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EULAR recommendations for management of #RheumatoidArthritis
6️⃣Glucocorticoids should be tapered & discontinued as soon as clinically feasible
8️⃣JAKi can be used but consider risk factors
via Prof Smolen #EULAR2022 https://t.co/7cocPSpgkH
Dr Ai Lyn Tan DrAiLynTan ( View Tweet)
#ClinicalPearl Oral Surveillance chance of having a MACE was highest....you guessed it, in those with past MACE events. Some CV risks have different risks ex HTN May have less risk vs high cholesterol @RheumNow @eular_org #EULAR2022 POS0237 https://t.co/kTn4rxMlej
Janet Pope Janetbirdope ( View Tweet)
Topical therapies take centre stage
Topical treatments have so often been the low level “sure you can try this” option. However there are exciting data that these approaches may become part of our main armamentarium.
Read Article
WATCH: Not Your Kind of RA
Dr. David Liew discusses abstract OP0035 presented at #EULAR2022
Background: It has been suggested that rheumatoid arthritis (RA) starts at a younger age in cities with a lower latitude (closer to both sides of the equator).
https://t.co/0l8b95emkn https://t.co/2leBR1nOBJ
Links:
Dr. John Cush RheumNow ( View Tweet)
Sing an ARIAA! #Bestinclass Rx of arthralgia w +MRI showed delay of #rheumatoid arthritis w #Abatacept vs #placebo. NNT to prevent 1 RA [is 8 w Rx for 1 yr & then d/c-Yrs ago #MTX delayed onset of RA but benefit waned after d/c Rx. Both ?RA spectrum POS0531 @RheumNow #EULAR2022
Janet Pope Janetbirdope ( View Tweet)
72% of you would treat some high-risk subclinical arthralgias with MTX
and Marta Mosca, in the #EULAR2022 highlights, broadly agrees
OP0070 Leiden data showed better function and presenteeism. And that’s a win in my book
@RheumNow https://t.co/BqTLy4HBWR https://t.co/cwzJkH0f71
David Liew drdavidliew ( View Tweet)
#OP0004 #EULAR2022 In line with EULAR President’s preech to go Digital, Prof Mosca highlighted a study which showed assessment of joints in RA could be done by taking photos and analysed their dorsal skin folds using convolutional neural network @RheumNow https://t.co/h03mieTcQt
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Post-ORAL Surveillance, the @eular_org RA treatment guidelines had to change.
In the 2022 version:
JAKi now separate sentence following bDMARDs, with proviso to mention risk.
Sometimes guidelines have to tell us what we’ve all inevitably been expecting
#EULAR2022 @RheumNow https://t.co/RPbPNi3vcW
David Liew drdavidliew ( View Tweet)
#highlight n•1 💫
The presence of specific peripheral blood T cell sub-populations associated w/ disease flares
in RA pts in remission after cs or bioDMARDs tapering or cessation
identified in 2 different abstracts
OP0011 and OP0074
@RheumNow #EULAR2022 https://t.co/SO2AgtkyTP
Aurelie Najm AurelieRheumo ( View Tweet)
Stimakovits et al. Influence of placebo vs active comparator in RA clinical trials. ACR response rates systematically higher in studies with active comparators. ACR20 OR 1.64 (1.44-1.86), ACR50 OR 1.46 (1.28-1.71), ACR70 OR 1.61 (1.28-2.02) @RheumNow #EULAR2022 POS0563 https://t.co/x7PQH11oue
Richard Conway RichardPAConway ( View Tweet)
We’re in the #EULAR2022 highlights: basic/translational first. Wait, don’t go…
because Temra cells are cool. Up in RA pts who are TNFi-IR, & may actually be more than a bystander.
Understanding TNFi resistance is path to:
predicting it
knowing best what to do with it
@RheumNow https://t.co/22Y6iinSbH
David Liew drdavidliew ( View Tweet)
Redondo-Rodriguez et al. Abatacept in RA-ILD. Prospective study 38 patients. 73.6% improved/stablised with abatacept at median 17 month follow-up @RheumNow #EULAR2022 POS0654 https://t.co/D2du0hAXIy
Richard Conway RichardPAConway ( View Tweet)
#POS1207 #EULAR2022 In N=98 RA patients with poor antibody response to rituximab after two doses, 19% responded after 3rd dose. Associated with longer Time of vaccine from last RTX & interestingly ultra dose 200mg used in the Netherlands @RheumNow https://t.co/TTXXtOU6vp
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Talking about tapering studies in inflammatory arthritis, but true throughout all of rheumatology:
Not all flares are equal.
This area is full of nuance, we need to think more closely about how we study them.
#EULAR2022 @RheumNow https://t.co/tzqqNZv5Ct
David Liew drdavidliew ( View Tweet)
Everything's better with MTX
Controlled RA on b/tsDMARDs: can we taper MTX?
maintaining remission pooled OR 0.81 (0.68-0.97)
Unless I'm reading it wrong:
it's true many will be fine, but
keeping MTX adds benefit (even in short term, before ADAb)
POS0286 #EULAR2022 @RheumNow https://t.co/ZlwXHgACWd
David Liew drdavidliew ( View Tweet)
Charles-Schoeman et al. ORAL Surveillance, post-hoc analysis of risk factor combinations. 65+ ever smokers appear at particular risk @RheumNow #EULAR2022 POS0674 https://t.co/UyTOITBTX9
Richard Conway RichardPAConway ( View Tweet)
If rheumatoid arthritis comes and goes before a rheumatologist lays their hands on it, is it really RA?
We're born skeptical on this. Ronald van Vollenhoven poses questions on what it means for studying drug-free remission in established RA disease #EULAR2022 @RheumNow https://t.co/9GJoqYtVBP
David Liew drdavidliew ( View Tweet)
So what diet to follow with autoimmunity in mind?
So many, all with different instructions.
Let’s concentrate on where they agree:
yes to fruits & vegetables
no to emulsifiers & processed foods
#EULAR2022 @RheumNow https://t.co/I9abweQOyZ
David Liew drdavidliew ( View Tweet)
#ClinicalPearl? #METEOR is a multi-country ~40K database of #rheumatoid arthritis. @eular_org #EULAR2022- found YOUNGER age of onset of RA close to equator, opposite to low Vitamin D if more NORTH /less sun and MORE #multiple #sclerosis. ?From low age at equator OP0035 @RheumNow
Janet Pope Janetbirdope ( View Tweet)
Looks like I’m not the only one who doesn’t let the absence of synovitis stop me from sometimes treating high-risk clinically suspect arthralgias i.e. ‘very early early RA’
The truth comes out in anonymous surveys!
#EULAR2022 @RheumNow https://t.co/BqTLy4HBWR
David Liew drdavidliew ( View Tweet)