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Myths of RA by Dr. Janet Pope
- RA development should have ACPA years before?
- there is a significant minority of early RA patients who are seronegative!
@RheumNow #RNL2023 https://t.co/pnOxTkfW0l
Robert B Chao, MD doctorRBC ( View Tweet)
How much of RA risk is attributed to lifestyle?
@Janetbirdope presents Nurse's Health Study showing 35%
BMI and smoking increase risk of RA... in patients with ACPA positivity
#RNL2023 @RheumNow https://t.co/g9DIrgc7pk
Eric Dein ericdeinmd ( View Tweet)
@Janetbirdope #RNL2023
Benefit of intra-articular jt injections in early RA
Injection of 6-12 swollen joints (!) vs systemic glucocorticoids
-- FAR better ACR20 and ACR50 with less side effects
@RheumNow https://t.co/AtgCKOd8IC
Eric Dein ericdeinmd ( View Tweet)
Can we prevent RA, Kevin Deane #RNL2023 @RheumNow. https://t.co/EtUEs3MyCN
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Upto 30% risk of #RA within 5 yrs if anti-CCP positive
#RNL23 https://t.co/E5wun837ud
Dr Gurdeep Dulay gurdeep_dulay ( View Tweet)
Stop RA trail:
Plaquenil didn’t prevent RA in patient with pre clinical RA. Kevin Deane #RNL2023 @RheumNow https://t.co/2Y5am2YEsQ
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
30% rule!
Risk of RA development in Pre clinical RA patient in the next 3 to 5 years .
Kevin Deane #RNL2023 @RheumNow https://t.co/J6Polz70im
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
#RNL2023 @RheumNow
There are a lot of RA Rx on market now - do we need more?
Dr. Brenner: YES
Stromal targets like LIF/LIFR, Notch3, cadherin-11 offer upstream benefits for our difficult to treat RA patients that don't respond to tradition cs/bDMARDs https://t.co/zJRRisGW9i
Eric Dein ericdeinmd ( View Tweet)
@RheumNow Live #RNL2023
Stanley Cohen, MD:
Use of JAK inhibitor in patients with known ASCVD: Number needed to harm 16
ASCVD is biggest risk factor for MACE events with JAKi https://t.co/gXNUOO8seG
Eric Dein ericdeinmd ( View Tweet)
Dr Brenner at #RNL2023
Excellent description on how fibroblasts are major producers of IL-6 producers
Clinically presents a target for blocking the fibroblasts, upstream the inflammatory cascade in RA
@RheumNow https://t.co/TserFZtvhV
Eric Dein ericdeinmd ( View Tweet)
JAKinib safety takeaways
- avoid in older population > 65 yo, malignancy, CV risk, VTE risk
- appropriate in younger pts without VTE/CVD risk factors
#RNL2023 @RheumNow https://t.co/5i1bRqqr7g
Robert B Chao, MD doctorRBC ( View Tweet)
Dr. Deanne reminds us that RA is worth preventing for many reasons. #RNL2023 @RheumNow https://t.co/va0RmdhUQR
Dr. Rachel Tate uptoTate ( View Tweet)
Dr. Kevin Deane on preclinical-RA
Very complex history on development of RA with multiple phases before detectable RA shows up in your clinic.
#RNL2023 @RheumNow https://t.co/vzQFhik0aK
Robert B Chao, MD doctorRBC ( View Tweet)
#RNL2023:
Kevin Deane: Anti-CCP positive leads to a 20-30% risk for articular clinical RA within 3-5 years
@RheumNow https://t.co/skp1K4r1hF
Eric Dein ericdeinmd ( View Tweet)
STOP-RA study on HCQ preventing RA...
HCQ did NOT prevent RA development in pre-RA pts
@RheumNow #RNL2023 https://t.co/Vv3szkqxWh
Robert B Chao, MD doctorRBC ( View Tweet)
#RNL2023 @RheumNow
Kevin Deane presents his STOP RA Trial
HCQ is safe and easy - can you use it in pre-clinical RA to prevent disease?
NO EVIDENCE of decreased progression of RA in HCQ compared to placebo https://t.co/1OSVubd9rO
Eric Dein ericdeinmd ( View Tweet)
Treatment with MTX in early CCP+ RA thought to be effective in slowing disease however StopRA study did not show a difference between HCQ and PBO in patients. We need to know more about HCQ vs MTX in this space! #RNL2023 @RheumNow https://t.co/7asmvVfXiC
Dr. Rachel Tate uptoTate ( View Tweet)
The holy grail. How to stop #rheumatoid #arthritis in at risk Pts. Who to treat, when to stop? Many RCTs but no home run-NNT is high. #MTX and a diff study #Abatacept that work while on Rx and #Rituximab, most don’t work esp after stopping Rx @kevindeane #RNL23 @RheumNow https://t.co/BkIxxS0ecn
Janet Pope Janetbirdope ( View Tweet)
Dr. Deane's current management of "pre-RA" pts
- carefully eval for synovitis
- lifestyle factors - stop smoking, diet, dental hygiene
- educate pt on ~30% risk
- annual in-person follow up
@RheumNow #RNL2023 https://t.co/Z0t0Yibyri
Robert B Chao, MD doctorRBC ( View Tweet)
How do you prevent RA in at-risk patient?
Smoking cessation! Healthy weight and exercise! Diet! Periodontal health! 🚭🏋️🥕🦷
Education & follow-up!
Not robustly proven to prevent/delay RA, but may be more important than early DMARD intervention!
Kevin Deane, MD
#RNL2023 @RheumNow
Eric Dein ericdeinmd ( View Tweet)