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Pre-clinical RA: starting off the wrong foot

Aurelie Najm, MD, PhD

Patients with clinically suspect arthralgia can represent a challenge for clinicians, in a sense that there are not yet reliable markers to predict evolution to clinical RA nor enough evidence to support routine prescription of conventional synthetic DMARDS or biologic treatments in this setting.

Ethan Craig Tweet
rheumecraig
@ericdeinmd @RheumNow *TICOSPA IMO, more an issue of poor tools for activity monitoring and insufficiently diverse toolbox. Works in RA as lots of choices and good activity measures. Until AxSpa has those, don’t see how we hope to meet “tight control”.
Olga Petryna Tweet
DrPetryna
@RheumNow #acr21 abst 195 prospective study of JAKi for refractory Still’s in 7 pts suggests JAKs can be useful as an add on but not in monotherapy : partial response 57%& failure in43%. No patient achieved complete remission. steroids could be decreased by63%~ https://t.co/rYHVReRHvL
Robert B Chao, MD Tweet
doctorRBC
Irish registry of AS pts included 76 women who were pregnant ⭐️58% uncomplicated, 41.9% complicated, 11% multiple complications ⭐️frequency of miscarriage ⬆️ ⭐️complications included C-section, preterm, NICU admission #ACR21 @RheumNow Abs#369 https://t.co/90dolEeTIw
Janet Pope Tweet
Janetbirdope
#ClinicalPearl. During Q&A of abst#0457 Kim A, et al plenary at #ACR2021 #ACR21 Dr Kim said with 3rd #COVIDvaccination dose the pts who had little or no response to spike protein DID mount a response. 3rd dose in vulnerable pts works #ACRBest @RheumNow
Pedro Castillo Tweet
_Castillo_Pedro
Secondary antiphospholipid syndrome (2APS) in SLE in Georgia Registry 👉12-14% of SLE pts 👉aCL 67%, LAC 51.5%, and aB2GP 7.7% 👉Inc rates of +dsDNA/Smith, livedo reticularis, serositis, & heme/renal/neuro d/o 👉⬇️rate in Black pts, but ⬆️thrombosis #ACR21 Abs 0078 @RheumNow
Robert B Chao, MD Tweet
doctorRBC
Self-monitoring app for AxSpA pts ⭐️adherence over 6 months poor 😔 ⭐️high disease activity and older age related to ⬆️frequency of reporting Abs#373 #ACR21 @RheumNow
Eric Dein Tweet
ericdeinmd
Lupus Nephritis in pregnancy: @HopkinsRheum Petri recommendations ⭐️AZA safe for LN, with tacro if needed ⭐️❌Voclosporin (alcohol content) ⭐️Belimumab uncertain @Rheumnow #ACR21 Great Debate
CreakyJoints.org Tweet
CreakyJoints
The good news: Most (around 90%) of people with chronic #inflammatory disease produced antibodies after the #COVID19 vaccine, but it was reduced compared to that of generally healthy people. #ACR21 #Plenary @alhkim https://t.co/KdWtIuuOtA
Danny Soulsby Tweet
dsoulsMD
Dr. Eric Yen presenting about lupus nephritis mortality in the USA (1999-2019): - Increasing trend in LN mortality x5 yrs - Increased odds of death for Black pts > Latinx > API > AI/AN - Urbanization (large central metro area) independent RF + effect modifier #ACR21 https://t.co/qf61SkCqw4
Eric Dein Tweet
ericdeinmd
#ACR21 Year in Review: TICOPSA - tight control treat to target in AxSpa does not meet primary endpoint, but favorable secondary outcomes. Was the control group at academic center already receiving good tight control? @Rheumnow
Tanmayee Bichile, MD Tweet
BichileT
The evolving JAK inhibitor story Black box Warnings regarding JAK inhibitor use and MACE, malignancy, thrombosis and mortality - full safety data remains to be examined. @ACRheum #ACRambassador #ACR21 https://t.co/imQ1LSxeXM
Eric Dein Tweet
ericdeinmd
"We have to stop meeting like this" @DrDavidKarp @Rheumnow #ACR21. I was hoping to have some Ghirardelli chocolates in SF... But here's hoping for Philly cheesesteaks next year 🤞
EnvisionRheumat Tweet
ERheumat
#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
Richard Conway Tweet
RichardPAConway
@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
Olga Petryna Tweet
DrPetryna
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
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