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Improving fertility in women with RA
For many women, the journey to motherhood brings a sense of anticipation and joy. However, for those with rheumatoid arthritis, this journey presents unique challenges. At ACR Convergence 2024, researchers discussed how advancements in reproductive medicine and RA management are paving the way for improved outcomes.
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Sex related differences in PsA
Different factors are known to influence disease characteristics and outcomes in psoriatic arthritis (PsA).
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Cognitive Impairment: The Hidden Burden in Lupus Care
Suppose you have a patient with lupus returning for follow-up. Their joint symptoms are well controlled. The kidneys—managed with a combination of biologic DMARD and mycophenolate—show no signs of active urinary sediment or protein. Yet, during the routine visit, your patient brings up fatigue and difficulty remembering things. How do you address this? Several studies presented at ACR24 focused on cognitive impairment in lupus.
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ICYMI: Precision medicine in Ssc ILD? Yes!
-Watch and wait approach can cause irreversible lung damage.
-⬆️CRP: biomarker of response (predicts mortality)
-⬆️KL-6: biomarker of severity (predicts progression of fibrosis)
-FAPI-PET: can eval disease activity vs response to ttx.… https://t.co/bTepwrsuNN https://t.co/e6xjtuquka
Links:
Adela Castro AdelaCastro222 ( View Tweet)
Beyond the Needle: Redefining the Assessment of Lupus Nephritis
Lupus nephritis is one of the most silent and severe manifestations of systemic lupus erythematosus (SLE).
https://t.co/fvGG0BZbOL
#ACR24 https://t.co/wPXQz9Vese
Dr. John Cush RheumNow ( View Tweet)
Abstract 2681: #SDOH factors & SLE risk:
- Low income (AOR=2.779).
- By race/ethnicity NHB (AOR=2.429), Hispanic (AOR=1.616).
Behavioral: Psych distress (AOR=2.127), no exercise (AOR=1.677).
Access: Medicaid (AOR=2.540), transport barriers (AOR=20.394).
@RheumNow #ACR24
Akhil Sood MD AkhilSoodMD ( View Tweet)
ACR24 take homes
➡️#Inflammatory #myositis
#Upadacitinib improved MDA5 ILD
#Baricitinib 4mg/d good in myositis delayed start #RCT
#Tofacitinb ➡️help for skin, calcinosis, rash in case series
➡️RCT ongoing
JAKi is ‘jacked’ in muscles 💪🏿
#ACR24 @RheumNow @ACRheum
1731 0348
Janet Pope Janetbirdope ( View Tweet)
Are Emulation Trials a Fantasy?
Are these ‘trials’ helpful, despite the biases that occur with observational data, or do they truly mimic the results of randomized controlled trials (RCTs)?
https://t.co/x6NogGQksW https://t.co/f8o8N55tlJ
Dr. John Cush RheumNow ( View Tweet)
axSpA: Moving the needle in time to diagnosis
The journey to axial spondyloarthritis (axSpA) diagnosis is often prolonged and challenging. Understanding the factors contributing to the delays is important to improve the clinical, psychological, social and economic outcomes.… https://t.co/wnwtj8jj0q https://t.co/Pds2uxVfJV
Dr. John Cush RheumNow ( View Tweet)
Are we under-monitoring in scleroderma ILD?
Dr. Janet Pope discusses abstract 0678, Patients with Interstitial Lung Disease Due to Systemic Sclerosis or Rheumatoid Arthritis Need Monitoring More Frequently Than Annually, and abstract 0706, Single Center Prospective Cohort of… https://t.co/1y1VXGvqjp https://t.co/4ofh45cYwq
Dr. John Cush RheumNow ( View Tweet)
Prof Petri reports the ff predictors of fracture in SLE:
-older age
-Caucasian race
-female sex
⚠️ Prednisone (but not recent IM triamcinolone or IV methylpred) is a MAJOR risk factor.
When possible, avoid prednisone!
@RheumNow #ACR24 #ACRbest abs2679
@rheumarhyme https://t.co/q2NMRaYsAF
Links:
sheila RHEUMarampa ( View Tweet)
Lacaille et al. Long term harms of previous steroids in RA. CV/infection mortality increase 7% every year/use. Takes 3.5 and 10 years to return to normal after 1 and 2 years use. Never returns to normal if >2 years use @RheumNow #ACR24 Abstr#2673 #ACRbest https://t.co/qcp5mCHmeB https://t.co/keXw5Qg2ld
Links:
Richard Conway RichardPAConway ( View Tweet)
What are the predictors of fracture in #SLE?
🦴Prednisone! Even at low doses ≤5mg
🦴Stroke
🦴Caucasian race
🦴Female
🦴Low BMD
Try to avoid steroid use. If they are needed, IM triamcinolone or IVMP preferable to oral GC.
Ab2679 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
Does CVD mortality risk change after stopping GC in RA?
➡️28078 incident GC users
➡️Incr mortality risk from CVD &infections persists post-cessation
➡️Risk never returns to pre-GC level after prolonged use
⏩Use GC at lowest dose for shortest time possible
Ab2673 #ACR24 @Rheumnow https://t.co/dtLU8obLke
Links:
Mrinalini Dey DrMiniDey ( View Tweet)
Ab2674 #ACR24
➡️Most pts starting 1st-line TNFi, who didn't achieve treatment response at 3M, also didn't achieve response from months 3-12
➡️1/4 pts achieving LDA/remission at 3M were no longer in LDA/remission at 12M
@RheumNow https://t.co/pFOo86tJTx
Mrinalini Dey DrMiniDey ( View Tweet)
Data from the RISE registry show that 9.3% of SLE pts had thrombocytopenia and a smaller percentage with mod-severe TP (2.7%). Severe TP was much rare.
Large data, but well represented grp?
@RheumNow #ACR24 abs2680 https://t.co/Y1Lo9lJGtO
Links:
sheila RHEUMarampa ( View Tweet)
An early favorable response to TNFi initiation indicates better long-term success in RA. Assess early and adjust treatment accordingly.
#ACR24 @RheumNow ABST#2674 https://t.co/YTThYiiLpZ
Jiha Lee JihaRheum ( View Tweet)
Wt ⬇️ = Better #PROs in
👇autoimmune #rheumatic #diseases if > 5% wt loss.
#ACR24 @ACRheum @RheumNow
Didn’t work for non overwt
Ex Normal BMI and T2DM 🤷 https://t.co/81OuTfZ0Nx
Janet Pope Janetbirdope ( View Tweet)
Mortality Risk After Stopping Glucocorticosteroids (GC) in RA.
In a study of 28,078 RA patients:
Mortality risk from CVD ↑ 7.5%/year of GC use; ↓ 1.3%/year after stopping.
Mortality risk from infections ↑ 6.8%/year of GC use; ↓ 4.9%/year after stopping.
Risks normalize 1.5–10… https://t.co/i6cKet1EEV https://t.co/ClMjIly20E
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#Poorer responses to #Rx in
#Females vs #males
Sex hormone and pathway differences
explained
👇
Biological differences
F start worse in disease activity
F May have ⬇️ response to #Rx
Yr in Preview C Ritchlin
@lihi_eder’s PsA work quoted
ACR24 @RheumNow @ACRheum @ACRBest https://t.co/EWoCvzOLiL
Janet Pope Janetbirdope ( View Tweet)
