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SpA Sleuths: The Case of Undiagnosed IBD
Abstract #0494 provides context to our continual search for better understanding of inflammatory bowel disease in patients with AS, nr-AxSpA, and PsA.
Read ArticleIssues in AxSpA: Treatment Intensification, Pregnancy
A lot of interesting studies will be presented at the poster sessions on Sunday, November 12 and some of them address practical real-world issues such as treatment intensification and the impact of pregnancy on axSpA imaging.
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DRESS-PS study LTE. 12 month observational extension. 114 patients PsA/AxSpA. Essentially patients TNFi tapered or not in T2T fashion. TNFi dose remained lower in tapering group but it is consistently creeping back up. Abstr#0775 @RheumNow #ACR23 https://t.co/aYoOl6Ccin https://t.co/BtMR95lIfs
Richard Conway ( View Tweet)
Abs#518 @RheumNow #ACR23
Deodhar: TOFA in AS, by b/l CRP levels
30% nml CRP (<5 mg/L) v 70% Elevated
At wk 12, TOFA >> PBO regardless of b/l CRP
Difference in response: greater in pts w elevated CRP
Safety rates: elev. CRP c/w PBO, but nml CRP had trend of high AEs for tofa v PBO https://t.co/b9NRNkU8ub
Eric Dein ( View Tweet)
Are Long-term NSAIDs safe in AS?
Ab#0528 #ACR23 @RheumNow
19,775 AS pts vs 59,325 controls.
Incidence of 16.9, 13.8 per 1,000 person-yrs, respectively
Long-term use of NSAIDs increased risk of CVD in non-AS control (aHR 1.64), but did NOT in AS pts (aHR 1.06)
Eric Dein ( View Tweet)
2 yrs extension of DRESS-PS study
100+ pts w/ PsA and AxSPA
-70% LDA state in both Ctrl & Intervention gps
-strong recovery after relapse
No difference efficacy protocolized & routine care tapering but inferior TNFi use (52 vs. 77%) in Intervention gp
@RheumNow #ACR23 ABST0775 https://t.co/V2DqCjT0w3
Aurelie Najm ( View Tweet)
Upadacitinib on wearable device-measure activity
SELECT-AXIS 2
Abs#0530 #ACR23 @RheumNow
UPA had numerically higher mean daily step counts than PBO
11% improvement v PBO at wk 14 (diff of 345 steps/day)
Sedentary pts: 22% improvement in daily step count from b/l on UPA (4% PBO) https://t.co/Gq91TmvfZC
Eric Dein ( View Tweet)
What are effects of TNFi on Lipids in AxSpA?
Ab#0531 #ACR23 @RheumNow
320 pts w AS - retrosp cohort, first-line TNFi, not on lipid Rx
Chol and TG increase in 1st 3 mos of treatment. LDL & HDL: no signif change
Inflam markers/Lipids correlated - suspect due to anti-inflamm effect https://t.co/qT5qUEOEvO
Eric Dein ( View Tweet)
Abs#0501 @RheumNow #ACR23
Uveitis in SpA, from Greece
AxSpA: 11.7% Uveitis. RF: HLA-B27 (OR 4.15), periperhal arthritis (OR 3.05)
PsA: 2.7% Uveitis. Ass w/ SpA FHx, Axial dis at dx, disease duration
Permanent vision loss in 16% AxSpA, 30% PsA pts, all with recurrent uveitis
Eric Dein ( View Tweet)
EISER study: Undiagnosed IBD in SpA
Abs#0495 #ACR23 @RheumNow
559 pts, 47% PsA/53% SpA (80% r-AxSpA)
Higher mean fecal calprotectin in r-AxSpA (395 vs 305 nrAxSpA/PsA)
14.6% IBD symptoms, 23 patients (4.4% were dx w IBD)
Fecal calprotectin & history can uncover IBD
#ACRBest
Eric Dein ( View Tweet)
Always great to see UCSD represent at #ACR23!
Pregnant women with rheumatic diseases and antiphospholipid syndrome higher a HIGHER risk for acute cardiovascular events
30% of events occurred postpartum
@RheumNow Abs#0722 https://t.co/CqZedfOlBC
Robert B Chao, MD ( View Tweet)
Treatment intensification was associated with a higher ASDAS cut-off (2.7) value than the recommended one (≥2.1), the recommended cut-off could be too stringent or consider other factors than disease activity, Webers, El-Din Abst#0517 #ACR23 @RheumNow https://t.co/ZtBXhufxU1 https://t.co/MzvZQoFbvw
Dr. Antoni Chan ( View Tweet)
Analysis from the DESIR cohort reveal that pregnancy does not aggravate imaging changes in axSpA.
Stat significant changes seen on Xray of LSIJ b4 & after delivery (p=0.037) but not worsening.
Do these findings also translate to⬇️pain/improved QOL?
#ACR23 ABST0513 @RheumNow https://t.co/s6xD2CaPwn
sheila ( View Tweet)
In a subgrp analysis of the SURPASS study by Dr @XBaraliakos et al, there was low spinal prog over 2 yrs in SEC & SDZ-ADL treated pts regardless of +/- Synd/⬆️CRP
Synd+ > CRP+ as predictor of radiog prog
Again, early dx = early tx
#ACR23 ABST0522 @RheumNow https://t.co/fGF4szPJbp
sheila ( View Tweet)
Tofacitinib efficacy and safety in axSpA pts by baseline CRP levels
Elevated CRP pts with higher response in ASAS20, ASAS40, BASDAI50, etc.
AE trended higher in normal CRP pts taking Tofa compared to placebo
@RheumNow #ACR23 Abs#0518 https://t.co/nbiD36x1Pa
Robert B Chao, MD ( View Tweet)
Long term safety data for bimekizumab (IL17i) in Psa & axSpA
Overall as expected; increased infections (esp fungal/candida) & hepatic events
No new signals... uveitis flares is interesting
Need H2H of IL17's! IXE vs SEC vs BIM
@RheumNow #ACR23 Abstr 0511 https://t.co/pBqly2JylA
Mike Putman EBRheum ( View Tweet)
Does pregnancy affect axSpA imaging?
Large study of 381 pts, in the DESIR cohort, f/up of 5 years.
Pregnancy did not aggravate imaging of axSpA women compared to prior to pregnancy.
@RheumNow #ACR23 Abs#0513 https://t.co/eeGuxGGB5E
Robert B Chao, MD ( View Tweet)
Difficult to treat D2T-axSpA (failure > 3 biologics), affects one in five patients exposed to b/tsDMARDs in this national registry. D2T is more common in women, presence of peripheral involvement, psoriasis, depression, Fakih O Abst#0514 #ACR23 @RheumNow https://t.co/OoymZzzQST https://t.co/EpTqS1C61A
Dr. Antoni Chan ( View Tweet)
Love teaching about the PsA-AxSpa-IBD venn diagram of disease manifestations
Interesting idea, using fecal calprotectin to trigger colonoscopy in pts w/PsA/axSpA
~40% w/pathologic finding, 4.4% dx w/IBD
Jives w/my clinical experience
@RheumNow #ACR23 Abstr0495 #ACRBest https://t.co/rIQpJnup9v
Mike Putman EBRheum ( View Tweet)
A possible curative therapy of an autoimmune disease via selective depletion of a TRBV-defined group of T cells. This could be potentially applicable to other HLA-B*27-associated spondyloarthropathies. Year in review, Seo #ACR23 @RheumNow https://t.co/NxxkpJhweH. https://t.co/41Po5CHid3
Dr. Antoni Chan ( View Tweet)