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Obesity, Surgery, and Optimizing Patient Care
Rheumatologic care involves multidisciplinary approaches and collaboration with specialties to treat complex, systemic diseases. While many Pods at RheumNow Live are disease specific, the Pod II focused on Advancing Practice on important and emerging areas affecting rheumatologic patients. This session focused on two major areas of need: obesity and peri-operative management.
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RT @ericdeinMD
#RNL26
Dx Modification of OA
@Tuhina_Neogi
Challenge in drug develop:
Models in young animal, not like human OA
Trial enrollment in pts w late, establ OA- not early interv tx
Many paths to OA - target mechanism to correct pt
Slow progress of dx, $$
Endpt? Sx or
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinMD
#RNL26
Placebo in Rheumatology - STEP talk
Kerschbaumer
What plays role in PBO?
Treatment adherence effect w better background therapy - may appear to be PBO
Impact in globalization of recruitment patterns, affects background PBO
Education of pts bridges gap
Dr. John Cush RheumNow ( View Tweet)
RT @richardPAconway
Who to screen for RA-ILD is a tricky one. It is not feasible to screen everyone. This is from ACR/Chest 2023 ILD guidelines and is based on identified risk factors. #RNL26 https://t.co/NtAWYCVclJ
Dr. John Cush RheumNow ( View Tweet)
RT @richardPAconway Disease activity is a strong risk factor for RA-ILD. Particularly for moderate/high disease activity but there appears to be a linear relationship (at least above a certain threshold) #RNL26 https://t.co/ot8ttdmu5G
Dr. John Cush RheumNow ( View Tweet)
Vasculitis
Sunday’s vasculitis session at RNL26 was a fantastic update on inflamed blood vessels, large and small, by two experts in the field.
https://t.co/ueg3yJDMu4 https://t.co/8uiI9A5G8x
Links:
Dr. John Cush RheumNow ( View Tweet)
RT @richardPAconway
Lifetime risk of ILD by RA/sex/MUC5B status. We can see the synergistic effect. Also note RA>MUC5B in general. #RNL26 https://t.co/L5MOVVGIt3
Dr. John Cush RheumNow ( View Tweet)
RT @richardPAconway
MUC5B is strong risk factor for RA-ILD. Specifically for UIP. Associated with both older-onset RA, and ILD earlier following RA presentation. #RNL26 https://t.co/qeLp1BqOEM
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinmd
RA-ILD #RNL26
Jeff Sparks
MTX and ILD
- Rare MTX-induced pneumonitis. 7 cases in n=4786 (0.3% cases) vs <0.1 on PBO, rare diff from ILD
- No increase in incident ILD - meta-analysis of 7 studies show OR 0.49 https://t.co/k2XeAzBsYB
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinmd
#RNL26 RA-ILD Jeff Sparks
ILD pooled prevalence 0.11
Sparks: "prevalence is high but not so high that we don't screen everyone," means lots of subclinical ILD
Subtypes:
UIP 50-60%, fibrotic
NSIP 30-40%, inflammatory
Less common: LIP, DIP, RB-ILD, DAD
Dr. John Cush RheumNow ( View Tweet)
RT @Gibson_RheumPAC
GLP-1 receptor agonists do more than promote weight loss.
They impact insulin resistance, inflammation, cardiovascular risk—and may influence musculoskeletal disease. #RNL26 https://t.co/ypKnOJojAm
Dr. John Cush RheumNow ( View Tweet)
RT @Gibson_RheumPAC
Obesity doesn’t just increase risk of rheumatic diseases-it worsens outcomes.
Patients with obesity have higher disease activity, poorer biologic response, and 20–25% lower remission rates in inflammatory arthritis. #RNL26
Dr. John Cush RheumNow ( View Tweet)
We are Doctors, Not Providers!
With apologies to Shakespeare, names are important. In health care, they can have ethical significance. The American College of Physicians (ACP) is concerned about the use of the term provider to describe physicians.
https://t.co/Vf6Wx0w28d https://t.co/RXTTFq34Rj
Dr. John Cush RheumNow ( View Tweet)
Staying Ahead of Spondyloarthritis
The diagnosis and treatment of spondyloarthritis can present challenging clinical scenarios for rheumatologists. At RheumNow Live, Pod IV focused on "Staying Ahead of Spondyloarthritis."
https://t.co/hZeqYC7wi3 https://t.co/2eKEueAukY
Dr. John Cush RheumNow ( View Tweet)
RT @richardPAconway
Dr Sparks shows risk factors for RA-ILD. Important for diagnosis (and screening?) Focus interventions on the modifiable ones! #RNL26 https://t.co/lE9Mkbq8oh
Dr. John Cush RheumNow ( View Tweet)
RT @richardPAconway
UIP is predominant radiologic pattern in RA-ILD. Contrast with our other diseases. But by no means exclusive - up to 50% of RA-ILD have a more inflammatory pattern. Important treatment implications! #RNL26 https://t.co/HmW1mz429i
Dr. John Cush RheumNow ( View Tweet)
RT @richardPAconway
Updated data on RA-ILD from Olmstead County. Cumulative incidence of 15.3% over 20 years! #RNL26 https://t.co/wVrTc3QM6Y
Dr. John Cush RheumNow ( View Tweet)
RT @ericdeinmd
Mucosal Hypothesis RA #RNL26
Demoruelle
Mucosal origins of RA?
Key sites of immune-environment interaction initiate local inflamm, becomes systemic
Link of lung inflamm/immune dysregulation - ass w/ smoking, ILD
NETs in lung drive RA path?
Gut/oral microbes drive
Dr. John Cush RheumNow ( View Tweet)
Dr. Fleischman on lupus dz activity including SLEDAI, which you can use on practice. But not for practice are SLE-DAS, BILAG, BICLA, SRI-4, DORIS @RWCSmtg #RWCS26 https://t.co/7sOaE7SMht
Dr. John Cush RheumNow ( View Tweet)
Advances in RA-ILD
Dr. Jeffrey Sparks gave a state of the art update on Advances in RA-ILD, many of which he and his group have played a big part in, on Saturday at RNL26.
https://t.co/xO7hBRKeqE https://t.co/rs1MS08Svl
Links:
Dr. John Cush RheumNow ( View Tweet)
