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Cognitive Impairment: The Hidden Burden in Lupus Care
Suppose you have a patient with lupus returning for follow-up. Their joint symptoms are well controlled. The kidneys—managed with a combination of biologic DMARD and mycophenolate—show no signs of active urinary sediment or protein. Yet, during the routine visit, your patient brings up fatigue and difficulty remembering things. How do you address this? Several studies presented at ACR24 focused on cognitive impairment in lupus.
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Gender Differences in SpA
One of the hot topics during the meeting was gender differences in SpA. Three abstracts presented addressed issues related to these differences particularly in the aspects of treatment response and disease activity.
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Lacaille et al. Long term harms of previous steroids in RA. CV/infection mortality increase 7% every year/use. Takes 3.5 and 10 years to return to normal after 1 and 2 years use. Never returns to normal if >2 years use @RheumNow #ACR24 Abstr#2673 #ACRbest https://t.co/qcp5mCHmeB https://t.co/keXw5Qg2ld
Links:
Richard Conway RichardPAConway ( View Tweet)
What are the predictors of fracture in #SLE?
🦴Prednisone! Even at low doses ≤5mg
🦴Stroke
🦴Caucasian race
🦴Female
🦴Low BMD
Try to avoid steroid use. If they are needed, IM triamcinolone or IVMP preferable to oral GC.
Ab2679 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
Does CVD mortality risk change after stopping GC in RA?
➡️28078 incident GC users
➡️Incr mortality risk from CVD &infections persists post-cessation
➡️Risk never returns to pre-GC level after prolonged use
⏩Use GC at lowest dose for shortest time possible
Ab2673 #ACR24 @Rheumnow https://t.co/dtLU8obLke
Links:
Mrinalini Dey DrMiniDey ( View Tweet)
Ab2674 #ACR24
➡️Most pts starting 1st-line TNFi, who didn't achieve treatment response at 3M, also didn't achieve response from months 3-12
➡️1/4 pts achieving LDA/remission at 3M were no longer in LDA/remission at 12M
@RheumNow https://t.co/pFOo86tJTx
Mrinalini Dey DrMiniDey ( View Tweet)
Data from the RISE registry show that 9.3% of SLE pts had thrombocytopenia and a smaller percentage with mod-severe TP (2.7%). Severe TP was much rare.
Large data, but well represented grp?
@RheumNow #ACR24 abs2680 https://t.co/Y1Lo9lJGtO
Links:
sheila RHEUMarampa ( View Tweet)
An early favorable response to TNFi initiation indicates better long-term success in RA. Assess early and adjust treatment accordingly.
#ACR24 @RheumNow ABST#2674 https://t.co/YTThYiiLpZ
Jiha Lee JihaRheum ( View Tweet)
Wt ⬇️ = Better #PROs in
👇autoimmune #rheumatic #diseases if > 5% wt loss.
#ACR24 @ACRheum @RheumNow
Didn’t work for non overwt
Ex Normal BMI and T2DM 🤷 https://t.co/81OuTfZ0Nx
Janet Pope Janetbirdope ( View Tweet)
Mortality Risk After Stopping Glucocorticosteroids (GC) in RA.
In a study of 28,078 RA patients:
Mortality risk from CVD ↑ 7.5%/year of GC use; ↓ 1.3%/year after stopping.
Mortality risk from infections ↑ 6.8%/year of GC use; ↓ 4.9%/year after stopping.
Risks normalize 1.5–10… https://t.co/i6cKet1EEV https://t.co/ClMjIly20E
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#Poorer responses to #Rx in
#Females vs #males
Sex hormone and pathway differences
explained
👇
Biological differences
F start worse in disease activity
F May have ⬇️ response to #Rx
Yr in Preview C Ritchlin
@lihi_eder’s PsA work quoted
ACR24 @RheumNow @ACRheum @ACRBest https://t.co/EWoCvzOLiL
Janet Pope Janetbirdope ( View Tweet)
LEVI-04 a novel neurotropin3-i showed:
-significant analgesia across all measures
-improvement in functional measures and PGA for all doses in a Ph2 RCT
- well tolerated
Hopefully will prove to be a therapeutic option for knee #osteoarthritis in future
@RheumNow #ACR24 absL15 https://t.co/kWsyyyGxyU
sheila RHEUMarampa ( View Tweet)
Conaghan et al. LEVI-04, neurotrophin-3 inhibitor in knee OA. 518 patients. Significant improvements in WOMAC pain and function, and PGA. So sign of any increase in rapidly progressive OA (as with NGF inhibitors) @RheumNow #ACR24 Abstr#L15 https://t.co/qud4wTAikY https://t.co/0wjjG4U4bf
Links:
Richard Conway RichardPAConway ( View Tweet)
Pts w #osteoarthritis and T2 DM
👇
Who Have
⬆️pain
Have
worse control of #diabetes
Even after adjusting for #BMI
Chicken or egg - which comes 1st
🤷♀️
#ACR24 @RheumNow @ACRheum
Abst#2110 https://t.co/eN2xAw0EMG
Janet Pope Janetbirdope ( View Tweet)
Does #hand #osteoarthritis
Benefit from
#traction #splinting?
Nope 👎
Small 2 site #RCT - not helpful
I may Recommend #splinting - sometimes pts get
Pain relief - in my opinion
but this one didn’t help
#ACR24 @RheumNow @ACRheum
Abst#2108 https://t.co/K0Ud7uCb1P
Janet Pope Janetbirdope ( View Tweet)
How long is a long acting #intra-articular #steroid #injection in #knee #osteoarthritis?
#IA steroids can be q3monthly
#RCT of IA #fluticasone #propionate
Was superior to #placebo
Seemed to last approx 24 weeks
➡️ sub analysis in moderate pain, BMI<30
#ACR24 @RheumNow #2106 https://t.co/QBFCqXd1Q8
Janet Pope Janetbirdope ( View Tweet)
#Scleroderma #molecular #signatures in #skin predict long term outcomes
👇worst with inflammatory signature
This may have clinical and trial applicability
Nice work!
Abst0711 #ACR24 @RheumNow @ACRheum https://t.co/3CFxu6bACu
Janet Pope Janetbirdope ( View Tweet)
#PAH in #SSc still has a poor #prognosis
👎
Esp #ILD with PAH - a double whammy
But also
group 1 PAH
And
Some are unclassifiable ▶️also bad px
Need
Earlier detection
More interventions
?prevention
Abst#0678 #ACR24 @RheumNow @ACRheum @sclerodermaUM https://t.co/AEQsTC1pzQ
Links:
Janet Pope Janetbirdope ( View Tweet)
#MDA5 #dermatomyositis assoc #ILD
May do better w
#tofacitinib vs #CNI in 515 pts
Too bad they didn’t do a pragmatic RCT as we do t know the reasons for prescribing each #Rx
But impressive survival w #tofa
#ACR24 @ACRheum @RheumNow abst1736 https://t.co/HLJknSYcNJ
Janet Pope Janetbirdope ( View Tweet)
Risk stratification of GCA pts: who might lose vision?
Cranial MRI with vessel wall enhancement used to calculate additive score... # of vessels affected
Higher scores a/w ocular GCA > non-ocular GCA > no GCA and decreased w/ tx
@RheumNow #ACRbest #ACR24 https://t.co/knDVrl84Qs
Links:
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
