ACR20 - Day 2.1 Save

This is the RheumNow podcast, and you're listening to highlights from the ACR twenty twenty virtual meeting. Our faculty reporters have been doing videos and recordings so that you could stay up to date. Hope you enjoy these and our panel discussions.

I'm Nicola Delbeth from, Auckland, New Zealand. It's really nice to be, with you again, today. So I'm gonna talk about a couple of really interesting posters, that have been presented at the twenty twenty ACR meeting, that address the uncertainty that we currently have about which advanced imaging test is best when we are, thinking about diagnosis of crystal arthritis. So the first is poster six forty seven. This is a study presented by Josefinder Singh in collaboration with Tristan Paskar.

So this is a study that compares dual energy CT with ultrasound scan, scanning for diagnosis of gout. It's a prospective study of accuracy. And in this study, they recruited, participants who had a possible diagnosis of gout, diagnosed gout using a microscopic diagnosis, so really the gold standard. And they compared a couple of, well, they had a couple of questions. First of all, which site is best to scan?

And secondly, which modality, dual energy, ultrasound, or both is better and most reliable. So really the take home messages from this study are that dual energy CT scanning of the feet and ankles had the best overall performance, that adding ultrasound, in fact, didn't have additional benefit, and also the feet and ankles are the best site, and adding in, the knees really didn't have any additional benefit. So overall, the sensitivity for dual energy CT was 87% and specificity was 100%. So the sensitivity is a bit higher than what we've seen in other dual energy CT studies. But certainly, I think in this particular study, that was very well performed, dual energy CT seems to be best, single test.

The investigators do make the point that if you, don't have dual energy CT, ultrasound is, certainly a good, alternative. The second study is, poster fifteen forty two, And this is another study that compares, dual energy CT and ultrasound. And this is a really interesting study because it's looking at differentiation between gout and CPVD. So again, both of these conditions were crystal proven, so again using the gold standard, for gout and CPPT, diagnosis. And overall what they found was that, dual energy CT again performed best for gout.

Again, kind of surprising given again what we know about ultrasound, but certainly very good diagnostic performance here. But it had a lower overall performance for CPPD, and certainly ultrasound performed much better for these investigators for CPPD with specificity of ninety percent and sensitivity of eighty eight percent. So I think the overall message here is that if you want to diagnose CPPD and you're thinking about advanced imaging, ultrasound is still the preferred option compared to dual energy CT. Of course, it's not all about diagnostic accuracy, particularly in the context of gout where, ultrasound overall, may still have very high sensitivity in particular, And we also need to think about other aspects such as ionizing radiation, and of course, ultrasound has benefits in that respect, and also convenience to the patient, the ability to scan and get results in real time. So I'm certainly not suggesting that we shouldn't be using ultrasound for gout, but certainly I think ultrasound is the preferred option for CPPD.

Thanks.

Hi. This is doctor Arty Cavanaugh coming to you on RheumNow from ACR Convergence twenty twenty. Today there was a presentation, actually at the plenary session by Peter Merkel, interesting abstract on Avacoban. Avacoban is a oral agent that blocks the C5a receptor. So it's a complement inhibitor, which is fascinating.

We've known about complement, gosh, for many, many decades. We all learned about it as we learned immunology, and we knew it was important. We measure complement levels because they're an important effector aspect of the inflammatory and immune response, but we haven't really had much to intervene with that. So, this was exciting. There is a agent approved that does target complement, and that's eculizumab.

Eculizumab is a monoclonal antibody directed at, the complement C5 protein. So Avacoban, on the other end, is an agent, an oral agent that inhibits C5a receptor. In this study, what they did is look at three on thirty patients with ANK associated vasculitis. All of them got very strong treatment with cyclophosphamide and then azathioprine or rituximab. And they looked at Avacoban compared to placebo and found a positive result.

So they had a greater chance of remission. They had a bigger increase in renal function, and overall they had lower exposure to prednisone with the use of Avacoban compared to just the prednisone by itself. So these are interesting data for several reasons. As I said, it's nice to have something that, targets complement, which we've known is an important aspect of the immune response, and, yet we have not had a way to inhibit that. I think it's super interesting to have a novel oral agent that inhibits a specific receptor.

There had been some oral agents that would, for example, inhibit various adhesion molecules, and none of them have yet come to development. But of course an oral agent has, features which would make it perhaps preferable in some cases to a parenteral agent, a subcutaneous or intravenous medication. Interesting target, a relatively novel target that's not been explored, and I would like to see the targeting of complement and how that might pan out in lupus. For example, the eculizumab is approved in paroxysmal nocturnal hemoglobinuria, in atypical, HUS, hemolytic uremic syndrome, and in NMO, neuromyelitis optica. So it's approved in diseases, and I can't imagine that we couldn't find a use in it, not only in vasculitis as we're shown in this poster, but in other diseases where we think complement mediated destruction can be important to the outcomes of the disease.

So definitely want to keep an eye on this and look and see further development of this and related agents. So this is Doctor. Ari Kavanaugh coming to you from the ACR Convergence twenty twenty on RheumNow, and we'll see you at the meeting and see you on RheumNow.

Hi, I'm Doctor. Janet Pope. I'm at RheumNow, and here we are at the ACR twenty twenty Virtual or Convergence meeting. I have with me Doctor. Dan Solomon.

I'd like to have you introduce yourself, Dan, and then I'd like to ask you as editor in ANR, really about what's going on, particularly in these strange times.

Sure. Thanks, Janet. I'm Dan Solomon. I'm a professor of medicine at Harvard Medical School and the chief of clinical sciences in the division of rheumatology at Brigham and Women's Hospital. And as you stated, I'm editor in chief of arthritis and rheumatology.

And I'm sitting in my home in Newton, Massachusetts, participating in ACR convergence.

In the comfort of your own home, like so many of our events right So first of all, I mean, this is a giant task, and I mean, you're a well known and esteemed researcher. So did you have to cut down on a lot of your other activities to be editor in chief?

Yeah, thanks for asking. I did. I actually have given up some of my other research work. It is about a 20% commitment, so a full day a week, let's just say. But it's broken up into a lot of one and two hour segments, often in the middle of the night, as you know, Janet, because I'm emailing with you.

But every day there's a flood of submissions and other work that has to be adjudicated. And so it really becomes about a six day a week effort. I try to take one day a week off.

Yeah, and that probably doesn't work. It's probably a twelve hour day off. Tell me what's going on with respect to COVID and how the journal's handling. Are we getting more submissions, less submissions? Are we getting reviewers saying, No way, I'm on a COVID board?

Or what's been happening with the metrics?

Yeah, so I think like all academic medical journals, ANR has seen a huge increase. So since COVID began about eight or nine months ago, our submissions have gone up by about 50%. So you and your colleagues who serve as associate editors are being worked hard at SMI. And occasionally, our reviewers and our associate editors are on the wards, and they say, Solomon, no mas. Stop sending me stuff.

And so we have to obviously be considerate of that. Some of the increase in submissions is COVID related. And the COVID related submissions, we've been able to adjudicate very quickly because we see them as being so important to public health that we've put a priority on them. And I often am sending reviewers and I'm sure you're doing the same notes to say, if you can't get this done in a week, just say no, and we'll go on to another reviewer. So we've really been able to stay very current with our COVID related work because we see it as so important for public health to make it happen quickly.

So a little bit of a touchy subject. We all value ANR. It is the number one ACR journal, of course. So do you think there's due process on this COVID material? Because I mean, that as an associate editor, as editor in chief, I mean, it's so important that we don't want to ever be in a we retract what's being said situation.

Yeah, Janet, it's a great question. And we wrote an editorial, which I think is now out in print, called The Infodemic. Myself and some of the deputy editors, Rick Buchalan, Peter Nygrovich, and Mariana Kaplan, describe this issue of wanting to get out quickly with science, but wanting to make sure that we're using a good review process. And we also recognize the self correcting nature of science, meaning if, for instance, something came out that wasn't quite right, there's going to be another person doing the study, and over time we will get it right. And that's part of the imperfection of our business, is that we sometimes get it wrong because of the speed, the desire to be quick.

Again, we have a full review process, but sometimes people get overenthusiastic and they don't look as carefully as they should. And that's happened. It hasn't happened, thankfully, at ANR. There's been no retractions. But we also recognize that, like the rest of the medical literature, there could be retractions.

And over time, we will get it right. And that's the beauty of science.

I think as well, science has always been an evolution. Truth is as we know it today and truth will vary as facts change too. So one final question. I know that standing at posters giving presentations, that sometimes editors or some of the editorial group will come up and say, we'd really love you to submit this here. That doesn't always happen to me by the way, but I've heard it happening to people.

Is there a negative or a drawback with the ACR twenty twenty convergence being all online to really, I guess, invite people to submit? I mean, we have tons of submissions, as you say, there are, but what's your feeling about that?

Yeah, yeah, we do target presentations to go and invite authors, as you just stated. And I'm sure that many of listeners will have had that opportunity to submit. And we invite the submissions, and sometimes we offer fast track review if it's a late breaking abstract, a late breaking trial that we want to give the author some incentive to submit. And typically, I am nudging people at their poster and sidling up to them and saying, I know you want send this to us in ANR next week. How about it?

And so this has all become an electronic invitation. So I spent a lot of the last couple of weeks looking over the program, targeting some important abstracts, trials, other presentations, and sending out emails. Our trials, our Fast Track Trials associate editor, Rich Fury, and I have been in close contact about which of those trials that we really want to target. So people will still be getting those invitations. They'll just be via email and not a personal hello and will you please submit.

So it's happening.

Right, and it is the way we're functioning. And I guess I'd like to put a plug in at ACR Convergence twenty twenty. We really do have some plenaries and late breaking that are fellows or students, PhD, elect students, and we'd invite them to submit. Submit your best to arthritis and rheumatology. Well, thanks Dan for coming on board and thank you for listening at RheumNow.

There's other great information. Go to the website. Thanks.

Thank you, Janet. Bye bye.

Hello, I'm Rinalini Day and I'm an academic rheumatology trainee based in Liverpool in The UK and I'm reporting for ACR twenty twenty for RheumNow. And today I'm delighted to be joined by Doctor Marwan Bukhari, who is editor in chief of rheumatology, which is the official journal for the British Society for rheumatology. So thank you for joining us today, Doctor Bukhari. So first of all, I was wondering if you could just tell us a little bit about the ways in which the journal has had to adapt due to Covid-nineteen, for example, due to trials being put on hold and such like.

Hi, thank you very much for the opportunity to give us a chance to chat about the journal and what we've been doing throughout the pandemic. It's been an interesting time for us. The first thing that has happened is that we've had an increase of almost 150% of submissions in the year and it's obviously been quite an interesting time because a lot of people have had some time in their hands, they've been less busy socially as they have been in the past, and they've been putting quite a lot of papers through. There's also been a big sense of urgency because we don't know how COVID affects our patients with rheumatic diseases that there's been a lot of urgency about doing very quick studies, which might not necessarily have been thought through that well, from around the world looking at different cohorts with very small numbers rather than amalgamating patients, so it can actually have meaningful figures. The journal itself, we've had problems in that we're obviously not at the meetings, we're not promoting the journal at the meeting.

So currently, I am sat in Lancashire rather than being in Washington at the ACR, we're all at the convergence, but we're all sort of like chatting to each other on here. And the opportunity to look out for what's new on commission editorials and commission reviews has been a problem. For running the journal itself, we've actually been doing okay because we've got an international editorial board. And so our editorial board meetings because they're being run remotely. We just had to be very careful in putting the timings so that it's the right time for here across The Atlantic in The Pacific and in the Antipodes trying to get all these time zones to actually attend the same thing can be challenging.

The trials have been put on hold. So we were expecting that some of the bigger trials would be coming our way and would be reported. But I think a lot of the investigators have been taken into trying to do COVID type research. And so we were expecting by now to have had quite a lot of papers coming out of some of the trials that would have heard about in the meetings, but we're still not seeing them and we're not seeing them in print as yet, because a lot of the publishing world really has gone to COVID and that's all that reporting on this has happened in COVID. And there's been a variability in the quality of the COVID research that's been done, but we should watch the space.

Great. And then how

do

you think COVID-nineteen has had an impact on the rheumatology literature in general, particularly from what you've seen? You've touched on it a little bit.

So Covid-nineteen itself has impacted because there's a perception out there that if they put COVID-nineteen into a paper, it suddenly becomes a much more interesting paper that will be read a bit more. And the fact of the matter is if it's a paper that's basically been around for a while, putting Covid-nineteen on it won't really make it that much more interesting. By the way, I contacted three of my patients in the cohort and two of them had Covid and one didn't isn't really going to make you know want to make a paper that's a preliminary paper much more publishable. Other things that have been happening is that there's been lots of hypotheses and case reports saying my patient got COVID and then developed polyarthralogy afterwards. That's very well recognised.

That's not a case report. People know about long COVID. A patient developed a reactive arthritis or developed a rash after COVID. That's all been recognised and reported elsewhere. So where the increase in traffic of vignettes and case reports especially to our journal which takes those has been around an order of magnitude higher.

We usually reach a certain number of submissions in December and we exceeded that by the June this year, just to show you what happened. So our December intake of papers has actually happened in June and we're now just having to panic and it's affected up our publishing times to an extent, not acceptance times, but from when we accept a paper, send it to our publishing house. They're struggling because we're outputting more papers than ever and to get the papers from acceptance to online publications has actually lengthened slightly and it's just due to the sheer volume of things that we're getting through. And we're trying to be fairly fair and pragmatic, but we might have to tighten things and not accept what we would have usually taken because there's such a large volume of submissions.

Yeah. Okay. More generally at the Congress, is there anything in particular that you are looking forward to seeing at ACR twenty twenty?

Well, ACR twenty twenty should be very good from the point of view of looking at quite a lot of few things that I'm interested in. So I'm interested in machine learning and there's going to be quite a few abstracts discussed about machine learning to predict flares and to predict how we model the way that we treat our patients. And I think looking at all of them together might give us a way of looking at how things are going to go going forward because our clinical practice has gone a lot virtual and maybe using machine learning might help us to separate what we need to do going forward. There are some abstracts looking at using drugs in diseases that traditionally we use them in. So looking at, for example, there's going to be a premenalstin Behcet disease, oral ulcers, etc.

Will be quite an interesting one to be looking at. That's a drug that's used in different place and using the small molecules again in psoriatic arthritis, etc. That will be quite interesting. And hopefully we'll be able to be looking at all of those and come out with maybe some new evidence base for what we'll be doing in the next few years.

Yes, certainly the machine learning with the virtual clinics that we're doing now very topical. And I was I was looking at the Appremilast abstracts only earlier in preparation for the what we're going to find in the poster sessions later today, actually. Yes, thanks for going through your personal highlights with us. Great, thank you for joining us today, Doctor. Bucari.

And thank you for watching RheumNow. Don't forget that if you want to be kept updated during this very different ACR twenty twenty Congress, you can follow me on Twitter Doctor. Minnie Day. And you can also follow the RheumNow Twitter feed as well. And thank you very much for watching.

Hello,

this is Doctor. Eric Dine reporting for RheumNow at ACR Convergence twenty twenty, reporting here from Baltimore, Maryland, just north of our home city of it, being done virtually, but out of Washington, DC. So excellent poster sessions this morning. I wanted to draw everyone's attention to the health care disparities posters that were available this morning and still available on the website. There were a couple very important, excellent posters.

The first one, Abstract 49 by Doctor. Sun out of University of North Carolina. They took a look at disparities in patient portal usage among patients. So Doctor. Sun looked at patients in their system of Epic, which patients went ahead and activated MyChart.

As you may expect, there's large disparities as to which patients were able to access it. So in rural areas, minority racial, ethnic groups, older age were associated with decreased health usage, decreased activation of their MyChart. Also lower income Medicaid and non English primary language were also associated with decreased activation. I think it would be very important to look at not just the activation numbers, but to see it in addition, how many patients were actually utilizing it to what degree they utilized, particularly as we're using more and more telemedicine and remote learning. I think that's going to be an area that we have to be mindful and explore.

The other study Abstract 45 out of WashU was a great study, just a quick survey of 132 providers that I think just hit on a very important point, looking at confidence in providers in evaluating lupus related rashes in patients with skin of color. Across the board, providers said that they felt uncomfortable or less confident in assessing patients with lupus and recognizing lupus rashes in non Caucasian skin tones. So this is something that I think expands beyond term dermatomyositis rashes or the classic erythema. It may look hyperpigmented, it may look different in dermatomyositis and all sorts of different autoimmune related skin rashes are important to be comfortable in all patients in all skin tones. So ninety three percent of those surveyed said they would want to learn more about rashes in patients of color.

And if you think back to your educational materials, pretty much all the photographs are of Caucasian individuals. So that's something that I think was a great thing for them to call attention to and something else for us to think about as we were developing and changing our education moving forward. This is Eric Dine checking in from the healthcare disparities poster session. I look forward to talking to you more throughout RheumNow.

Hi, I'm Doctor. Sheila Reyes from The Philippines reporting for RheumNow from ACR twenty twenty. I'd like to share the findings of abstract number two zero five, where they looked into the potential risk of methotrexate induced long term liver fibrosis using the fibrosis for index or fib four. This cross sectional study enrolled one hundred and seventy patients with established RA. Sixty percent of these patients were treated with methotrexate.

According to their findings, seventy one percent of patients had a low fib four value of less than 1.45 and not significantly different between patients receiving methotrexate, those who were previously treated with methotrexate, and patients who were never treated with methotrexate. There was no correlation between fib-four values and the cumulative dose of methotrexate. Also, the cumulative dose of methotrexate was not significantly higher in patients with a fib four index of more than 1.45. And no association was detected between the fib four index and parameters of disease activity like DAS, ESR and CRP levels, as well as BMI, traditional cardiovascular risk factors and the metabolic syndrome. The authors concluded that RA patients on long term maintenance methotrexate have low fib four values suggesting that methotrexate is not associated with an increased risk of advanced liver fibrosis.

What does this tell us? Coming from a region where methotrexate continues to be a mainstay of treatment for RA, these results show the importance of stratifying our patients and doing close follow-up on those who are at risk of developing liver disease and that we can use the fib four index as a marker in this group of patients. Follow me on Twitter at RheumAreampa and tune into RheumNow for more videos and reports. Thank you.

This is Doctor. Catherine Dow reporting for RheumNow. I'm at the ACR twenty twenty convergence meeting. It's a virtual meeting and so far it has not disappoint. I wanted to share with you one of the plenary abstracts that was presented and this was on COVID-nineteen.

And so this is a study actually looking at the TriNetX, data bank. And what they did was they compared patients who have rheumatic diseases versus patients who don't have rheumatic diseases. So the general population and they wanted to see what the outcomes were for rheumatic disease patients at four months and then again at six months. So they identified seven sixteen rheumatic disease patients who had COVID-nineteen. What they found were that patients were at risk for hospitalization, particularly if they had high blood pressure, diabetes, chronic kidney disease, and asthma.

So rheumatic disease patients actually had more of these comorbidities than the general population. In addition, they found that patients with rheumatic diseases actually did have more hospitalizations, ICU stays, mechanical ventilation, acute kidney injury, venous thrombotic events, as well as requirement for renal replacement therapy. What's also interesting is that these patients also had an increased risk for venous thrombotic events that persisted at six months, Didn't end at four months but actually persisted at six months with a relative risk of one point six. At six months they didn't find any, increased risk for mechanical ventilation. So this study actually was a little bit different compared to the results of the Global Rheumatology Alliance, where they didn't find that patients who had rheumatic diseases had a higher risk for hospitalizations or complications from COVID-nineteen.

And they had pointed out that perhaps the difference was that with the GRA registry, this was all patients who had rheumatic diseases. Whereas with the TriNet X, population, these are, a study of both rheumatic disease patients versus non rheumatic disease patients. So in a way, I mean, data did correlate with GRA because they did identify the same kind of risk factors that could lead to high risk for COVID-nineteen complications. So that's diabetes, high blood pressure, kidney disease, and then lung disease or asthma in the case of the TriNetX data. So, this is something that, you know, we all worry about with our patients.

There's been a lot of abstracts that shows that perhaps our patients do not get COVID-nineteen as much. Now the question is whether patients are more careful, they're socially distancing, they're wearing their masks, they're washing their hands, or is it maybe some of our drugs may be protective? But this is actually a very interesting study that brings out the fact that perhaps our patients with rheumatic diseases might have a higher rate of hospitalization and complications from COVID-nineteen. So just for you to be aware of, please follow me on Twitter kdao2011 and have a great day.

Hi, this is Doctor. Kevin Winthrop coming to you live virtually from Portland, Oregon. You might wonder why I'm all dressed up. I'm going to an election party. It's been five days now.

I'm still at the same party. I got I need to go home. Hey, I just wanted to say a few things that I found today that were interesting. Jack asked me to just throw in my 2¢ on a few things. I spent my morning in clinic but before, clinic I woke up early and hit the poster session at six hundred PST.

A couple things caught my mind, a few things that I was involved in, a few things that were presented by others. Abstract two fifteen, Ernest Choi caught my attention right away because it was a nice in-depth analysis of the issue of venous thromboembolism or VTE in the setting of JAK inhibition and this time focused on the OOPA data upadacitinib. It was nice they were able to model risk factors for VTE in the program and not surprisingly they found what we found in other programs is that the single biggest risk factor is a history of VTE and clearly patients who have a history of VTE are at much higher risk, if they're put on a JAK inhibitor, to have another one as opposed to those who have no history of VTE. So this is not necessarily a surprise. I do think it's something that can be used of course to guide management.

I'm not sure I would choose JAK inhibitor in someone who has a history of VTE. Other things interesting in that analysis in the multivariate analysis, they did not find COX-two inhibitors to be associated with VTE. Now if you remember back to the Barry data when that was modeled and presented, that was a surprising finding that in addition to a history of VTE that another significant risk factor that was independent was use of COX-two inhibitors, and that was hard to explain. I wasn't sure why that was the case, but interesting in this data that was not seen. Other things noted in the data, there was some quirky associations with, one of the dosing groups, OOPA, I think the lower dose, actually, there was a statistical association with statin use.

Again that's hard to explain, I'm not sure, that's probably some sort of confounding or fluke in the data, but overall I thought what I took home from this was again that history of DVT and age, and of course that's a risk factor as well. So if you look at some of the other JAK inhibitor data presented this morning, and there's a bunch of integrated safety assessments presented. I was involved in several of those. I'm going to get to that in a later little three minute blurb here, But just to contrast, I also presented this information in poster two twenty nine in the same session,

and this was in the

filgotinib LTE data up to five point five years of exposure history, and I'll get into that in the infection stuff later, but the VTE stuff was interesting there. Now, the risk factors weren't modeled, there's really just not enough events to model, and that's really true of the OOPA data too, there's not a lot of statistical power because there's not a lot of events. But the rates in fill go were around 0.2 for the two hundred milligram group, and I think for OOPA the rate was also quite low and was quite stable through time. So I look forward to the real world. I think that's where the issue of VTE is really going to be better understood.

Interesting real world data published recently by Phil Meiss in ARD looking at corona data didn't really see any increased risk of VTE with Tofacitinib starters as compared to those starting TNF blockers, and the rates were around zero point two per 100 patient years, if I remember right. So, I think we have a lot more to learn about VTE. I think it's probably a risk factor. Maybe it's just a risk factor of really high doses, particularly in people who have risk factors for VTE. So I think stay tuned while this gets figured out the next few years.

So for Jack and RheumNow, I'd say go back to watching RheumNow tonight after the conference before the conference tomorrow and enjoy your virtual ACR. Cheers.

Hi, ACR Converge twenty twenty. I'm Doctor. Rachel Tate coming to you from my family's home outside of Louisville, Kentucky. We've already addressed treat to target for AS patients. So let's switch gears a little bit and I want to discuss treat to target for psoriatic arthritis patients.

A systematic literature review out of France, this is abstract number three twenty one found six seventy three psoriatic arthritis articles. Of those they chose 73 to analyze that represented actually 27 PSA cohorts And they found that outcome measures much like this disease are very heterogeneous for this patient population. Thus, we actually need to define treat to target better in psoriatic arthritis. In addition to this, there's another article I wanted to share with you, but this one's from The US, it's abstract three twenty four. This showed further difference between those patients who are enrolled in randomized clinical trials versus clinical practice.

So again, outcome measures also were found to be different. This makes real world and of course choosing between outcome measures for trials therefore very difficult. A retrospective analysis abstract three twenty out of Israel this time, used MDA and DAPSA scoring to determine outcome measures in general for our psoriatic arthritis patients. And this actually showed that only sixty five percent of the cohort that were evaluated for these treat to target measures. So of the entire amount, only sixty five percent.

So we really think our main obstacle and treat to target implementation for psoriatic arthritis is actually defining what treat to target measures are. So until we have validated practical disease activity scoring and agreement amongst all of us, it's going to be difficult to make treat to target implemented within our patients rather in clinical trial or in clinical practice. Shifting gears just a little bit, but still very important to this topic. Abstract three forty four suggested that BasDi scoring, which as you know, is originally used for axial disease measurement in axSpA, it showed similar scoring in PSA patients in terms of responsiveness, a change in score and overall scoring in general. And this is regardless of axial involvement.

So it kind of makes sense given that only five out of the six scoring measures are not specific to axial involvement at all. So the question really for me is, will this be something for the future? Is this an option that we can look at for clinical trials and hopefully even in clinical practice? So given the importance for treat target and rheumatoid, there's no doubt that we will all benefit from having treat to target measurements for our patients in spondyloarthritis and PSA and AS. But I really think that the difficulty is going to remain that we need to determine best measures considering the very domains and the clinical presentations of these diseases.

So stay tuned for all of your ACR twenty twenty updates at roomnow.com. And of course, follow me on Twitter uptotape.