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Day 1 Report from ACR21

The first full day of Abstracts and Presentations from ACR Convergence, the 2021 Virtual meeting, was full of highly engaging sessions, quality posters and unique presentations.  To hear more about the best of the best, I would encourage you to look at our Day 1 Recap Video and Day 1 ACR Best Abstracts. Here are a few of my favorites from the first day.

Treating Pre-Clinica/Subclinical Arthritis with Abatacept

Abstract 0455 – Preclinical RA remains a questionable challenge – who will progress to RA?  Can you prevent this?  Who should be treated? Who should get DMARDs?  This prospective trial evaluated the intervention of Abatacept vs. Placebo in at-risk individuals with arthralgias, ACPA+ test and inflammation on MRI.  100 patients were recruited and 98 were treated. Patients were 70% female with mean pain scores of 4.2/10, TJC=3 and no swollen joints.  After 6 mos. ABA clearly showed an advantage.  The primary endpoint was improvement in MRI inflammation (RAMRIS scoring of synovitis, tenosynovitis and osteitis) 61% ABA vs 31% PBO.  New onset RA was less with ABA (8% vs 35% PBO). There were also more dropouts in the PBO group.  After 6 mos of blinded treatment, everyone went off DMARD (ABA) and 12 mos later there was still more RA in the PBO group (data not shown).  This early trial suggests ABA intervention in those with subclinical arthritis may may prove useful in preventing or delaying RA onset.

Blood Brain Barrier and Cognitive Dysfunction in SLE. 

Abstract 0456 – Dr. John Hanley presented his research with on 149 SLE patient who were assess for BBB leakage, functional brain abnormalities (by rsfMRI) and Cognitive dysfunction. Overall he found cognitive dysfunction in 48% of SLE patients – yet few of them had been previously diagnosed with neuropsychiatric SLE. Moreover cognitive dysfunction correlated with functional MRI abnormalities and BBB leakage. These data suggest a higher than expected amount of CNS dysfunction in lupus and that further study on this is needed.

IL-23 Inhibition Works in Psoriatic Arthritis (PsA)

Abstract 0453 – The results of the phase 3 trials (KEEP-sAKE 1 & 2) were presented and shows that 1407 active PsA patients (failing either a DMARD or biologic) were treated with RIZ or PBO.  At 24 weeks  RZB had better ACR20 response rates (55% vs 31%) compared to PBO (P  < 0.001).  Minimal Disease Activity was also superior with RIZ (25% vs. 11%).  IL-23 targeting appears to be as effective in PsA as it is in Psoriasis.


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