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HZV in pts w/ #rheumatic dse by Dr CCMok et al
🔸Prevalence rates of HZV infxn (per 100py): SLE 1.7, RA 0.64, other RDs 0.76
🔸RFs assoc'd w/1st HZV infection
📌#SLE dx, serum albumin, serum creatinine; ⬆lympho/neutro ratio, CYC & Prednisolone use
@RheumNow #ACR21 abs0862 https://t.co/TXRmoBBDXK
sheila RHEUMarampa ( View Tweet)
MACE risk Tofa vs TNFi ORAL surveillance: age 50+ w/1 additional CV risk, MTX-IR
👉higher # MACE, MI in Tofa 5 or 10 mg bid (no increase in stroke)
👉risks for MACE w/tofa: tobacco, ASA, age 65+, male sex
👉counsel high risk pts (?avoid use)
Abst#0958 #Plenary #ACR21 @rheumnow https://t.co/tg35cts9tw
TheDaoIndex KDAO2011 ( View Tweet)
Clinical Pearl at #ACR21 by Dr. John Stone:
⭐️Patients w/ RNAPIII positive SSc do not always have puffy hands, Raynaud's phenomenon, or ANA positivity!
#ACRBest @RheumNow @SChatterjee https://t.co/9J6OBibi4l
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Oral Surveillance outcomes in a nutshell Tofacitinib two doses vs TNFi event driven trial more AEs of interest in Tofa groups MACE Malignancy SIE in older groups VTE esp #tofacitinib 10 mg BID @RheumNow #ACR21 #ACRBest abst#0958 https://t.co/j39g7yVVFB
Janet Pope Janetbirdope ( View Tweet)
Dr Naovarat reports on 18 year outcomes of HIV and rheumatic disease. 16 patients treated with TNFi, including 2 who switched to tocilizumab and ustekinumab. No major infections. Rising viral load in 1 led to discontinue. Abstr#0965 #ACR21 @RheumNow https://t.co/jcGPaURKmb
Richard Conway RichardPAConway ( View Tweet)
#ACR21 #Rheumatology #Pearl: In #Takayasu's, listen for bruits on the back- could be originating from pulmonary artery or descending aorta.
@RheumNow https://t.co/0wGdR3Rqy2
Mrinalini Dey DrMiniDey ( View Tweet)
Supplementation for 5 years with vitamin D3 +/- n-3 fatty acids reduced incident autoimmune disease by 25-30% in older adults vs. those who received neither supplement. The effect of vitamin D3 appeared stronger after 2 years @RheumNow #ACR21 Abst#0957 https://t.co/uOwNyjxEoG https://t.co/S5kIM4kj6L
Dr. Antoni Chan synovialjoints ( View Tweet)
Don't stop hydroxychloroquine in SLE, even when doing well. Associated with ⬆️flare risk. x2 even when in remission. Abstr#0959 #ACR21 @RheumNow https://t.co/1gGx0V5oxk
Richard Conway RichardPAConway ( View Tweet)
1133 MACE events in Oral Surveillance study - Tofa use in high risk pts had more MACE events than TNFi use. Abstr# 0958 #ACR21 Problems with the gimmish are:
- Older patients, w/ Hi CV Risk
- 50% prednisone use
- Use of TNFi as comparator (effective at lowering CV risk) https://t.co/lzIyhgzvRe
Dr. John Cush RheumNow ( View Tweet)
The strawberry🍓gums of granulomatosis with polyangiitis! (Note: not always so florid)
@RheumNow #ACR21 #RheumTwitter #MedTwitter https://t.co/qDfGJ5JeWz
sheila RHEUMarampa ( View Tweet)
⭐️IR for MACE, MI, non-fatal MI numerically ⬆️ in Tofa vs. TNFi
⭐️HR for MACE/MI/stroke >1 for Tofa vs. TNFi
⭐️Risk factors: Smoking, ASA use, Age>65, men
⭐️Pts without risk factors, IR for MACE were similar
Abs#958
#ACR21 @RheumNow #ACRBest
https://t.co/xA3aGu5Sqi https://t.co/VnPHBhrmdx
Robert B Chao, MD doctorRBC ( View Tweet)
okay, so let's look at the #ACR21 plenary as we go
so a reminder - FDA-mandated phase 3b/4 safety endpoint study
specifically looking at patients >50yo with at least one other CV risk factor
today we're looking at MACE: that's CV death (excl PE), MI, stroke
ABST0958 @RheumNow https://t.co/9U8Sahb9Q7
David Liew drdavidliew ( View Tweet)
Vitamin D ⬇️incident autoimmune diseases & so do fatty acids but latter is not stat signif. 25k older adults with factorial design, no interaction. ? Buy vit D stock @RheumNow #ACR21 #ACRBest VITAL trial abst#0957 https://t.co/Qk3VwNOZie
Janet Pope Janetbirdope ( View Tweet)
Can vit D, omega-3 fatty acids prevent autoimmune dx development, even in non-deficient people?
(some plausibility, no other meds can)
vit D *might* have an effect, esp post-2y
cautious interest seems okay!
extension worth looking at
VITAL trial add-on #ACR21 ABST0957 @RheumNow https://t.co/H5aF8Vl79u
David Liew drdavidliew ( View Tweet)
Can vit D and omega3 prevent autoimmune dz?
25,871 adult pts randomized:vit D 2000 IU daily, omega 3 (1 g/d), combo, PCB and followed 5 yrs
Vit D & combo showed statistical sig over time, omega3 showed a favorable trend
Abst#0957 #Plenary #ACRbest @rheumnow https://t.co/moMCm9IJmO
TheDaoIndex KDAO2011 ( View Tweet)
Take your supplements 🐠 fish oil and Vit D! VITAL RCT presented by @karen_kc123 shows Vit D +/-n-3 fatty acid ⬇️ incidence of AID compared to PBO.
Promising although AID were self reported!
@RheumNow #ACR21 #Abst0957 https://t.co/xdEdKuwXci
#ACRBest https://t.co/zWrr9oC7F5
Aurelie Najm AurelieRheumo ( View Tweet)
Interesting study with Dr. Julia Manasson on gut and skin microbiome in monozygotic twins discordant for psoriatic disease. (red = Psoriatic). Gut ruminococcus bromii virtually absent in psoriatic pts. Eager to see further studies!
#ACR21 Abst#0944 @RheumNow https://t.co/zrZPBAjh5p
Pedro Castillo _Castillo_Pedro ( View Tweet)
Clinical Pearl at @ACR21
Is patchy tongue erythema + angular chelitis representative of Sjogren's or oral candidiasis?
Beware: Oral candiasis is a mimic of Sjogren's tongue.
Differentiate by asking if burning of tongue. If so, not Sjogren's -- start PO antifungal!
@RheumNow https://t.co/FbdiX8PFKV
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
I honestly find Vit D literature confusing! VITAL RCT omega3 and vit D in preventing autoimmune diseases. They seems to work?🧐The confidence intervals just shy of 1.00...I am still skeptical..but keeping vit D normal doesnt hurt I guess....#ACR21 @rheumnow abst#0957 https://t.co/QFcz2zK4Ic
Bella Mehta bella_mehta ( View Tweet)
Physician global score was the strongest predictor of future flares in AS patients with TNFi dose tapering. 29 (27%) flared at 2/3 of standard
dose, 21 (20%) at 1/2 dose, 29 (27%) at 1/3 dose and 27 (25%) after discontinuation @RheumNow #ACR21 Abst#0929 https://t.co/pIzLgexe3k https://t.co/UM9cGLiYl7
Dr. Antoni Chan synovialjoints ( View Tweet)