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How do we manage difficult discussions about pregnancy in RA?
Most rheumatologists know that it is important to get pregnancy planning right for women of childbearing age living with rheumatic diseases. That is easier said than done, though: the details are difficult, it is overwhelming for the patient, and the conversations are hard.
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SMART study - MTX split into morning and evening once weekly vs all together. 253 patients. Split dosing better efficacy (DAS28 4.1 vs 4.5, p=0.03), more LFT elevation but less neutropenia. Abstr#1583 #ACR23 @RheumNow https://t.co/tkrds4uqQP
Richard Conway ( View Tweet)
Split dose oral MTX (15/10mg) versus single dose (25mg) in RA RCT 250pts
EULAR good resp
16wks 22 vs 10% (sig)
24wks 37 vs 28% (ns)
50% more addition of 2nd csDMARD in single dose
#ACRBest @RheumNow #ACR23
ABST1583
For more thoughts, have a read https://t.co/urA6X4rY0D 👇🏼
Aurelie Najm ( View Tweet)
SMART on MTX
Ab#1583 @RheumNow #ACR23
Single dose MTX 25 mg v Split dose (same day 15/10 mg). FA 5 mg 2x/wk. 16w can add csDMARD
Split 29% vs 22% - EULAR response improve - not signif. Better DAS28
Split: 35% added 2nd csDMARD vs. 54.5% in single dose
No stat diff in sAE
#ACRBest
Eric Dein ( View Tweet)
Should Methotrexate be prescribed as split dosing?
Multi-center, RCT of RA pts showed split dosing of 25mg MTX resulted in higher efficacy + reduced need for additional DMARDs, compared to single dose MTX
@RheumNow #ACR23 Abs#1583 https://t.co/zjjnzWUl5E
Robert B Chao, MD ( View Tweet)
What is frailty?
How does it affect RA outcomes?
Pop based cohort study
13000+ RA vs. 26000+ matched ctrl
Over 2x more frailty 5.6% vs 2.6%
OR frailty in RA 2.3
Adjusted for rurality, neighborhood income quartiles AND BL comorbidities index
@RheumNow #ACR23 ABST1275 https://t.co/ZkOpgHPSE0
Aurelie Najm ( View Tweet)
SMART study #ACR23 Plenary abs #1583: po split-dose MTX (vs single dose) once weekly in RA pts had ^^ efficacy & reduced need for add'l DMARDs. No major AE, but slight increase in frequency of persistent transaminitis in split-dose group. https://t.co/wHzjpSnfuA @rheumnow https://t.co/0hNTMGbt47
Dr. Rachel Tate ( View Tweet)
Large VA study of >1k RA-ILD pts
No difference in risk of respiratory hospitalization or death in RA-ILD pts using TNFi vs. nonTNFi/JAKi
Data does not support avoiding TNFi in RA-ILD
@RheumNow #ACR23 Abs#1582 https://t.co/LTNLXEIAPo
Robert B Chao, MD ( View Tweet)
Ab#1582 @RheumNow #ACR23
RA-ILD outcomes of TNFi v non-TNF b/tsDMARD
VA Data, propens match emulation study
No incr risk of death in TNFi vs non-TNFi
But are TNF safe?
- Don't support systematic avoidance. But are there specific pops - unsure. Don't answer if efficacy in RA-ILD https://t.co/AApEjZs4DM
Eric Dein ( View Tweet)
Important plenary session, RA-ILD outcomes in VA cohort study
No difference in death/hospitalization for TNF vs non-TNF treated patients. Jives w/my priors; I do NOT avoid TNF in RA-ILD
Encouraging if you (like me) prefer RA-active tx for RA-ILD 😉😆
@RheumNow #ACR23 #ACRBest https://t.co/TIDzMLOfs4
Mike Putman EBRheum ( View Tweet)
Non TNFi b/tsDMARDs vs TNFi in RA-ILD. New-User, Propensity Score Matched Study. 454 patients. No difference! resp-related hospitalisation aHR 1.22 [0.92, 1.60] No difference mortality. Abstr#1582 #ACR23 #ACRbest @RheumNow https://t.co/HzzVo9dJHi https://t.co/mZuHq4GShU
Richard Conway ( View Tweet)
The SMART study by Dhir et al: once-weekly, oral split-dose MTX (10mg/15mg) in RA pts had⬆️efficacy & ⬇️need for addtl DMARDs vs. once-weekly, single-dose MTX
Reassuring.
. . .
In my practice, pts tolerate MTX split dosing better esp w/⬆️doses
#ACR23 ABST1583 @RheumNow https://t.co/F8p2aKmmH4
sheila ( View Tweet)
Long term follow up T2T in RA
12 yrs BeST & 20yrs IMPROVED studies
50% recalled
68% remission 91% LDA
HAQ 0.5
These are GOOD outcomes
Especially considering setup before we had several MoAs
What’s lacking: current ttmt & number of bioD, ctrl group
@RheumNow ABST1273 #ACR23 https://t.co/9KcsHLupJc
Aurelie Najm ( View Tweet)
RA-ILD is an heterogeneous condition
Different risk factors identified dep/ on radiographic pattern
RA-UIP:
-male sex OR 2.7
-ACPA+ OR 2.2
-male + ACPA + smoking OR 13
RA-NSIP:
-RF+ OR 3.2
Likely to support different pathological mechanisms
@RheumNow #ACR23 ABST1269 https://t.co/rC2F9YAceQ
Aurelie Najm ( View Tweet)
Never forget the physical toll that RA has taken on our patients.
RA pts in BC🇨🇦, dx 1996-2008 (n=13367)
Fraility score 5y post-dx:
twice as likely to be frail vs matched controls
I would love to see those dx 2008-2018
Have biologics moved the needle?
#ACR23 ABST1275 @RheumNow https://t.co/gMXo5Pp1qA
David Liew drdavidliew ( View Tweet)
RA peripheral blood mononuclear cells display IFN-gamma signature
Driven by 2 cell subsets: T cells & macrophages
IFNg driven transcription factors
Increased only in ACPA+ RA
Differential biology could inform ACPA stratified therapy
ABST1271 @RheumNow #ACR23 https://t.co/EN2noKGupK
Aurelie Najm ( View Tweet)
To remind us. Glory be! GLORIA a #RCT in elderly active #RA: MTX+10 mg daily #prednisolone which was better than MTX alone. But more infections and no comparison of inexpensive Rx such as adding #HCQ. Still debated as to benefit vs risk of this strategy @RheumNow #ACR23 @ACRheum https://t.co/slOmESbIOW
Janet Pope ( View Tweet)
Have we forgotten our physical rehab roots in RA?
RA with severe functional disability
1y of personalised exercise program vs routine care
n=215, Leiden
broad functional gains as expected
Remember:
the meds are critical, but can only take you so far.
#ACR23 ABST1335 @RheumNow https://t.co/FszhGAv7ln
David Liew drdavidliew ( View Tweet)
A bit of talk about treating pre-RA, but how do patients feel about it?
Clinically suspect arthralgia pts, Leeds
Influenced by different factors:
symptoms
personal risk
meds experience
knowledge
perceived effort
Acceptable tradeoffs are very personal
#ACR23 ABST1258 @RheumNow https://t.co/wZGfdffNji
David Liew drdavidliew ( View Tweet)
The order of use will affect the safety and effectiveness of drug Rx in #Rheumatoid #arthritis So if #Rituximab is used in later line #Rx - is looks worse@than ex #TNFi used early. Never forget prescribing bias / confounding the results. @RheumNow @ACRheum #ACR23 https://t.co/JJ8BY7n9VM
Janet Pope ( View Tweet)
