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Punjadath et al. Predictors of progression palindromic rheumatism to RA. 30 patients. 47% progressed to RA. Total number of joints involved, RF, CRP predicted progression univariate. Only total joints significant in mutlivariate but underpowered. @RheumNow #ACR25 Abstr#2261 https://t.co/FtVKdGtEr9
Richard Conway RichardPAConway ( View Tweet)
Does fiber boost MTX efficacy?
LB15: Fiber + MTX led to
📉 Greater drop in DAS28 (–1.00 vs –0.34 placebo)
🧬 ↓ Th17 cells & Th17/Treg ratio
Some food for thought
@RheumNow #ACR25 https://t.co/VhLVP1nRy2
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
How great would it be to have a diagnostic RA-ILD Urine Dipstick?
Small cohort 14 RA-ILD vs. 64 RA no ILD
Urine ILDScore includes 2 proteins
SPOCK1 and PGRMC1
Independently asso with ILD w/ OR 6.19
Urine ILD score alone AUC 0.9
ILD urine score + clinical data AUC = 0.95
Needs https://t.co/7PqX8kdjKJ
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Interesting study evaluating the "CALLY" index (serum albumin × lymphocyte count / CRP / 10,000) for predicing mortality in AAV
I typically dislike these because (1) they are often cumbersome to calculate & (2) they often perform poorly
This one piqued my interest; pretty https://t.co/ziroQOH5Cq
Mike Putman EBRheum ( View Tweet)
A new genetic score for ILD prediction! 🫁
Developed in the Veterans RA cohort and Validation in a Swedish cohort
Model using classic RA-ILD risk factors and a cocktail of genetic risk
A cut off of 0.05 in this cohort would exclude 36% from HRCT or PFTs
Good performance https://t.co/6UsoSQAtyK
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Effect of air pollution in RA
Prospective cohort 1000+pts w/ 12000+ visits
Higher levels of pollution
& specific size of particles PM25
asso w/
-10% higher odd of flare
-Higher DAS CRP and CDAI
Now the interesting pattern:
PM25 exposure increases 3 weeks before flares https://t.co/MOskJzk05g
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
In case you have a (gut) feeling something’s off…
Abstract 2315: The gut microbiome in #SpA 🔬
⬆️ Proteobacteria (incl. Escherichia spp)
⬇️ Firmicutes (“good” bacteria)
Higher disease activity ↔️ lower alpha diversity
@RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
A prediction model for RA-ILD in RA pts: is it possible?
Not quite yet!
Veterans Affairs RA registry 2700+ pts
5% of prevalent ILD
Associated w/
-GDF-15
-Pentraxin 3
No prediction for Incident disease
Needs more work to understand implications for practice
@RheumNow #ACR25 https://t.co/CmW72nybcQ
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Does specific ANCA subtype inform infectious risk?
Retrospective review of 270 AAV patients revealed that about 1/3 pt developed severe infections... of these:
- 64.1% MPO+
- 35.9% PR3+
Most infx during year 1 of tx
No difference between CYC vs. RTX
@RheumNow #ACR25 abst 2510
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
HCQ weight-based dosing: out
HCQ whole blood monitoring: in
Whole blood levels more precisely balance risks of SLE flare (under-dosing) vs. toxicitiy (over-dosing)
Many pt on <5 mg/kg had supra-therapeutic blood levels with risk for toxicity
@RheumNow #ACR25 #ACRBest Abst 1722 https://t.co/qIbACxAW39
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Pooled data fr diff SLE cohorts by Dr SGarg et al were evaluated to determine an upper threshold tx range of HCQ
750-1150 ng/mL: safe & effective HCQ levels
>1150ng/mL-supratx, no added tx benefit
CKD st >/=3: 2x ⬆️odds of toxic hcq levels
#ACR25 @RheumNow Abs1722 #ACRBest https://t.co/RFx1VO0bov
Links:
sheila RHEUMarampa ( View Tweet)
3rd plenary session!
#1722 Defining safe HCQ levels in SLE: whole-blood 750-1150ng/mL= therapeutic range; >1150ng/mL ➡️ ~2× toxicity risk; <750ng/mL ➡️ higher flare risk
CKD ≥3 increases odds of supratherapeutic levels
New era of precision monitoring in SLE?
@RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
How does DADA2 present?
Ten studies provided data on a total 225 patients
1) skin findings
2) fever
3) stroke
4) cytopenias
@RheumNow #ACR25 Abst 1615 https://t.co/xZuTk6YFdJ
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
PET and histologic discordance in aortitis
Of 5 aortitis patients who had PET/CT prior to aortic surgery with path, only 1 showed concordance (neg PET, neg biopsy)
4/5 patients had inflammatory biopsy with neg PET
Small # but PET is not perfect!
@RheumNow #ACR25 Abst 1620
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
When MAS is suspected. Soluble IL2 receptor alpha and CXCL9 may be useful (however t cell lymphomas and viral infections like hepatitis may also have them)
#ACR25 @RheumNow
Key takeaways below https://t.co/wJv1dvwU88
Bella Mehta bella_mehta ( View Tweet)
Soluble IL2 receptors help assess macrophages behavior. Ferritin also asses the same in Macrophage activation syndrome.
ADA2 is the newer biomarker for hemophagocytic syndromes.
#ACR25 @RheumNow
Interferon gamma also a newer important target in MAS https://t.co/7sWwninBTM
Bella Mehta bella_mehta ( View Tweet)
Simultaneous measurements if S100, Ferritin and IL-18 increase diagnostic utility of these biomarkers in Stills disease.
@RheumNow #Acr25 https://t.co/3wmijNcpVY
Bella Mehta bella_mehta ( View Tweet)
Low percentage of glycosylated Ferritin was more specific for Stills disease but not used frequently in clinical practice.
@RheumNow #ACR25 https://t.co/wTK1eIcSKX
Bella Mehta bella_mehta ( View Tweet)
Biomarkers in Stills disease and MAS. #ACR25 @RheumNow
IL 6 may not be helpful compared to CRP, and IL 1 beta is difficult to measure
IL-18 seems to be the best one. https://t.co/u3oBTd4eaP
Bella Mehta bella_mehta ( View Tweet)
What do we know about IL-18
Normal levels less than 500
Non specific 500 to 15000
Stills (quiet) 2000 to 10000
Mas/glares 20000 and more
@RheumNow #ACR25 https://t.co/ZAltAD5Q8V
Links:
Bella Mehta bella_mehta ( View Tweet)
