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BSR Guideline for Psoriatic Arthritis - 2022 Update

d Jack Cush, MD

The British Society of Rheumatology has published their updated 2022 recommendations for the use of biologics and targeted synthetic treatments in patients with psoriatic arthritis. These guidelines follow initial treatment with a single conventional systemic disease-modifying anti-rheumatic drug, typically methotrexate typically. They noted that up to 50% of people with PsA require biologic or targeted synthetic (b/ts)DMARD therapy. 

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EULAR 2022 – Day 4 Report

d Jack Cush, MD

Bags are packed, ready to go, but wait there’s more abstracts to show.



The big news today were the “late breaking” abstracts. This is usually a favorite session of many as this is where the newest of study data often is showcased. 

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Axial Spondyloarthritis

Update on Axial SpA at EULAR 2022

d Antoni Chan, MD, PhD

This year at EULAR 2022, there were important and interesting topics in Axial Spondyloarthritis (AxSpA). These are my picks of abstracts from the conference.

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Malignancy risk on b/tsDMARDs in patients with prior malignancy history

d Eric Dein, MD

For autoimmune patients with a history of malignancy, the initiation of biologic or targeted synthetic disease modifying agents (bDMARD/tsDMARDs) may provoke concern.

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Witholding MTX after both doses or only after the second dose of ChAdOx1 vaccine yields higher antibody repsonse compared to continuing MTX. Witholding MTX after second dose reduced the risk for flare. Data from MIVAC 1 and 2 #EULAR2022 @RheumNow LB https://t.co/GfL4eDXchb
Dr. Antoni Chan synovialjoints ( View Tweet)
Sing an ARIAA! #Bestinclass Rx of arthralgia w +MRI showed delay of #rheumatoid arthritis w #Abatacept vs #placebo. NNT to prevent 1 RA [is 8 w Rx for 1 yr & then d/c-Yrs ago #MTX delayed onset of RA but benefit waned after d/c Rx. Both ?RA spectrum POS0531 @RheumNow #EULAR2022

Janet Pope Janetbirdope ( View Tweet)

72% of you would treat some high-risk subclinical arthralgias with MTX and Marta Mosca, in the #EULAR2022 highlights, broadly agrees OP0070 Leiden data showed better function and presenteeism. And that’s a win in my book @RheumNow https://t.co/BqTLy4HBWR https://t.co/cwzJkH0f71

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David Liew drdavidliew ( View Tweet)
#EULAR2022 LB003: W/d MTX w COVID vax MIVAC 1: hold MTX both vax vs continuing MIVAC 2: hold after 2nd dose only vs continuing ⭐️MTX hold: improved Ab titers, no diff in MIVAC1/2 ⭐️Higher reported flare for holding with both doses (36%) vs just 2nd dose (12%) @Rheumnow

Eric Dein ericdeinmd ( View Tweet)

Kohm et al. Efficacy of IL12/23i ustekinumab independent of MTX in PsA. No additive benefit of MTX on joint, skin, QoL, function @RheumNow #EULAR2022 POS1059

Richard Conway RichardPAConway ( View Tweet)

Novel ePROMS use. Use of ePROMS RAPID3/PASS and asking patients if they had a flare had high diagnostic accuracy identifying those not needing DMARD or steroid intensification up and eligible to skip their next outpatient clinic visit. Seppen et al #EULAR2022 @RheumNow POS0381

Dr. Antoni Chan synovialjoints ( View Tweet)

Everything's better with MTX Controlled RA on b/tsDMARDs: can we taper MTX? maintaining remission pooled OR 0.81 (0.68-0.97) Unless I'm reading it wrong: it's true many will be fine, but keeping MTX adds benefit (even in short term, before ADAb) POS0286 #EULAR2022 @RheumNow https://t.co/ZlwXHgACWd
David Liew drdavidliew ( View Tweet)
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EULAR 2022 – Day 3 Report

d Jack Cush, MD

By now, those of us attending the meeting know how to find a free coffee or sprite, have found comfortable meeting nooks and know our way around! PAnd congrats to you virtual Rheums for mastering the multi-screen, multitask simultaneous consumption posters, tweets and oral abstract presentations.

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Mulder et al. COMPLETE-PsA trial. MTX+LEF vs MTX mono. 78 patient RCT. LEF 20mg, MTX 25mg. MTX+LEF more effective (MDA 59% vs 32%) but less well tolerated (3 SAE vs 0; N+V, diarrhoea. No mention of LFTs). @RheumNow #EULAR2022 POS0078 https://t.co/2D84EFmabc
Richard Conway RichardPAConway ( View Tweet)
Frisell et al. Safety b/tsDMARDs from 10 years ARTIS. There is a mass of interesting data here, look at that figure! Higher rates of discontinuation due to AEs for tofa, bari, sari, rituximab. May be explained by chanelling and residual confounding @RheumNow #EULAR2022 POS0637 https://t.co/KrspU6c9Cs
Richard Conway RichardPAConway ( View Tweet)
Babies! Safety and Outcomes Data on Pregnancies #EULAR2022 highlighted several posters on pregnancy, an important subject as most rheumatic diseases afflicts women during their childbearing years. I wanted to share with you the ones that caught my eye... https://t.co/ulQIo2gdlO https://t.co/dpoMd5Wbah

Links:

Dr. John Cush RheumNow ( View Tweet)
Add on MTX does not impair UST immunogenicity in PsA. #EULAR2022 POS0079 @RheumNow https://t.co/CalEn7KpsX https://t.co/NZUqdX0XKo

Links:

Dr. Rachel Tate uptoTate ( View Tweet)
Some / most of promises of #JAKi are fulfilled. Efficacy, adherence = on mono vs combination Rx with MTX. But some emerging safety issues. NK cells reduce inflammation of NK cells on fibroblasts re other MOA. @eular #EULAR2022 ⁦@RheumNow⁩ The promise of #JAKi I RA https://t.co/8Ry3vVMyzO
Janet Pope Janetbirdope ( View Tweet)
#EULAR2022 POS0213 Beware of paradoxical low lipids in RA! ⭐️ETN+MTX vs MTX T2T: Early ETN: increased in HLD, lesser LDL, differs from MTX. Correlates with clinical disease activity @RheumNow https://t.co/c6GXadVwYN
Eric Dein ericdeinmd ( View Tweet)
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EULAR 2022 – Day 2 Report

d Jack Cush, MD

A full day at EULAR with oral and poster presentations of abstracts in the morning and a plethora of scientific (review) sessions in the afternoon. The latter covering topics like sarcoidosis, Still’s disease, fibromyalgia, back pain, sarcopenia, APS, IgG4 and imaging in vasculitis.

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Babies! Safety and Outcomes Data on Pregnancies

d Kathryn H. Dao, M.D.

EULAR Congress 2022 highlighted several posters on pregnancy, an important subject as most rheumatic diseases afflicts women during their childbearing years.

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