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lung%2Cbright.jpg

RA-ILD: an update

d Julian Segan, MBBS, BMedSc, FRACP

Interstitial lung disease (ILD) remains a leading cause of mortality in rheumatoid arthritis (RA). Estimates of involvement of ILD in RA remain relatively imprecise (estimated prevalence 5-20%), though this partly reflects the wide spectrum of ILD and differing ascertainment.

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Puzzle pieces

Where are we with treating Pre-Rheumatoid Arthritis?

d Richard Conway, MBBChBAO, PhD

The ability to prevent RA in individuals at risk is a holy grail in rheumatology. There is a long history dating back to the PROMPT trial of methotrexate and PRAIRIE trial of rituximab. Both otrials showed an effect, but it seemed more likely to be a delaying of RA than prevention or modulation. Framing it another way, there were better outcomes in pre-RA because we were actually treating RA as it emerged with a proven effective treatment. It is in this setting that three trials of ongoing studies in RA preventative therapy are presented at ACR.

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Hanlon @MeganHanlon4 @dougveale et al. Loss of macrophage homeostasis occurs in pre-RA, and appears to be an early factor in RA development @RheumNow #ACR22 Abstr#0554 https://t.co/UL1jVGVlrA https://t.co/i1WWQlHs2m

Links:

Richard Conway RichardPAConway ( View Tweet)
Rech et al. 18 month results of ARIAA, 6 months abatacept in pre-RA, 1 year drug-free follow-up. 35% vs 65% developed RA. MRI response 57% vs 29%. @RheumNow #ACR22 Abstr#0530 https://t.co/35M2sPkIbW https://t.co/S8K39jkCh0

Links:

Richard Conway RichardPAConway ( View Tweet)
Schieir et al. Women with early RA less likely to achieve remission. 12 months 37% vs 43%. 4 years 61% vs 64%. Time to remission 19 months vs 16 months. @RheumNow #ACR22 Abstr#0532 https://t.co/ZRuqqaPHHU https://t.co/pDBHHtLEhs

Links:

Richard Conway RichardPAConway ( View Tweet)
Porter et al. Asymptomatic Pre-RA to symptomatic Pre-RA to early RA steady increase in bacterial infection compared to HC. Causality or Reverse Causality? I think more likely reverse - disease related immunosuppresion @RheumNow #ACR22 Abstr#0535 https://t.co/i5iN3Db7rf https://t.co/2ynYF7Vqbl

Links:

Richard Conway RichardPAConway ( View Tweet)
Wilson et al. Sputum ACPA or RF assoc RA development in serum ACPA+ individuals. x4 more likely - 46% vs 12%. @RheumNow #ACR22 Abstr#0533 https://t.co/7kpeXWjeKI https://t.co/Sx41DOJAAX

Links:

Richard Conway RichardPAConway ( View Tweet)
Riskedal et al. DNA methyllation based biomarker for sero- RA. Accurary 1.0 for sero+ RA and reactive arthritis, 0.75 sero-RA, 0.5 PsA. Promising but not there yet. @RheumNow #ACR22 Abstr#0531 https://t.co/clLR0V33WJ https://t.co/7Hts9gtkW9

Links:

Richard Conway RichardPAConway ( View Tweet)
Trend of reduced opioid use when initiating biologics and JAKi in RA though effect size small and very high baseline use (>50%) in this insurance claims database. Residual pain and harm minimisation still areas of need. @RheumNow #ACR22 ABST0925 https://t.co/XGHu0fIMF0 https://t.co/PutNNQiKnY

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Julian Segan JulianSegan ( View Tweet)
EULAR19.abstract.jpg (keep)

ACR Best Abstracts - Day 1

d Jack Cush, MD

The RheumNow faculty reporters have been scouring the meeting and online presentations to find the best abstracts from ACR22. Here are some of their choice abstracts reported today on day 1 of ACR 2022 (#ACRbest).



 

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bacteria,infection,color

Infections in pre-RA: a cause or a consequence?

d Aurelie Najm, MD, PhD

Rheumatoid arthritis is known to be associated with a higher risk of infections. In abstract 0535, Porter and colleagues have assessed infection rates in the pre-RA and early RA phases as defined by antibiotics prescription and hospital admissions with an infection main diagnostic code in the UK National database.

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Across 9 trials of Upadacitinib in RA, PsA and AS, 40%–50% of patients had ≥ 2 CV risk factors, ≥ 65 years 6%–23%. Rates of adjudicated MACE and VTE with UPA were infrequent, consistent with background rates in RA, PsA, and AS Abst 0510 https://t.co/HDkQ6ELnAy #ACR22 @RheumNow https://t.co/SRJYdFFNIQ

Links:

Dr. Antoni Chan synovialjoints ( View Tweet)
What has changed since the 2020 @ACRheum #reproductive guidelines? Abstract #1717 425 SLE/RA patients: 📍 significant improvement in pre-#pregnancy counseling and discussions in reproductive goals 📍No improvements in birth control use or documentation

Catherine Sims, MD DrCassySims ( View Tweet)

Can we use sputum to identify progression to RA in at-risk individuals? Sputum anti-CCP-IgA anti-CCP-IgG & RF-IgM positivity = 4-fold increase risk of classified RA in IgG CCP+ at-risk individuals. Sens 67% Spe 80% https://t.co/o6PCvxgYGM Abs #0533 #ACR22 #ACRBest @Rheumnow https://t.co/CxDjanjBKT

Links:

Aurelie Najm AurelieRheumo ( View Tweet)
@erasmusmcintl @RheumNow Data here from @earlyarthritis (CATCH Canada cohort), similar results. It's not just pain differences - but that's real too. It's lots of things, but whatever the case we ignore sex and gender's impact in RA at our peril. ABST0532 #ACR22 @Janetbirdope @TheLancetRheum @RheumNow https://t.co/27uQmNAlPF
David Liew drdavidliew ( View Tweet)
Emerging and exciting treatments in RA: #ACR22 preview https://t.co/5JtblF9MxE https://t.co/oYSiLguLkJ

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Dr. John Cush RheumNow ( View Tweet)
Are DNA methylation marks the new seronegative RA biomarkers? Riskedal et al. propose a new model based on whole-blood DNAm profiles Sens 90%, Spe 88%, Accuracy 89% for classification of RA Accuracy RA Sero+ 100%, RA Sero- 75% https://t.co/3occAQPZ1u Abs#0531 #ACR22 @Rheumnow https://t.co/QXhMxyWC8g

Links:

Aurelie Najm AurelieRheumo ( View Tweet)
18mo data of ARIAA study (6mo ABA in pre-RA): 12mo after discontinuation Progression to RA ABA 35% vs PBO 57% p=0.008 Improvement in synovitis, osteitis & tenosynovitis ABA 57% vs. 29% PBO Enough to move into clinical application? https://t.co/2CDN9M31mB Abs#0530 #ACR22 @Rheumnow https://t.co/R54AokGSiK

Links:

Aurelie Najm AurelieRheumo ( View Tweet)
Rates of MACE and VTE with upadacitinib were infrequent and consistent with background rates in RA, PsA and AS patients. Factors associated with MACE/VTE: age>65, HTN, DM, smoking, history CV event/VTE Abs#0510 @RheumNow #ACR22 https://t.co/AjtJF0p3QK
Robert B Chao, MD doctorRBC ( View Tweet)
England et al. Influence of FVC on choice of b/tsDMARD in RA-ILD. FVC predicts hospitalisation and mortality. However, it did not appear to influence choice of b/tsDMARD. Overall 67% of RA-ILD patients initiated TNFi, weird! @rheumnow #ACR22 Abstr#245 https://t.co/swuNHv96WD https://t.co/vy5FUPnNjo

Links:

Richard Conway RichardPAConway ( View Tweet)

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