For rheumatologists, instinct says in RA everything’s better with MTX. For tofacitinib, where immunogenicity not an issue, is that actually true? Canadian registry data: maybe no after 36m, low no. ?valid, markups mine Need to see more of this! #ACR21 ABST0827 ⁦@RheumNow⁩ https://t.co/VVwd4SZgVx

Dr. Thomas reviews risk for progression to RA 👉+ACPA (9% risk) 👉1st degree relative 3-9X risk 👉70% risk in 5 years of both are true!👈 #ACR21 @rheumnow https://t.co/y5eUyacBFT

An important message from Dr Ranjeny Thomas on #RA #disease control: "Patients can have a significant impact on the control of their disease, and the interventions we recommend need to be personalised to their resilience ability." #ACR21 @RheumNow https://t.co/h63uz5kfU8

Booking regular clinic visits for controlled RA pts - can we be more efficient? 12m RCT Self-monitoring app, supported self-initiated care only one scheduled follow-up visit controlled RA pts DAS28/pt satisfaction same visits/y: 1.7 vs 3.0 @reade_020 #ACR21 ABST0830 @RheumNow https://t.co/600XTKo9GM

Risks for RA: - chromosome 6 has HLA risk genes encoding HLA-I and -II - HLA-DRB1 *04:01 and *04:04 stonrgly assc w/ RA in white Americans/Europeans - the Shared epitope increase risk for RA & severe disease; high assc with ACPA+ Protective➡️HLA-DRB1*13:01 @rheumnow #ACR21 2/2

Chances for RA if a family member has RA? Dr. B Masri reviews familial studies: 👉person w/1st degree relative w/ RA has 2-4 X risk 👉Multigen study standard incidence ratios: 3.02 child, 4.64 siblings, 9.31 in multiplex family, 6.48 twins, 1.17 in spouses #ACR21 @rheumnow 1/

Dr. Ranjeny Thomas on preventing RA: 👉60% genetics/immunopathogenesis (noncontrollable factors) 👉40% lifestyle modifications: healthy diet, healthy weight, avoiding tobacco, reduce occupational exposure, improve exercise/sleep, decrease stress. #ACR21 @rheumnow 1/2 https://t.co/eoh3kcekR8

Dr. R Thomas: current studies on prevention of RA: 👉oral DMARDS (MTX, HCQ) 👉biologics (RTX, abatacept) 👉 studies regulating T cells to restore tolerance 👉biomarkers of tolerant state & look at people who don't develop RA 👉 imaging as window of subclin dz. #ACR21 @rheumnow https://t.co/5bsu5459az

#ACR21 Abs#0818: Starting biologics in moderate vs severe RA activity: ▶️ Moderate disease activity: more likely to reach LDA, remission ▶️ Severe disease: greater overall improvements, but less likely to reach remission https://t.co/9jBtN9wUGF @Rheumnow

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So it's day 2 at #ACR21, and you know what that means - it's ORAL Surveillance day! This is the figure everyone will be talking about, leading up to details in the plenary. Why are the other bars higher than the pink bars? ABST0831 plenty of @RheumNow coverage coming on this https://t.co/B80cSmhNV7

Abst#0788 #ACR21. Forgot to measure vitamin D? ▶️ Red cell distribution width (RDW) inversely correlates w vit D 25(OH) levels prior to MTX ⭐️ RDW ⬆️ after starting MTX, no longer correlates https://t.co/b5EPDmGE18 @Rheumnow https://t.co/cNN14ErOmF

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ORAL Surveillance In mod-severe RA pts >50yo, with CV RF & no hx malignancy, patient-years of exposure required for one event (vs TNFi): MACE tofa 5mg bid: 567 tofa 10mg bid: 319 malignancy tofa 5mg bid: 276 tofa 10mg bid: 275 #ACR21 ABST0831 @RheumNow https://t.co/9vyXPTMFzj

• Safety and Efficacy of Tofacitinib vs TNF Inhibitors in RA Patients Aged 50 Yea…

#ACR21 Abst#0793. Japanese multicenter US cohort (KUDOS) study, looked at difficult to treat (D2T) RA pts ▶️ 1/5 pts are D2T (fail 2+ b/tsDMARD, mod disease or GCs) ⭐️ Contributors of good outcomes: IL-6i (OR 9.6), concomitant MTX (OR 7.1) @Rheumnow https://t.co/9YSa4ebQlR

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Greater #comorbidity burden is assoc. w/ worse improvement and disease activity in 1st yr of treatment in ERA @earlyarthritis. Comorbidities esp affect SJC and patient and physician global assessments. #ACR21 Abs#0798 @RheumNow https://t.co/02BRqYp9Yk

• The Impact of Comorbidities on the Simple Disease Activity Index (SDAI) and Its…