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Upadacitinib is a Double Edged Vascular Sword in GCA
Dr. David Liew discusses abstracts O751, O738, and O734 presented at #ACR25.
https://t.co/eTmVehP2Cd https://t.co/vxehwRWM2D
Dr. John Cush RheumNow ( View Tweet)
#2662
Using Medicare data to emulate real-world RA-ILD trials, investigators compared RTX vs ABA, TOC, JAKi & TNFi
No sig differences in mortality, resp, hospitalisation or lung transplant across groups, suggesting other b/tsDMARDs may be as safe as RTX for RAILD
@RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
#2661 In >5000 veterans with RA-ILD, 8 distinct FVC trajectories were identified. >1/2showed a progressive decline (≥0.7%/yr). These progressive patterns predicted higher mortality & respiratory hospitalisations, underscoring major disease heterogeneity. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Inflammation skews lipid levels in RA: the “lipid paradox”
Using data from CERTAIN and VARA, inflammation (hsCRP)-adjusted TC & LDL better predicted ASCVD events than standard lipids.
Are we missing RA pts who need statins?
@RheumNow #ACR25 A#2681
Jiha Lee JihaRheum ( View Tweet)
#2681 Tackling the “lipid paradox” in RA: inflammation-adjusted TC & LDL (using hsCRP correction) improved ASCVD risk prediction and flagged more high-risk patients than standard lipids. A smarter way to guide statin use in RA. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Observational study from VCRC AAV patinet, >70% had pulm involvement at some point
As expected, nodules favor GPA (63% vs 12% MPA) & DAH favors MPA (61% vs 31%)
More ILD in MPA (11% vs 1%) & more endobronchial in GPA (12% vs 2%)
Helpful pearls!
@RheumNow #ACR25 Abstr#0721 https://t.co/Iu5MdiTABR
Mike Putman EBRheum ( View Tweet)
Not all RA meds are equal for the heart.
In >10K older adults w/ RA, advanced therapies lowered MACE risk (HR 0.63) vs csDMARDs, while GCs ↑ risk (HR 1.54) and undertreatment ↑ it 13-fold.
Control inflammation, protect the heart.
@RheumNow #ACR25 Abstract #2642
Jiha Lee JihaRheum ( View Tweet)
Sleep Apnea in Psoriatic Arthritis – A Wake Up Call
Fatigue is one of the most disabling symptoms in psoriatic arthritis (PsA), yet its causes are often underexplored. At #ACR25, Abstract #0549, a possible hidden contributor was studied: obstructive sleep apnea (OSA). In a https://t.co/E3cy1Uss73
Dr. John Cush RheumNow ( View Tweet)
Lung Disease in ANCA-associated Vasculitis
Dr. Mike Putman discusses abstract 0721, "Pulmonary Manifestations of Granulomatosis with Polyangiitis and Microscopic Polyangiitis", presented at #ACR25.
https://t.co/A5uKT4jG1I https://t.co/7E4k7QdiNK
Links:
Dr. John Cush RheumNow ( View Tweet)
Lung Ultrasound in CTD-ILD
Prospective cohort 146 pts CTD-ILD
30 preclinical ILD
76 limited ILD
40 extensive ILD
Median LUS scores higher if Extensive ILD
LUS scores correlation w/ fibrosis severity, DLCO & FCV
Agreement between LUS and HRCT severity 0.74
Excellent inter https://t.co/R9zGmCTT8Q
Aurelie Najm AurelieRheumo ( View Tweet)
#1748 Higher air pollution, esp PM2.5, linked to ⬆️RA disease activity and more flares in >1000 Korean patients. Each rise in PM2.5 significantly boosted DAS28, CDAI & joint counts.
Does cleaner air mean calmer joints?
@RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
US Electronic Health Record cohort 2000+pts
Incidence Heart Failure over 10 yrs 6.8%
HF asso w/
Older
Male
Lower eGFR
Hypertensive medication
Diabetes
TTMTS MTX, TNFi
Higher CRP
Probably surrogates for High Disease Activity...
How do we detect it?
Maybe not by using the https://t.co/s9SjEyk3WF
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
#1751 In early RA, higher disease activity, inflammation & older age linked to more ILD changes on machine-learning chest CT. Even subtle QCT abnormalities correlated with reduced lung function pointing to early inflammatory pathways in RA-ILD. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Serrano-Combarro et al. Abatacept in RA-ILD. 343 patients. Progressive ILD in 23%. Similar to the numbers progressing on baricitinib by same group. Previous MTX treatment appears to REDUCE risk (OR 0.45). Disease activity increases risk (OR 1.29). @RheumNow #ACR25 Abstr#2265 https://t.co/0tl0kGgm5p
Richard Conway RichardPAConway ( View Tweet)
Data from this retrospective cohort study by Alomari et al show that SLE pts on SGLT2is
⬇️rates of PulHPN (OR 0.79)
⬇️all-cause mortality (0.49)
⬇️hospitalizations (OR 0.56)
⬇️LN (OR 0.4)
vs non-SGLT2i users(p<0.001)
Impt role of SGLT2i as adjunct tx
#ACR25 @RheumNow Abs2438 https://t.co/NQJTzQwRCt
sheila RHEUMarampa ( View Tweet)
#1747 Serious infections ~2× more common in RA-LD, esp RA-ILD. Pulmonary, bacterial, viral & fungal infections all increased, underscoring need for tailored prevention and vaccination. @RheumNow #ACR25 https://t.co/soyzqLk7Vj
Mrinalini Dey DrMiniDey ( View Tweet)
#1746 In large US RA cohort, elevated GDF-15 & pentraxin-3 levels linked to prevalent RA-ILD; high GDF-15 predicted future ILD risk.
Other fibrosis-related mediators from IPF or heart failure were not associated, suggesting RA-ILD has distinct pathogenic pathways @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Mulcaire-Jones et al. Changes in PFTs over 1 year in early RA. Improved 31%, worsened 25%. No difference based on baseline disease activity, or MTX use. Those with baseline ILD were MORE likely to improve. ?due to effect of treatment @RheumNow #ACR25 Abstr#2235 https://t.co/bJeLYN9oN7
Richard Conway RichardPAConway ( View Tweet)
EGPA relapse in MANDARA including OLE
Majority of relapses are asthma / sinonasal in nature
Of non-airway:
- arthralgia/myalgia
- sensory peripheral neuropathy
@RheumNow #ACR25 Abst1769 https://t.co/cPjjzl4RWS
Links:
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Serrano-Combarro et al. Baricitinib in RA-ILD. Observational, 42 patients. Progressive ILD in 26%. More frequent in women. @RheumNow #ACR25 Abstr#2229 https://t.co/ZXfgxKoau7
Richard Conway RichardPAConway ( View Tweet)
