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#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)
COVID-19 mRNA vaccination immunogenicity
(vs immunocompetent):
TNFi: 2.3x reduction
JAKi: 2.6x
AZA: 3.5x
MTX: 4.4x
steroids: 9x (but confounded by other meds)
MMF/MPA: 21x
B cell depleting: 57.7x (but 6m gap probably helps)
amazing work led by @alhkim
#ACR21 ABST0457 @RheumNow https://t.co/cl5vBpNzvQ
David Liew drdavidliew ( View Tweet)
Dr. @AlHKim on COVaRiPAD data:
274 pts chronic inflam dz (RA/SLE/IBD/SpA/MS/SS,/Vasculitis) vs 53 control
👉90% Ab+ response (⬇️3.4X titer)
👉MMF⬇️21X
👉MTX⬇️4.4X
👉AZA ⬇️3.5X
👉BCDT⬇️ 57.7X
👉JAKi ⬇️2.6 X
👉GCs⬇️9X
👉TNFi impaired neutralization delta
#ACR21 #plenary @rheumnow https://t.co/b0DgLjDi6E
TheDaoIndex KDAO2011 ( View Tweet)
Provocative study in pre-RA. SC Abatacept in patients with pre-clinical RA can:
-improvement MRI inflammation
-⬇️evolution to clinical RA at 6 months
-No new safety signal
Yes, but we need longer term follow-up and an estimation of NNT.
#OP0505 @Rheumnow #ACR2021 https://t.co/2P1Yk3IyeR
Aurelie Najm AurelieRheumo ( View Tweet)
New treatments in #psoriaticarthritis Brepocitinib TYK 2/JAK 1 inhibitor had superior efficacy vs PBO in active PsA at Week 16, with improvements in more refractory domains over 52 weeks. Safety consistent with other JAKi @RheumNow #ACR21 Abstr#0488 https://t.co/ugsV7uRwro
Dr. Antoni Chan synovialjoints ( View Tweet)
#ACR21 #Abstr0456 How can we explain cognitive impairment in #lupus? Using f- and DCE-MRI, a study showed:
💠Abnormalities in brain functional connectivity
💠Extensive Blood-Brain Barrier leakage (BBB)
BBB could be a future target @RheumNow https://t.co/KLeWfbQUQ0 https://t.co/ibNvBUWlMK
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Polyautoimmunity: axSpA and Familial Mediterranean Fever by Dr. Rachel Tate ( @uptoTate )
Mysteries behind polyautoimmunity have confounded rheumatologists for decades. One such association, the co-existence of FMF and axSpA, remains rare.
https://t.co/GbU1ikeyQw
#ACR21 https://t.co/dRd6yxjieS
Links:
Dr. John Cush RheumNow ( View Tweet)
So what’s interesting is that type I IFNs actually tighten the BBB. Is this dysfunctional in SLE? Or does this argue that CI does not correlate with SLE disease activity perhaps? #ACR21 #ACRAmbassador https://t.co/y5x2k3NQFi
Alfred Kim alhkim ( View Tweet)
COVaRiPad study - Immunosuppression affects COVID-19 vax Ab levels. 247 pts, 90% seroconverted but @ reduced (3.4 fold) titers. Lowest w/ MMF (21x) and B cell Rx vs MTX/AZA (3-4x). Pts on B cell therapy should wait 6 mos to recv vax #ACR21 Abstr# 0457 https://t.co/1gkCsJSDBk
Dr. John Cush RheumNow ( View Tweet)
Why is lupus nephritis mortality trending up in the US, in contrast to overall SLE mortality?
Race matters
Urban location can make things worse
I'm outside looking in but hope it's not too bold to say disparities affect whether you live or die from LN
#ACR21 ABST0454 @RheumNow https://t.co/wmB9l9fFTT
David Liew drdavidliew ( View Tweet)
Dr De Miguel on subclinical large vessel vasculitis in PMR. US assessment. 22% had subclinical GCA. 90% LVV, 10% cranial GCA. Abstr#0466 #ACR21 @RheumNow https://t.co/PDCynMAigi
Richard Conway RichardPAConway ( View Tweet)
