Much has been written about tapering medications in rheumatic diseases, often due to high costs of medications, a desire to avoid side effects and patient preference to take less medications (especially if they have side effects). This is countered by something we all know: medications not taken don’t work, and those that are frequently missed may not provide optimal outcomes for the majority of patients.

While COVID vaccination and subsequent booster remain the cornerstone, pre-exposure prophylaxis such as Evusheld (tixagevimab and cilgavimab) has been approved by FDA in December 2021 and EMA in March 2022 for people immunocompromised either due to a medical condition or receiving treatment with immunosuppressants and may not mount an adequate immune response to COVID vaccination. How does this therapy fare in RMD patients?

Is there finally something new on the horizon in Sjogren’s syndrome? 

The masses have returned to ACR22, a live, face-to-face, and virtual, meeting that began Saturday in Philadelphia. There were hassles and glitches, yet the education and sessions were as you’d expect with many good presentations worth recapping.

Once in a while, I find an abstract at the ACR meeting that can potentially save lives and be implemented in practice now.   In Abstract #0939, Dr. J Patricia Dhar and colleagues shared data from a pilot study examining a new method to monitor cervical health in African American Women with Systemic Lupus Erythematosus (SLE) using a self-sampling brush to assess cervical cytology and human papilloma virus infection.

Data presented at ACR22 shows that cycling through TNFi in axSpA patients with primary lack of efficacy with first line TNFi has limited additional benefit in controlling disease. 

Interstitial lung disease (ILD) remains a leading cause of mortality in rheumatoid arthritis (RA). Estimates of involvement of ILD in RA remain relatively imprecise (estimated prevalence 5-20%), though this partly reflects the wide spectrum of ILD and differing ascertainment.

The ability to prevent RA in individuals at risk is a holy grail in rheumatology. There is a long history dating back to the PROMPT trial of methotrexate and PRAIRIE trial of rituximab. Both otrials showed an effect, but it seemed more likely to be a delaying of RA than prevention or modulation. Framing it another way, there were better outcomes in pre-RA because we were actually treating RA as it emerged with a proven effective treatment. It is

Minimal Disease Activity criteria are used to evaluate PsA disease activity and response to treatment. Given that a patient only has to meet 5 of the 7 criteria, should the individual components be weighted equally? 

The RheumNow faculty reporters have been scouring the meeting and online presentations to find the best abstracts from ACR22. Here are some of their choice abstracts reported today on day 1 of ACR 2022 (#ACRbest).  

It’s widely accepted that Psoriatic disease has multi-system, multi-domain potential that can lead to life altering complications if left untreated or undertreated. Rheumatologists have shifted the way we discuss treatment options and disease state expectations with patients. Two #ACR22 abstracts stood out to me regarding the Psoriatic disease patient experience and will, ultimately, add to what I do in clinic. 

Is patient-administered cervical cancer screening an option for women with SLE? Should I prescribe estrogen containing contraceptives to SLE women with APL antibodies? What complications should I be aware of in pregnant women with SLE? Here are three abstracts that provide insight.

Rheumatoid arthritis is known to be associated with a higher risk of infections. In abstract 0535, Porter and colleagues have assessed infection rates in the pre-RA and early RA phases as defined by antibiotics prescription and hospital admissions with an infection main diagnostic code in the UK National database.

In abstract #0327 presented during the poster session on Saturday, Dr. Ai Li Yeo and colleagues investigated the usefulness of serial anti-dsDNA testing in predicting flares among SLE patients who have persistently positive anti-dsDNA titers. 

Today's plenary session features a novel proposal on how and which patients with Idiopathic Inflammatory Myopathy (IIM) should be screened for cancer.  Abstract 0002 by Oldroyd et al, entitled "Cancer Screening Recommendations for Patients with Idiopathic Inflammatory Myopathy" took on this thorny practice issue.