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In a retrospective study of TAK patients, ~about 1/3 developed new lesions on imaging over time
Most lesions:
- stenotic
- L carotid
- Abdominal aorta
- SMA
50% of the 1/3 = 2 or more lesions
Serial imaging is crucial!
@RheumNow #ACR25 Abst 1631
Brian Jaros, MD Dr_Brian_MD ( 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)
Delay in PsA diagnosis
Meta Analysis of 32000+ pts
Median diagnostic delay 2.5 years
Median delay in referral 1 year
Increase odds of Rx damage from 50%
Geographic variation
We need to do better
#ACR25 @RheumNow #ABSTRACT1713 https://t.co/CWwqosa5NT
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
PMR patients need healthcare professionals who know a bit about their disease.
Survey of US HCPs, amongst responders:
- 68% were not aware/unsure about PMR
- of those who were aware, knowledge was… not great (see below)
PMR needs everyone’s respect
#ACR25 ABST1617 @RheumNow https://t.co/SpyEnAW8lI
David Liew drdavidliew ( View Tweet)
A largely understudied area:
Impact of peri-menopause in PsA
Toronto Cohort 473pts, HRT 1.5%
Peri menopause =
increase DAPSA, TJC, SJC, FACIT-fatigue, HAQ
compared to pre- and post-menopause
No association w/ BMI, but with fatigue
Less impact when education level increases https://t.co/bSuGxZCbGn
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
“The true master clinicians I know have an exceptional tolerance for uncertainty”
- @LCalabreseDO, #ACR25
(Gary Hoffman and Carol Langford got a specific name check there too)
‘Fake Rheum: Case-Based Approach to Rheumatology Mimics” @CCalabreseDO @RheumNow https://t.co/VkKXoMn1Ls
David Liew drdavidliew ( View Tweet)
Abstract 1718: Immune checkpoint inhibitors (ICI) in pre-existing #SLE
Compared to non-SLE pts, those with SLE receiving ICIs had:
🔹 ↑ risk of thrombocytopenia & pancytopenia
🔹 No significant difference in all-cause mortality
@RheumNow #ACR25 https://t.co/N1iOvxbsAZ
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
IL-5 agents may in fact work for severe EGPA manifestations
Although severe pt were excluded from enrollment in MANDARA, post-hoc and OLE data suggest development of severe manifestations is rare in benra treated patients
@RheumNow #ACR25 https://t.co/slUpAT9mWo
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
The first father-daughter session at ACR?
Brilliant session in diagnostic thinking and mimics in rheumatology from @LCalabreseDO and @CCalabreseDO, teasing apart heuristics, biases, and examples straddling the ID-Rheum divide. Well worth catching on the replay #ACR25 @RheumNow https://t.co/16FEqVyDGg
Links:
David Liew drdavidliew ( View Tweet)
ANCA status does not inform IL-5 agent response in EGPA patients
Terrier et al. analyzed the OLE of MANDARA and compared ANCA+ and ANCA- subgroups:
- similar rates of remission
- similar rates of GC withdrawal
- comparable relapse rates
@RheumNow #ACR25 Abst 1594
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Abstract 1657: Can LLMs track medication history?
GPT-4 outperformed most LLMs in identifying TNFi start/stop events and reasons for switch.
💊 Common reasons for TNFi switching: lack of effectiveness, adverse events, and insurance/cost barriers.
@RheumNow #ACR25 https://t.co/5FUR9tBoyu
Akhil Sood MD, MS AkhilSoodMD ( 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)
Functional MRI studies have been out there for a while, but mechanisms and significance underlying fMRI findings are unclear
fMRI study in 38 active PsA pts w/ significant fatigue
Altered functional connectivity between posterior insula to cerebellum & superior frontal gyrus https://t.co/3s9CJUg2uN
Aurelie Najm AurelieRheumo ( 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)
#ACR25 Abstr#1532 “The more the merrier” or “Too many cooks..” Preliminary data of CTA313, dual CD19-BCMA CAR-T in 15 #SLE pts showed deep depletion & good response. Global study is planned. Will have to keep on eye on safety (G3 herpes zoster, pneumonia & neutropenia) @RheumNow https://t.co/0KQa9K6bYB
Md Yuzaiful Md Yusof Yuz6Yusof ( 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)
