Prolonging the Controversy of Hydroxychloroquine Dr. Kathryn Dao (@KDAO2011 ) shares several abstracts from #ACR21 that addressed the topic of HCQ and cardiovascular safety. https://t.co/J6sVzYJkUZ https://t.co/dBZmtwQ927

• https://bit.ly/3wyEJTb

COVaRiPad study - Immunosuppression affects COVID-19 vax Ab levels. 247 pts, 90% seroconverted but @ reduced (3.4 fold) titers. Lowest w/ MMF (21x) and B cell Rx vs MTX/AZA (3-4x). Pts on B cell therapy should wait 6 mos to recv vax #ACR21 Abstr# 0457 https://t.co/1gkCsJSDBk

KEEPsAKE trial 1 (DMARD-IR) and 2 (DMARD/biologic-IR) on risankizumab (IL23i) for PsA: 👉phase 3 DBRPCT 24 weeks 👉150 mg week 0,4, 16 weeks 👉improved ACR20,ACR50,ACR70 👉improved PASI90 👉improved HAQ-DI 👉no increased safety signals #ACR21 Abstr#0438 #Plenary @rheumnow https://t.co/ioIBXgV4Hi

ARIAA study of abatacept in pre-RA. Abatacept ⬇️MRI inflammation and reduces progression to RA. Of course it does. Like all these studies, really not sure what this is telling us. Abstr#0455 #ACR21 @RheumNow https://t.co/yNVVZFBWDq

Prevention study using Abatacept in 100 patients with arthralgia is superior (61%) to placebo (31%) in improving subclinical inflammation in RA at-risk patients (ACPA+, MRI+, Arthralgia+) at 6 months. No new safety issue emerged @RheumNow #ACR21 Abst#0455 https://t.co/DoRItcHfBE

• Abatacept Reverses Subclinical Arthritis in Patients with High-risk to Develop …

ARRIA Study: Abatacept vs PBO in pre-clincial RA (N98) pts x 6 mos. Showed ABA prevented arthritis (8 vs 35%), improved MRI inflamm (61 v 31%), fewer D/C (14 vs 43%) - all signif. Further FUV 12 mos off therapy still significant at 18mos #ACR21 Abstract 0455 https://t.co/ZxFUj6KfLT

#ClinicalPearl What lasts longer/⬆️retention in sero+ RA: Abatacept or TNFi or JAKi? #ACR21 abst#0463 @RheumNow Adjusting for confounding incl line of Rx / past bio Rx, #abatacept wins. But data not stratified for bio naive or exposed. Not sure if that would alter results https://t.co/1dEQncwPQF

#ClinicalPearl Leflunomide for chronic CMV retinitis failing antiviral Rx? Suppresses inflammation & Arava May have antiviral properties. Didn’t know it. Kolfenbach & Palestine 6S117 eye opening experiences #ACR21 @RheumNow

#ACR21 Abst#0290: Ever wonder about other predictors of mortality in pts w/ RA-Lung Disease besides ILD (OR 2.3) or older age? ⭐︎ ↑ mortality associated w/ pleural effusions (OR 3.3) AND, notably... ⭐︎MTX use was protective (OR 0.4)!!! @RheumNow https://t.co/KKRkQVY2pf https://t.co/JsU2Rqzi6R

• Developing a Score to Predict Preclinical Interstitial Lung Disease in Patients…

Abst0242 #ACR21 @RheumNow FROST: 1st line Rx of SJIA 73 pts. two study arms: biologics & GC/MTX arm. In biologic arm 14% IL-1i switched to IL-6i, 0% from IL-6i to IL-1i. 50%GC/MTX eventually initiated biologic therapy . 57% of pts d/cGC use, and 75% had cJADAS-10 score ≤ 2.5 https://t.co/vH0AnocTr2

Is holding MTX during breastfeeding overblown? @MotherToBaby data showed that infants get 0.4% of mom’s dose 24 hrs post-MTX dose. Skip breastfeeding 1 day post-MTX may be safe. Consider monitoring infant CBC. Studies needed to follow infants longitudinally #ACR21 @rheumnow https://t.co/ikJvkk5BjI

Dr. Chambers review @MotherToBaby prospective data on HCQ use in pregnancy (n=279): 👉no major defects (regardless of dose) 👉no oral clefts 👉SGA slightly lower in exposed group b/c of underlying dz 👉no case of retinopathy in babies after 1 year f/u @rheumnow #Pregnancy https://t.co/vw2eryFgro

Despite >20y of bDMARDs, our patients still have a 50% greater risk of cardiovascular issues (similar to family history or abdominal obesity) Cardiovascular disease in RA is not historic, it's today's reality we too often ignore. 2020 data @VUamsterdam #ACR21 ABST0286 @RheumNow https://t.co/Az4wHNUOGe

Abst#0268 ➡️Do lipids change w/ some bDMARDs in RA? YES! ⭐︎ TCZ: ↑ TC, LDL, TG & ↓ in hsCRP relative to initiating TNFi. ➡️Does this lipid ↑ confer risk for CVD? Not necessarily as it may not be atherogenic per Reynolds Risk Score! #ACR21 @Rheumnow https://t.co/Gy62mg6GhZ https://t.co/5uC8Zy0Lbr

• Effect of Biologic Agents on Lipids and Cardiovascular Risk in Rheumatoid Arthr…

Dr. M Clowse (on HCQ during pregnancy): 👉All pregnant women get HCQ 400 mg/day regardless of how big they are (she does not dose based on mg/kg/d) 👉with maternal metabolism/volume distrib, levels are low. #ACR21 @rheumnow #pregnancy @drbags71 https://t.co/dZtFLdKOvk