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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)
#ACR25 SMILE RCT of Incomplete #SLE (ANA+ but not meeting SLICC) showed HCQ didn’t slow down SLE progression. But multiplex arrays showed reduction in autoantibodies with HCQ that were distinct from abs assoc. w progression. Would biomarker endpoints be the answer? @RheumNow https://t.co/XcvacgObVo
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Short chain fatty acids (SCFA) and the relevant microbiome have been linked to RA development and severity.
Study of monozygotic twins, where only one has RA, two diff cohorts:
lower SCFA
lower SCFA microbiome
Biomarkers, or even therapeutic target?
#ACR25 ABST0442 @RheumNow https://t.co/HW1YfkfOG3
David Liew drdavidliew ( View Tweet)
Need better lymphoma biomarkers in Sjögren’s?
APRIL joins BAFF as a promising candidate—high APRIL levels linked to ↑ B-cell activation, disease activity & future lymphoma.
Easily measurable, potentially targetable.
@RheumNow #ACR25 Abstract #1683
Jiha Lee JihaRheum ( View Tweet)
What can we use to better predict MACE in RA patients?
ESPOIR cohort showed value of two cardiac biomarkers:
- hs-cTnT
- soluble ST2
Combined, predicted MACE even after adjusting for disease activity/traditional CV RF. We need something like this!
#ACR25 ABST1334 @RheumNow https://t.co/EUNDuuMaYD
David Liew drdavidliew ( View Tweet)
Loarce et al. Poor performance of CXR and PFT in diagnosing RA-ILD (compared to HRCT). Message is, if you think they have RA-ILD, you need to do CT. @RheumNow #ACR25 Abstr#1335 https://t.co/eeSTf72mvM
Richard Conway RichardPAConway ( View Tweet)
Who with #SSc-ILD will progress?
progression is non linear - can stabilize and worsen
Search for Predictive biomarker
For clinical care & enriching RCTs
Maybe #KL6 🤷♀️
Maybe IP-10, MIG
No strong #biomarker
Depends on what is used
#ACR25 @RheumNow @ACRheum
Abst#0882 #0883 https://t.co/lyTRUEY9SI
Links:
Janet Pope Janetbirdope ( View Tweet)
