RheumNow - ACR 2017 San Diego - Day 1 Save

Hey. I'm Jack Cush. I'm coming to you from ACR seventeen in San Diego. It's already shaping up to be a big meeting. This is the first day, day one, Sunday morning.

The exhibit floor hasn't yet opened. I'm here in the room now booth. And I'll tell you that there's a lot of exciting stuff at this year's meeting. In biologics, there's gonna be new biologics, new p nineteen inhibitors, rizan kizumab. There's gonna be new studies on pregnancy in AS and SPA.

There's gonna be new studies about baricitinib and filgotinib and other of the JAK inhibitors. There's a mesenchymal stem cell vaccine that's gonna be covered. There's new research on osteoarthritis, and gouge is gonna be a prominent area. I think there's gonna be a lot going on still in RA and PSA and ankles and spondylitis. Again, we're gonna have a lot of reports this year from our faculty.

We're covering the meeting both with short little snippets of information that you'll follow on our social media feed, and, they'll have pictures and citations for you. We'll have articles. We'll have videos from, leading authorities and from the RheumNow There'll be plenty of them, covering all areas from education to pregnancy to ankylosing spondylitis to gout and psoriatic arthritis. I think you'll be excited. If you're here at the meeting, come by the booth, pick up a RheumNow mouse pad, some gout stop cards.

Great. And then lastly, the RoomNow pen. It's killer. This year, it's green. See you tomorrow.

Terms of broader issues in rheumatology, but also very narrow specific issues in rheumatology. So very helpful. Very individual things, updates on even somewhat arcane things that you wouldn't think of. So it's very valuable both in terms of broader issues in rheumatology, but also very narrow specific issues in rheumatology. So very helpful.

Good morning, everyone. I'm Olga Petrina. I'm reporting from annual ACR meeting here in San Diego. Today in the morning, I walked by Poster Hall and noted two very interesting posters presented by Hospital for Special Surgery. Both of them are talking about the outcome in total knee replacement and hip replacement surgery and the role of socioeconomic factors in the outcomes of the surgery.

So I'll start with poster two twenty, which evaluated the role of English proficiency in the outcome of the knee replacement surgery. And interestingly, in the beginning, at the two year follow-up, as well as the initial assessment, patient with low English proficiency tend to have worse pain scores prior to surgery and after. And after additional analysis and adjustment of factors, the number was not statistically significant. Similar findings were found in a poster 02/21 presented by the same group of physicians where they evaluated the role of immigrant status on the outcome of the same kind of surgery. So they evaluated patients in communities with high amount of foreign born residents in in the community.

And what they found is that their foreign born status was not statistically significant in the outcome of the knee replacement surgery where female gender was and the level of education seemed to play a role. So all in all from both posters, researchers concluded that social factors contribute to the outcome of surgery and they affect pain scores, but there has to be more to it than just the foreign born status or language proficiency, and those community communities need to be evaluated for other factors that contribute to those outcomes. Thank you. If you want to learn more, please follow us on roomnow.com, and have a nice day. Okay.

Good morning, everyone. I'm Olga Petrin. I'm reporting from the annual ACR meeting in San Diego. This morning in a poster hall, I came across an interesting poster presenting frame two study results, which compared Rimusuzumab to Alendronate in terms of efficacy and safety. And although Rimusuzumab performed very well in terms of efficacy, where patients with severe fractures had much higher increase in bone density over time in the Rimosuzumab treatment group with 15.2% increase in BMD comparing to only 7.4 increase in alendronate group.

But the concern in the studies was something that hasn't been seen in the previous Rimucizumab studies, and that was a higher risk of cardiovascular events. So in general, the incidence of cardiovascular events and ischemic cardiovascular events was significantly higher in ramucizumab group as opposed to alendronate. This was not observed in a previous phase two trials of Rheumatuzumab, and those results require future evaluation for safety. Thank you. If you would like to know more, please follow us on rheumnow.com, and have a nice day.

Hi, I'm Paul Supka. I'm coming from St. Paul, Minnesota. I'm a rheumatologist that's fairly active on Twitter. You can follow me psupka if you'd like.

I just want to plug that we have the ACR annual tweet up today at 04:30. I am involved in things like the Rheumatology Journal Club on Twitter, which is roomjc.com or roomjc. If you want, follow me along on Twitter, and I'll be mentioning a bunch of things that are relevant to tech in rheumatology and medicine over the next few days and just a whole bunch of various other social tweets. Thanks, and, talk to you later.

You know, man, they they wanted to meet you.

Hi. This is Artie Cavanagh, and I'm at the ACR meeting this year in San Diego, my hometown. Very exciting. This is really the first day of the main part of the meeting. A lot of posters today.

800 posters in the poster area. I tried to see a lot of them. I have a big interest in psoriatic arthritis among other things and a lot of posters there on psoriatic arthritis, new treatments and also new outcome measures. I think the better we do with getting new treatments, the better we want to do. And that's really exciting.

So very exciting times. Just at the start of the meeting right here in San Diego, a lot more to come, lot of good lectures to come, a lot more posters, and hopefully learn a lot of things we can bring back to the clinic when we go back and take care of our patients. Artie Cavanaugh here, San Diego, for RheumNow, the ACR meeting, twenty seventeen.

Hi. I'm Cassie Calabrese here at ACR twenty seventeen in San Diego, and I just came from the first plenary session where I heard an interesting abstract presented by Park and all from South Korea with the help of Kevin Winthrop looking at the efficacy of a seasonal influenza vaccine in rheumatoid arthritis patients on methotrexate versus if methotrexate was held for two weeks after getting a dose of vaccine. It was a prospective, multicenter, randomized trial where patients were either continued on a stable dose of methotrexate for their rheumatoid arthritis or the methotrexate was held for two weeks after seasonal influenza. They looked at efficacy, fourfold rise in antibody titers after four weeks, and some other secondary endpoints like seroprotection. They found that if you hold the methotrexate for two weeks, was more effective both in rise in antibody titers and seroprotection.

I think this is very interesting and may be clinically useful for us, although they did not look at clinical outcomes, like do these patients get fewer cases of the flu? That would be certainly something we'd wanna hear about. But I think this is very useful information to us, when considering timing of giving the flu vaccine to our RA patients. If you wanna hear more, come to roomnow.com.

Hi. I'm Greg Silberman from the NYU School of Medicine, and I'm here at ACR twenty seventeen. I'm excited about my plenary session tomorrow, Monday, at about 11:30, where we're gonna discuss our work in the microbiome and systemic lupus erythematosus. It was a lot of work, hard to recruit that many patients. We studied at a genetic level all the diversity of different bacteria that live intestines of lupus patients.

We've all been hearing about how the microbiome molds all immune responses. We wouldn't have an immune system if it weren't for the fact that we're colonized. And what we discovered is that many lupus patients have remarkable distortions, dysbiosis as the phrase go, amongst the complicated communities that they have in their intestines. The take home lesson is people that had no disease activity at the time of visit, they had a diagnosis but sleet eyes of zero to two, They look like normal people with the normal distribution of bacteria. But in fact, in general, as you became more ill, your sleet eye score got higher.

You had more and more abnormalities, and you had an expansion of a single bacteria in the intestine, an obligate anaerobe called Rheumatococcus Novus. It actually is otherwise pretty benign. It's a keystone species. Everybody has it. But in fact, as you get sicker in lupus, there seems to be more and more abundance.

But even more importantly, what we found is there is a direct relationship in the levels of a IgG antibody in the bloodstream. The more of this bacteria you have, the more of that antibody response. Why is that important? Because it cross reacts with DNA. And the whole idea is we think that certain strains of this bacteria drive IgG anti DNA production, and this actually seems to only occur if you have active lupus nephritis.

We know anti DNA is a major driver. We always thought it was mammalian DNA that's driving it. Now we think it's an immune mimic, a glycan in one strain of Rheumatococcus Novus. This may all sound very complex, but it's just a bacterial response, an antibacterial response, and this is just part of a really well known syndrome. We've learned about it a long time ago.

We learned about it in second year medical school. This may just be a variant just like post streptococcal glomerulonephritis, just like post streptococcal rheumatic fever, now it appears that a first cousin of streptococci, a different kind of streptococcal like strain, Rheumatococcus, is inducing the antibodies that get deposited immune complexes in your kidneys. Kidneys. This is great news for lupus patients because we may have a more accurate test. We may understand why people transition from genetic susceptibility to overt disease and not only early detection management, how bad is your response, but this may suggest therapies where we can actively modulate the microbiome, perhaps with antibiotics, more likely just some, prebiotics.

So a lot of opportunities, so come and join me and, learn more about it at the program tomorrow at 11:30. I'm Greg Silberman from ACR twenty seventeen. You have a great day.

Hi. I'm John Goldman. I'm a solo rheumatologist in Atlanta. I'm here at ACR twenty seventeen, and I got out of a talk from Anthony Fauci last night that was just excellent. What he did is he looked at the role of infectious diseases, and he looked at them across different presidential, shall I say, terms.

He called it from AIDS to Zika, which is like from a to z. And he explained that it's important that when you're dealing with the government and with infection that you work with both sides. So he worked with Reagan, George h Bush, then Clinton, then George w Bush, and then Barack Obama. One of the things that he pointed out that the infectious emergencies in each of these terms that really came to a head was in the first year. So when he talked about AIDS, he talked about emergence of the disease or reemergence, Like, for instance, Ebola.

When Ebola came in, that was a reemergence. He talked about Zika. But what he did is he looked at these, different diseases, explained to the actually, when the Trump, group came in, he had a meeting with their cabinet, and he talked about the role of infection and the problems and what kind of issues are going on. Perhaps one of the most important points that he made is these diseases can come as emerge, can go away and come back as reemerge, And they have now been able to master doing more, shall I say, immunization or vaccinations. Initially, it would took a couple of years.

Now they're down to three to four months so that they can do something to basically help prevent some of these illnesses. So these are very important. He uses a map. He said the first time he used the map of the world, the only thing he had on there was AIDS. Now this map is loaded with all kinds of infectious entities from all over the the world.

And what he tried to do is to make an analogy. During Reagan, it was HIV. During George Bush, it was another. During Clinton, it was another. Then with Obama, you had the Ebola.

So each and Zika. So these things came up, and they need to be identified in the cabinet that he presented to. He made it a really clear, very simple, well managed talk to help explain how these illnesses can affect the country.

Okay. Hi. I'm doctor Rachel Tate from Arthritis Care and Research Center in Dallas, Texas, and I'm coming to you from ACR twenty seventeen in San Diego. One of my favorite parts of this conference is getting to know the bright and burgeoning stars in rheumatology. And one of those people who is right next to me, Doctor.

Brooke Mills, is one of my favorite people who's presented an amazing abstract, number three fifty five on rheumatology.org. And she's going

to tell us a little bit about what she presented today. Hi Brooke, thanks for joining us. Thank you Doctor. Tate. So our study focused on two things.

One, it focused on the perception and attitudes of all women with rheumatic diseases towards pregnancy and lactation. Secondly, we wanted to look at specifically lactation and how lactation affects the rheumatic disease activity and vice versa. And lastly, we wanted to look at how women who breastfed on DMARDs or biologics did and what their outcomes their outcomes of their infants were. So what we did was we sent out a survey and it consisted of two parts. Part one focused on our first objective and part two focused on our second objective.

And what we found was that as far as part one goes, over fifty percent of women negatively changed their views on pregnancy after disease diagnosis. A third of women negatively changed their views on breastfeeding after diagnosis, and thirty percent of all women decided not to have kids altogether after they are diagnosed with the disease. When we asked them why and what their main concerns were, we found that sixty seven percent of women were most concerned about medications that they would be taking during pregnancy and lactation affecting their babies. And so we want to open this up to better education for our patients in regards to this topic. And as far as lactation goes, we found that, we were able to survey women before and after disease diagnosis, and we didn't find any difference in the ability to breastfeed or duration of breastfeeding in women before and after disease diagnosis.

And lastly, we had 19 women breast feed 22 babies on a DMARD or a biologic. And we're currently in the process of getting the pediatric records of the children that they breast fed. And that is our plan registry that you're asking me about. And so far, and what the data that we have of these 22 babies, we don't have any delay in milestones and we also don't have any increased rate of infection in these babies.

Brooke, thank you so much. I think this shows you that there's a lot of education for all of us to be had in the future And I really appreciate you coming by the booth and saying hi. So there's more to come from ACR twenty seventeen in San Diego. Check us out at roomnow.com. Thanks again.

So I'm Catherine Dow. I'm from Dallas with the Baylor Research Institute. I'm partners with Jack Cush, survived this long after fifteen years, but I wanted to report to you live now from the ACR meeting in San Diego. And I'm excited to share with you. There's actually three abstracts that I'm not sure if you've encountered or not but the first one is an abstract that is a collaboration, multi center collaboration between Canada, McGill University as well as with Cedars Sinai in New York.

What they did was follow patients for ten years with early, arthritis. This is their ERA clinic, early rheumatoid arthritis. They followed these patients as to whether or not they received oral methotrexate monotherapy versus methotrexate sub q injection versus methotrexate plus a DMARD or methotrexate in triple therapy. And they wanted to see the duration of therapy that when patients were initially initiated will survive. Meaning not survival in terms of, survival of therapy where they have to change therapy or they have to add on therapy and what they found is that patients who were started initially on oral methotrexate actually, did worse compared to starting patients on sub q methotrexate or combination DMAR therapy.

Take home message here is if you're going to start a newly diagnosed rheumatoid arthritis patient on methotrexate, do sub q or combination therapy. And then, should I start for another one or just go ahead?

Alright. So give me a favor and say, for more information, go to rheumnow.com, and I'll be reporting on other things and see if

Oh, okay. I can go on with my next stat. And another That'll work. Wanna cut it? Definitely.

Yeah. Okay. You wanna cut it.

So Alright. Sign off by saying there's we got more information on this subject and others. Rheumnow.com. Check it out.

Fact, doctor Bikirk is gonna present her data tomorrow around 02:30 on more of this topic. And if you really want more topic and you want to read my blogs and you want to follow my tweets, go to rheumnow.com. So this is Doctor. Catherine Dow from Dallas, Texas here in San Diego at the ACR twenty seventeen meeting. I've encountered quite a few abstracts that I found very interesting.

One of them is by Doctor. Eric Mathis from the Mayo Clinic and what he did was he followed a group of polymyalgia rheumatica patients, over 300 of them, and wanted to see what the duration of steroids are that patients are going to require and also the dose. And what's so interesting is, like in clinical practice we typically tell patients, well, around two years should be on steroids, but patients end up having a lot of relapses. So actually this confirms our suspicion that patients with polymyalgia rheumatica actually requires longer periods of therapy. In fact, the majority of patients end up discontinuing therapy permanently at around six years after starting prednisone.

And what's interesting is that the median time it takes for patients to go to five milligrams a day is about one and a half years so that's about what I see in my own practice as well and really when you compare patients on steroids versus those who are not on steroids and this is just a general cohort, the amount of steroids that these patients are on did not increase the rate of fracture. Now I don't know whether or not these patients were prophylaxed with a bisphosphonate to prevent fracture or not but they also didn't see an increased rate of infection, hypertension, hyperlipidemia or diabetes and the only thing that they did see is that there's an increased risk for cataracts with a hazard ratio of one point seven two. Taking from this, I will tell my patients that it's going be an average of five to six years before patients can get off of steroids, and so that they don't keep bothering me and saying, Hey, Doc, when am I going to get off the steroids? So this is Catherine Dow reporting for RheumNow. Come visit our website to learn more about this study.

Okay. Hi. My name is Philip Robinson. I'm from the University of Queensland in Brisbane, Australia. I'm here at ACR here in beautiful San Diego.

I just came from a great session. Three great speakers, Ruth, Minkin, John, Pauling, and Chris Denton, talked about the vascular complications of scleroderma. So first Ruth started and really talked about lung disease. And one of the really good take home points I thought that she made was when you're thinking about pulmonary hypertension, really need to think about left sided disease and you also need to think about chronic thromboembolic disease as well and do things like a VQ scan. We always get very hung up about connective tissue related disease, and that's what's that what's causing that, but we need to think about those other things as well.

And then John went on and talked about digital ulcers, and he talked about things that I wasn't aware of. Like, there were different types and different ideologies. And one of the things that I wasn't necessarily aware of was the good efficacy of SSRIs in Raynaud's phenomenon. And if your calcium channel antagonists aren't working, then there's a great thing to step onto. And then finally, Chris Denton talked about renal crisis and about the huge difference that ACE inhibitors have made.

And really interesting data in that if you present with a very high blood pressure, you actually got a good prognosis. So all of those things are really great take home points that I took from that, and I'll be taking them back to change my practice. For more information, I think you should go to roomnow.com to get lots more updates.

So my name's Erwin Lim. I'm a rheumatologist from Sydney, Australia. I just attended a wonderful lecture on checkpoint inhibitors by Doctor. Bingham. Checkpoint inhibitors are a wonderful new therapy for oncology where these new agents actually turn on the immune system to treat otherwise poorly treatable cancers.

Why is it relevant for rheumatologists? Well, by turning on the immune system, you then end up having autoimmune diseases. And these diseases cause all sorts of rheumatic manifestations, including terribly difficult to control inflammatory arthritis, sicker symptoms, polymyalgia, rheumatica, you name it, it seems to be able to create and occur. Why else is it important? It's poorly recognized at the moment, but because these agents are going to be used more and more, we're all going to need to learn how to treat these diseases.

Come back to roomnow.com for further information about ACR seventeen.

Hi. I'm Jack Cush, executive editor of rheumnow.com. I'm coming to you from ACR seventeen here in San Diego. It's day one. It's the end of day one.

Some great presentations. I wanna talk about Jeff Curtis's plenary session presentation, which I thought was really important to rheumatologists. In this presentation, Jeff talked about Medicare claims data, where he looked at women who were starting on a bisphosphonate, and they had not been on a bisphosphonate for a year before. They went on a bisphosphonate, were on a bisphosphonate for three years, and then they stopped their bisphosphonate. So the issue here is if you take a drug holiday with from a bisphosphonate, what is the fracture risk going forward?

And so he actually did this. He showed that, there was a sizable number of women. I can't remember the exact percentage, but there was a may know sixty thousand women who actually stopped their bisphosphonate. And he counted up the ones who were on one bisphosphonate alone. That was alendronate, and there was a sizable number.

And there were others that were on other bisphosphonates that they might change during the same study period. And what he showed, in following these people after they stopped for another three years that, the risk of developing a, hip fracture was up forty percent for those who stopped their bisphosphonate and were off it for two years. There was a marginal increase in hip fractures after being off for three to six months, but the real risk where it went up sizably was for those who are off of it for two years. When they looked at the same hip fracture risk only for those who were taking Fosamax or alendronate, it was a twenty percent increased risk, after being off of it for two or more years. So overall, there was, these are surprising data that if you had had a prior history of a fracture and you went on a drug holiday, you now had a two hundred percent or doubling of your risk of subsequent fracture.

The overall rates for all major, fractures was up, I think ten percent for all patients considered in this study. So I I this is sort of, I think, sobering data, for those patients who want to go off drug, and you're gonna need to counsel them that if you go off drug, the benefits of being off may be lost with time, especially if they're gonna be off for more than a year, especially if they're off for more than two years. So that's it from roomnow.com. Tune in for more videos. Day two is coming.

See you then.

This is Catherine Dow from Dallas, Texas, here at the ACR meeting in San Diego for RheumNow. I want to share with you another study that I found very interesting and this is a study of patients who have evidence of prior hepatitis B. So this is a Hong Kong study and obviously in Asians hepatitis is pretty high and hepatitis B in particular. And what they did was they looked at a group of patients who were diagnosed with a rheumatic disease, from the period of November 2016 to April 2017. It's a perspective study and they screened patients for hepatitis.

What they found was that about thirty four percent, that's thirty four percent of patients with rheumatic disease has evidence of hepatitis or prior hepatitis. Prior hepatitis definition of that means that they're hep b surface antigen negative, hep b surface antibody positive, hep b core antibody positive. So there still is a chance for reactivation. And in fact, there was about seven percent of patients who actually had evidence of positive hep b virus DNA even though their hep b surface antibody, positive and hep B surface antigen negative. Now, the rate of hepatitis B surface antigen positivity is about three point five percent which is similar to the Japanese studies which is two point eight percent.

And what they did was that only about fifty percent of these patients with occult or carrier hepatitis B status actually received prophylaxis before starting on a biologic or a DMARD. Only fifty percent. They followed all patients out for five years and they found that actually even those who didn't get prophylaxis didn't reactivate. So that's actually very interesting because, you know, we always worry about the risk for reactivation even in patients who may not have active hepatitis b but occult carriers but this is reassuring in the fact that sometimes patients don't get screened before they get started on DMARDs and biologics but the rate of reactivation is actually pretty low. Food for thought, something to, keep in mind, Please screen your patients for hepatitis B and C before starting on the DMARD but if you let one of those patients slip by it's not going be the end of the world.

For more information look for this abstract on roomnow.com. So this is Doctor. Catherine Dow reporting for RheumNow. I'm from Dallas, Texas and now in San Diego at the ACR twenty seventeen meeting. I want to share with you just a very exciting abstract that was presented today on lupus, and this is on combination synergistic B cell depletion, B cell therapy.

So what they did was they took a group of patients. They gave them rituximab at week zero and two followed by belimumab every four weeks. They follow these patients for two years. And now you're thinking and I'm thinking, oh my goodness. These patients are on dual B cell therapy, and the cost is gonna be high, and the risk for infection may be high.

So what these investigators found was that these patients actually responded very well without any major incidences of infection. There was one GI infection that was hospitalized. However, the patient recovered and had been doing well. In addition, what they found was that these patients had lower amount of autoantibodies. They also found that there's a decrease in NET induction.

And in addition to that, they found that the amount of proteinuria had improved. Patients were able to stop. Now this has stopped mycophenolate as well as reduced their steroids. So pretty remarkable findings. Now I'm not sure if I'm gonna be able to have, insurance cover both B cell therapies for lupus patients but this is food for thought.

For more information visit roomnow.com.