RWCS Highlights - Day 1 Save

The 2021 Rheumatology Winter Clinical Symposium (RWCS) launched yesterday as a hybrid meeting. Led by exceptional teachers and researchers in rheumatology, this live and streaming conference had many highlights and takeaway messages.  As always, this conference lends itself to data for the practical clinician. Here are my pearls from several sessions on Day 1.

Rheumatology 2020: Year in Review. New developments in Rheumatoid Arthritis - Drs. Jack Cush and Artie Kavanaugh

• PREDICT-RA: No way to predict which RA patients will sustain remission after tapering off ADA
• Retuerto et al, ACR #818 small Spanish study detailed switching between JAKi likely efficacious and safe 
• Rogier, et al, ACR #481:  Most ACPA negative patients with subclinical synovitis do not develop inflammatory arthritis and we should not use subclinical synovitis to initiate treatment in this population 

Checkpoint inhibitors – Eric Ruderman, MD

• Roberts, et al, Autoimmunity Reviews, 2020 showed that treatment of irAEs does not worsen ICI efficacy nor worsen underlying malignancy 

IV IgG – Anna Postolova, MD

• IVIG can potentiate corticosteroid response. (Salmum MN, J Allergy Clin Immunol. 1999 May;103(5 Pt 1):810-5) 
• Check IgA, IgE, and IgM prior to starting IVIG and consider checking pneumococcal, diptheria, and tetanus titers. Patients who are devoid of IgA can rarely experience anaphylaxis due to IgE antibodies against IgA. In those patients consider subcutaneous IG. Dr. Anna Postolova