulatory activity and efficacy in animal models. ⬇️ Plasma cells and Ig secretions in vitro & vivo
⭐️Well-tolerated in animals w/o adverse events
🔥Phase 1 study in healthy volunteers!
@Rheumnow
Eric Dein ericdeinmd ( View Tweet)
Physical exercise did not increase BME disease in SIJ and spine in PsA. The risk of increased BME after 11 weeks of HIIT was not higher compared to controls in a cohort of PsA patients with low to moderate disease activity @RheumNow #ACR21 Abst#1362 https://t.co/DHj4D5Ojb1 https://t.co/J4KV5zdpey
Dr. Antoni Chan synovialjoints ( View Tweet)
Abst1424 #ACR2021 @RheumNow study of SEC in children w/ERA or JPsA : 72% reduced flare risk. Improved JADAS-27 score in both the ERA and JPsA categories. ⬇️ disease activity, enthesitis count & joints with active arthritis. adverse events & serious AEs in the SEC & PBO comparable https://t.co/J4MdxeYxWZ
Olga Petryna DrPetryna ( View Tweet)
What predicts response to MTX in RA?
👉🏼DAS28-ESR
👉🏼RA duration
👉🏼Pt global assessment
👉🏼Swollen joint count
Abs#1227 #ACR21 @RheumNow
https://t.co/s942zvFiZ1
Mrinalini Dey DrMiniDey ( View Tweet)
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)