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Effective Treatments for Rheumatoid Arthritis ILD
The American College of Rheumatology guidelines for the diagnosis and management of interstitial lung disease, which includes rheumatoid arthritis interstitial lung disease (RA-ILD), has been one of the most controversial topics in the runup to ACR Convergence.
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🆕 2023 ACR Guidelines for Management of Interstitial Lung Disease (#ILD) in Systemic Autoimmune Rheumatic Diseases 🫁
🔸 Screening & Monitoring Recs
🔸 Treatment Guidelines ILD/RP-ILD
#RheumTwitter #PulmTwitter #MedTwitter #MedX https://t.co/JreVO0kgEf
Mithu Maheswaranathan, MD ( View Tweet)
Part 2: Clinical Year in Review #ACR23 https://t.co/Yb8Xh2UKFY
Mithu Maheswaranathan, MD ( View Tweet)
Congrats to Dr Kaitlin McCarter for her #ACR23 investigating predictors and mortality of pre-existing RA flare after immune checkpoint inhibitor.
46% flared
Seropositive- OR 2.0
NO association with mortality
-ICIs are safe to use in RA
-Flares are not a proxy of efficacy https://t.co/eoy0FJb1nA
Jeffrey Sparks MD MMSc jeffsparks ( View Tweet)
LNK01001 12 mg or 24 mg BID to 24 weeks in moderate to severe RA achieved ACR 20 (91.1%, 90.7% respectively), were generally safe, well tolerated with most TEAEs being mild to moderate. Effect seen in Week 1. Wu C, Late breaking Abst#L09 #ACR23 @RheumNow https://t.co/M29LYtEs9I
Dr. Antoni Chan ( View Tweet)
#ACR23 Abs #L07 data do not support tapering of TNFi treatment among RA patients in sustained remission in 3 year study. https://t.co/d0ZBWDKZlB https://t.co/EdllyGUT1y
Dr. Rachel Tate ( View Tweet)
Rx of #inflammatory #arthritis with #glucocorticoids doesn’t seem to affect outcomes in #malignancy treated with #checkpoint #inhibitors. Good news as new or flaring inflammatory arthritis as an irAE can be severe. #ACR23 @RheumNow @ACRheum #1055 @CanRIO_Tweets https://t.co/tFIPcQq2X6
Janet Pope ( View Tweet)
Tapering ABA vs. stable dose ABA in RA
No diff in DAS28 remission at 2 years
But…
Only in patients receiving concomitant MTX
Those tapering ABA mono also experience higher functional important
Of note: not an RCT
@RheumNow #ACR23 ABST2542 https://t.co/yycCDTnRiF
Aurelie Najm ( View Tweet)
The ADIRA trial showed no significant difference in change in DAS28 bet grps in the adjusted analysis.
Intervention included food delivery svc & probiotic shot
Limitations included study design issues such small sample size
#ACR23 @RheumNow @rheumarhyme https://t.co/J6LEb0yONS
sheila ( View Tweet)
#ACRBest https://t.co/nx3bzhmeBW
Aurelie Najm ( View Tweet)
There is a dose, duration and recency-dependent relationship between previous GC use and MACE. GC doses 5mg/day, durations of 30 days, and use one year prior to MACE were all associated with an increased risk of MACE, Wallace B Abst#2430 #ACR23 #ACRBest https://t.co/2ExboBvo2W https://t.co/FuqXdFFwqP
Dr. Antoni Chan ( View Tweet)
Synovial tissue histology correlates w/ several clinical parameters in early naive RA
Combination ohigh CD68 infiltrate
Fibrinoid Necrosis in tissue asso w/
-better DA reduction
-higher EULAR moderate/good resp
Included in a prediction model (AUC0.7)
@RheumNow #ACR23 ABST2483 https://t.co/2jCMSzV7ak
Aurelie Najm ( View Tweet)
Body mass is associated w/ ttmt response in RA
Data from RACAT & TEAR studies
TNFi > triple th in underweight gpe but not in overweight gpe
Similar result in gpe w/ low leptin levels
& low adipokine scores
True biology or confounding bias?
@RheumNow #ACR23 ABST2541 https://t.co/OhKj6QNaSa
Aurelie Najm ( View Tweet)
Who uses #cannabis in #rheumatic #diseases? Those who smoke, have higher pain, more anxiety, poor sleep are more likely to have used cannabis for their rheumatic disease. Half of the >2900 respondents have tried #cannabis. Use of #biologics reduced use. #980 @RheumNow @ACRheum https://t.co/DQDRQN40zR
Janet Pope ( View Tweet)
Wouldn’t it be great to be able to predict which women with RA would improve during pregnancy, & which would worsen? We’d be able to adjust DMARDs accordingly.
Gene expression signatures might tell us more - one key cluster here was 21x predictive.
#ACR23 ABST2481 @RheumNow https://t.co/OiDV5sUiYC
David Liew drdavidliew ( View Tweet)
Erosive hand #OA may be more painful than treated #RA patients. The burden of OA is often not alked about, and this study highlights it! @RheumNow #ACR23 https://t.co/jLbvtMmgE0
Bella Mehta bella_mehta ( View Tweet)
Gene signature predicts RA trajectory during pregnancy:
Blood RNAseq *before* pregnancy
🚺 improve during preg: Strong Neutrophil signature
🚺 experience dis worsening:
Strong B cell signature
Needs replication but could have major implications!
@RheumNow #ACR23 ABST2481 https://t.co/gOHwEvOOM6
Aurelie Najm ( View Tweet)
Anti-fibrotics in RA-ILD
Retro analysis of 74 pts
AEs frequent 55% and discontinuation in 46% (more than in initial RCTs)
No diff between AF
FCV trajectory mildly improved
ABST2479 @RheumNow @Juge_P_A @PhilippeDieude #ACR23 https://t.co/GqsHxkIFgD
Aurelie Najm ( View Tweet)
GCs on MACE in RA in VA
A#2430 #ACR23 @RheumNow
Not just ongoing steroid usage, also prior usage 1 year ago
5 mg use for 30 days one year ago - increases MACE events by 3%
5 mg use for 90 days one year ago - increases MACE events by 9%
Eric Dein ( View Tweet)
