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Think Before You Order: Choose Wisely

Kathryn H. Dao, M.D. Nov 14, 2022

Early in medical training, we are taught diagnoses are made 90% of the time based only on the history and physical exam of the patient; laboratory tests play a minor role. When ordered, tests are used as evidence to support the diagnosis already made by the physician.

Aggarwal @docrota et al. ProDERM results on skin and QoL. Statistically significant improvements in CDASI (both activity and damage) and SF-36. @RheumNow #ACR22 Abstr#2239 https://t.co/vsnvYUla13

Effect of Treatment with IVIG (octagam10%) on Skin Symptoms and Quality of Life…

Let's review how GCs induce #Osteoporosis 👇(every Rheum should know this!) 💊GCs have bone cell specific effects on: 💠Osteoclasts ⬆️resorption, survival 💠Osteoblasts ⬇️🦴formation & prolif; ⬆️apoptosis 💠Osteocytes ⬆️apoptosis & skeletal fragility #ACR22 @RheumNow @rheumarhyme https://t.co/n61OXkmRgr

Espinosa-Ortega et al. Effect of DM ab on damage (as per MDI) over time. Most damage in PM/Scl>seronegative>other abs @RheumNow #ACR22 Abstr#2241 https://t.co/g8xTRyw6NZ https://t.co/sR1tT2QmU3

Autoantibodies and Damage in Patients with Idiopathic Inflammatory Myopathies: …

BKZ resulted in clinically meaningful improvements in FACIT-Fatigue and pain (PtAAP) in approximately half of pts w/ active PsA who are bDMARD-naïve or TNFi-IR. Abs 2119 #ACR22 @RheumNow https://t.co/29gzmMZRlG https://t.co/qziqGNxQih

Bimekizumab Treatment Results in Improvements in Fatigue and Pain in Biologic D…

After 1st TNFi, cycling/swapping strategies both acceptable in PsA w/ similar retention rates. Further studies needed to perform survival subgroup analysis regarding different extra-articular manifestations and PsA subtypes. Abs 2149 #ACR22 @RheumNow https://t.co/SRPhSiGeUI https://t.co/EYDULe52A3

Cycling versus Swapping Strategies in Psoriatic Arthritis: Results from the Rhe…

Luedders et al. Higher plasma MMP-7 and MMP-9 assoc development incident RA-ILD in RA patients @RheumNow #ACR22 Abstr#2252 https://t.co/woVErubytC https://t.co/r916r1AxtN

Higher Matrix Metalloproteinase Levels Are Predictive of Incident Interstitial …

More PsA pts on DEUC vs PBO achieved each of the MDA components at 16 weeks. Abs 2136 #ACR22 @RheumNow https://t.co/OrrDWfvGty https://t.co/CdCQzmgOOO

Deucravacitinib, an Oral, Selective Tyrosine Kinase 2 Inhibitor, in a Phase 2 T…

🌟 COVAX register 🌟 🦠flares of IMRD following covid vax uncommon 👉factors associated with flare: ⬆️disease activity 🙋‍♀️ female 💊no DMARD @ vax 💊stop/⬇️ DMARD @ vax 👉⬇️ flare assoc with: 💥young 💉RTX @RheumNow #ACR22 Abst #2274 https://t.co/S892lKcEvS

Long term RZB provides durable efficacy response in PsA through 100 weeks. No new safety signals. Abs 2145 #ACR22 @RheumNow https://t.co/HfJvS1HzDW https://t.co/T67lDnxeLy

Efficacy and Safety of Risankizumab for Active Psoriatic Arthritis: 100-Week Re…

Updated ACR GIOP guidelines: Panel recommends doing Initial fracture risk assessment using the CLINICAL fracture risk assessment then RE-assessing while pts continue on GCs (👇) ☝️Magic nos. GC>/= 2.5mg/d for >3mos #ACR22 @RheumNow @rheumarhyme #Osteoporosis https://t.co/7oWqHg8Tdv

Connolly @CaoilfhionnMD et al. 3 doses SARS-CoV-2 vaccine assoc reduced breakthrough infection in Omicron wave in RMD patients. @RheumNow #ACR22 Abstr#2275 https://t.co/ONXiY8JShK https://t.co/QHNYG9XuJ0

Three Dose SARS-CoV-2 Vaccination Is Associated with Reduced Risk of Breakthrou…

Wilson et al. Sputum levels of TGF-β1, TNF-α, MCP-1, and IL-4 are significantly elevated in RA-ILD and a portion of these cytokines are also increased in subclinical disease and correlated with lung physiology @RheumNow #ACR22 Abstr#2253 https://t.co/V1fG0QC9od https://t.co/d2YvVIV3Jq

Sputum Cytokines Are Elevated in Rheumatoid Arthritis-Associated Interstitial L…

Should You Repeat the ENA Panel? Dr. Kathryn Dao ( @KDAO2011) discusses abstract 0725, presented at #ACR22 Convergence. Abstract 0725: Utility of Repeat Extractable Nuclear Antigen Antibody Testing- a Retrospective Audit https://t.co/6A2ksN6yC2 https://t.co/U62Ab7jj3d

https://bit.ly/3O9wYMe

Strand et al PROs from SAPHYR (ping @EBRheum ) Significant improvement in SF-36 physical and mental, EQ-5D-3L. Numerical improvement in EQ VAS, FACIT-F, HAQ-DI, PtGA, and pain scores @RheumNow #ACR22 Abstr#2243 https://t.co/RffjBHkjIU https://t.co/0wbnmUhbWy

Patient Reported Outcomes from a Randomized Phase 3 Trial of Sarilumab in Polym…

"A novel mode of action which has generated a degree of excitement" - Paul Emery PD-1 agonist - peresolimab in RA Good impact in b/tsDMARD refractory patients "Correction of an immune state" - we're shooting for homestasis Definitely a space to watch! ABSTL01 #ACR22 @RheumNow https://t.co/W2lWrBgNOT

McDermott @jeffsparks et al. Subpleural ILAs on CT in 16% RA vs 5% non-RA, OR 3.74. 10 year mortality 53% RA-ILA vs 23% RA non-ILA, 22% non-RA non-ILA. HR mortality 3.20 for RA-ILA vs RA non-ILA @RheumNow #ACR22 Abstr#2248 https://t.co/HZ3y8CANUl https://t.co/nfjFq2REEh

Prevalence and Mortality of Interstitial Lung Abnormalities in Rheumatoid Arthr…

Figueroa Parra @zach_wallace_md @jeffsparks @AliDuarteMD RA patients have higher risk of severe COVID, especially those with ILD @RheumNow #ACR22 Abstr#2249 https://t.co/xUwStp451C https://t.co/N5A0oo1Kyk

Impact of Interstitial Lung Disease on COVID-19 Severity Among Patients with Rh…

#ACR22 Abs 2144: JAK inhibition induced different gene profile in circulating immune cells w/prominent downregulation of pro-inflammatory pathways in CD4+naïve T cells AND a shift in their metabolic signaling towards a more quiescent state. @RheumNow https://t.co/qYmr6A3zvS

JAK Inhibition Re-balances Gene Expression Profile of Circulating Immune Cells …

Dual Energy CT Study in 32 #gout pts on #allopurinol escalated over 2 yrs to achieve Uric acid <6 - tophus urate volumes and tophus soft tissue volumes reduced - chronic inflammatory soft tissue within the tophus is slower to respond than crystals @RheumNow #ACR22 abst#2203 https://t.co/dtHQqg9iFR

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Think Before You Order: Choose Wisely

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