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Pre-clinical RA: starting off the wrong foot
Patients with clinically suspect arthralgia can represent a challenge for clinicians, in a sense that there are not yet reliable markers to predict evolution to clinical RA nor enough evidence to support routine prescription of conventional synthetic DMARDS or biologic treatments in this setting.
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Self-monitoring app for AxSpA pts
⭐️adherence over 6 months poor 😔
⭐️high disease activity and older age related to ⬆️frequency of reporting
Abs#373
#ACR21
@RheumNow
Robert B Chao, MD doctorRBC ( View Tweet)
This was in Lupus https://t.co/iqEPVFfHmc
Dr. John Cush RheumNow ( View Tweet)
Lupus Nephritis in pregnancy:
@HopkinsRheum Petri recommendations
⭐️AZA safe for LN, with tacro if needed
⭐️❌Voclosporin (alcohol content)
⭐️Belimumab uncertain
@Rheumnow #ACR21 Great Debate
Eric Dein ericdeinmd ( View Tweet)
The good news: Most (around 90%) of people with chronic #inflammatory disease produced antibodies after the #COVID19 vaccine, but it was reduced compared to that of generally healthy people.
#ACR21 #Plenary
@alhkim https://t.co/KdWtIuuOtA
CreakyJoints.org CreakyJoints ( View Tweet)
Dr. Eric Yen presenting about lupus nephritis mortality in the USA (1999-2019):
- Increasing trend in LN mortality x5 yrs
- Increased odds of death for Black pts > Latinx > API > AI/AN
- Urbanization (large central metro area) independent RF + effect modifier
#ACR21 https://t.co/qf61SkCqw4
Danny Soulsby dsoulsMD ( View Tweet)
#ACR21 Year in Review: TICOPSA - tight control treat to target in AxSpa does not meet primary endpoint, but favorable secondary outcomes. Was the control group at academic center already receiving good tight control? @Rheumnow
Eric Dein ericdeinmd ( View Tweet)
The evolving JAK inhibitor story
Black box Warnings regarding JAK inhibitor use and MACE, malignancy, thrombosis and mortality - full safety data remains to be examined.
@ACRheum #ACRambassador #ACR21 https://t.co/imQ1LSxeXM
Tanmayee Bichile, MD BichileT ( View Tweet)
"We have to stop meeting like this" @DrDavidKarp @Rheumnow #ACR21. I was hoping to have some Ghirardelli chocolates in SF... But here's hoping for Philly cheesesteaks next year 🤞
Eric Dein ericdeinmd ( View Tweet)
plenary I. #ACR21
Interesting data with the delta variant from @alhkim https://t.co/oUCOXSc9wA
Marie Kuchynski MD Doctorkuch ( View Tweet)
#ACR21 #ACR2021
Rheumatology Reproductive Health
👉🏻 Biologics and breast milk
👉🏻 Good vaccine response with TNFi (like with covid vaccines )
👉🏻 ustekimumab seems safe in pregnancy
👉🏻 Tofacitinib/ small molecules may cross placenta/ be in breast milk ➡️ contraindicated in preg/BF https://t.co/qk3sLR4QHz
EnvisionRheumat ERheumat ( View Tweet)
@alhkim presenting COVaRiPAD data on SARS-CoV-2 vaccination. Most mount immune response. Risk of poor response BCDT >> MMF >> GCC > MTX/AZA/JAKi/TNFi > immunocompetent. Abstr#0457 #ACR21 @RheumNow https://t.co/lf8cAEWGXf
Richard Conway RichardPAConway ( View Tweet)
Can we predict who which PsA pts will be radiographic progressors?
Abs#449 identified 103 candidate biomarker peptides corresponding to 69 proteins that could ID progressors
More data needed
#ACR21
@RheumNow
https://t.co/OLfPRNjTKV https://t.co/6UTn1J7nJH
Robert B Chao, MD doctorRBC ( View Tweet)
Abst0437 #ACR21 @RheumNow factors assoctd w/poor response to mRNA Covid-19 vaccine in rheum pts Rx w/Rituxan: ⬆️ exposure to RTX over time, ⬇️ IgG levels prior to RTX, short interval btw RTX course & BNT162b2 vacc. RA highest&ANCA-vasculitis lowest probability for a + response. https://t.co/DsrJBlNvr7
Olga Petryna DrPetryna ( View Tweet)
#ACR21 Abst#0457: #COVID19 Vaccine Responses In Patients w Autoimmune Diseas
⭐️Prosp observ: pre-vax▶️5 mo.
⭐️ 90% +Ab responses, but ⬇️ titer
⭐️MMF 21x⬇️ titer, MTX 4.4x⬇️, AZA 3.5⬇️
⭐️BCDT: 58, JAK: 2.6, TNF 2.3
⭐️GC ⬇️ even on <5mg!
https://t.co/BGU4CP9M0s @Rheumnow #ACRbest https://t.co/7QhsTGTwnZ
Links:
Eric Dein ericdeinmd ( View Tweet)
Sublingual Cyclobenzaprine for fibromyalgia. It seems to improve pain, and across the board on secondary endpoints. But all by a modest effect. Big placebo response also. Not time to get overly excited yet. Abstr#0477 #ACR21 @RheumNow https://t.co/aUtwaH5oEh
Richard Conway RichardPAConway ( View Tweet)
Wanted to highlight our work @HSpecialSurgery presented at #ACR21 using unsupervised clustering of multimodal data - histology and ultrasound to identify phenotypes such as moderately inflammatory subtype in #osteoarthritis @RheumNow #abst0212
some features highlighted in fig https://t.co/HRzhMXctB9
Bella Mehta bella_mehta ( View Tweet)
#ACR21 Abst#0284
My 56 yo ♀RA pt expressed concern for developing dementia last wk. This study helps recognize her RF beyond aging:
➡️ Large joint swelling (HR 2.2)
➡️ CVD (HR 2.4): stroke (HR 3.2) + chronic HF (HR 1.8)
➡️ DM (HR 1.6)
#ACRBest @Rheumnow
https://t.co/wsZnaLwSmD
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR21 Plenary Abs#0457 @alhkim #COVaRiPAD study:
👉Patients with inflammatory diseases on #immunosuppression have impaired #SARSCoV2 immunity post-vaccine
👉#Steroids, MMF & B cell depletion therapy more severely affect responses
👉https://t.co/7qTABcpm0h
@RheumNow #ACRBest https://t.co/EfuHjh3vw5
Mrinalini Dey DrMiniDey ( View Tweet)
Abst0254 #ACR21 @RheumNow CARRA SJIA cohort defines factors associated with medication free remission for ≥6 month-period: younger age, normal CRP levels & shorter time btw diagnosis and start of Rx. none of pts who developed MAS (3.9%) able to d/c Rx for ≥6 months
Olga Petryna DrPetryna ( View Tweet)