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    Chronic low back pain is a common complaint that brings patients to the doctor’s attention. Although the majority of low back pain is mechanical in nature, an important minority is inflammatory in nature. Therefore, prompt referral to a rheumatologist is warranted particularly in the presence of other features suggestive of axial spondyloarthritis (axSpA).
    Drs. Jack Cush and Arthur Kavanaugh discuss highlights and key takeaways from ACR 23.
    While there wasn’t much original new programming and research presented on the final day, that didn’t slow the RheumNow faculty from tweeting the noteworthy “Best of ACR” abstracts. Enjoy these below.
    Since chronic kidney disease is one of the strongest CV risk factors, any new strategy to reduce proteinuria and avoid a decline in renal function may likely improve patient outcomes. In large cardiovascular outcome trials, the use of a fairly new-kid-on-the-block therapy, sodium–glucose cotransporter-2 inhibitors (SGLT2i) appear to be both cardio and renal-protective. Would the use of SGLT2i have the same impact in SLE?
    The last day at ACR23 was a ghost town as most left, largely because there was limited programming on the fourth and final day. The main attraction on Day 4 was the late-breaking abstract – oral presentations.  Here’s a list of the late breakers; below, I provide commentary on the ones that caught my attention.
    We have known about the VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome for nearly 3 years, but there has been relatively little to say about how to treat it. To date there have been over twice as many publications about VEXAS (263 publications) as there have been patients described with respect to treatment strategies (116 patients). One of the late breaking abstracts may finally have rectified this imbalance.
    Should rheumatologists be counseling patients on cervical cancer prevention and screening? The data from Abstract #1479 at ACR Convergence 2023 suggests that this should be an important conversation with our female lupus patients.
    These year’s annual ACR Convergence has been a success with the return of an insanely active Poster Hall! F2F learning amidst miles of research and many young talented aside wizened establish presenters is such a welcome return to ACR, the way it should be.
    For as long as I can remember, methotrexate has been the anchor drug treatment of rheumatoid arthritis. We also know it has limited oral bioavailability at doses greater than 15mg. There are subcutaneous forms that offer better bioavailability, but its subcutaneous nature can sometimes sway patients away from trying it in addition to its higher cost. Split dosing of methotrexate can be a solution to attain higher bioavailability; however, its
    Today was a big day for the Plenaries, Curbside Consults, ACR Business meeting (and induction of our new ACR President Dr. Deborah Desir) and Late-Breaking Posters. Our hot-button reporters have compiled these #ACRbest abstracts for you! (November 14, 2023 at #ACR23)
    Acute anterior uveitis is the most common extra-musculoskeletal manifestation in axial spondyloarthritis (axSpA) affecting up to 50% of patients in some age groups. AAU can have a significant impact on quality of life with risk of permanent visual deficits if not adequately treated. 
    In Abstract 0850, Dr. Andrea Fava from Johns Hopkins presents research on the value of urinary biomarkers as measure of intrarenal inflammation.
    The American College of Rheumatology guidelines for the diagnosis and management of interstitial lung disease, which includes rheumatoid arthritis interstitial lung disease (RA-ILD), has been one of the most controversial topics in the runup to ACR Convergence.
    Over the years of navigating the annual meeting, I found the sessions with the most impact to my practice were the Plenary Sessions. During these sessions, the latest research is presented, new ideas are floated, and old myths debunked. Here are the top ACR2023 Plenary abstracts I found impactful for my practice.
    Guidelines (ACR/EULAR/GRAPPA) for the management of psoriatic arthritis (PsA) recommend the early referral of patients with the suspected condition for early assessment and treatment. There remains a diagnostic delay of 1-2 years in PsA and ideally treatment should be commenced within 1 year of symptom onset. How early is early in PsA and is there a window of opportunity for treatment in PsA to ensure optimal outcomes?