ACR20 - Opening Day 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.

Hi, I'm Jack Cush with RheumNow, reporting from RheumNow, meaning my office at home. I'm gonna report on Abstract nine fifty two, The Recipe Study. This is authored by Pooja Khanna and colleagues. This is an interesting trial of pegilodecase use wherein mycophenolate was used to, inhibit or abrogate the anti drug or anti PEG antibody response, which sometimes screws up the long term outcomes in patients treated with pegilodecase for refractory gout. So this title was reducing immunogenicity of pegilodecase in patients with refractory gout.

This was a phase two trial, double blind randomized trial where patients received either mycophenolate or placebo prior to and during treatment with peglodecase. They screened or enrolled 42 patients, they treated thirty two who had received at least one dose of peglodipase. The primary endpoint were those who achieved a clinical response with a serum uric acid less than six at week twenty four. That was achieved by sixty eight percent of people on mycophenolate and thirty percent of placebo. So it was a success.

The toxicity or side effects with mycophenolate was relatively little. So this is the first novel trial, the first novel use of mycophenolate in patients also receiving peglodecase. We've had a few studies, uncontrolled reports using azathioprine and maybe methotrexate. We've had a few 10 patient cohort studies and that's another cohort study of methotrexate use while using peglodecase. This is novel in that uses mycophenolate, which seems to be really well tolerated and gave a good outcome, especially with the primary endpoint being sixty eight percent of patients normalizing their uric acid.

This is, I think, an important report. We're gonna see this presented, I think on Saturday. I'd look forward to it. That's it. Tune in for more videos on RheumNow.

Hi, I'm Doctor. Janet Pope. I'm a reporter at RheumNow. I'm janetburdeaux is my tweet handle. I'd like to talk about a study at the ACR twenty twenty convergence, the virtual meeting.

This is abstract number two. This is on hydroxychloroquine and chloroquine and looking at hospitalizations for viral infection in the pre COVID-nineteen era. So we've heard a lot about antimalarials and you'll hear a lot about them at this meeting. What this was is Doctor. Cristiano Mora et al looked at about sixty four thousand patients with RA and lupus from a large claims database.

And they looked at hospitalizations, morbidity, infection. They adjusted for the comorbidities of the patients. And the bottom line on about sixty four thousand patients with these two diagnoses is that whether you use hydroxychloroquine or chloroquine or none of the above, there seem to be no difference on infection rate, on hospitalizations for infection. And so what does this mean? I think the take home message on this is that although antimalarials have been looked at on decreasing COVID-nineteen infection, I think we can put that to rest.

But what we can say is we are neither seeing harm nor benefit of our patients on these medications in a very large database. Thanks and enjoy your ACR convergence and please come to room now for more up to date information. Thank you.

Hi, I'm Jack Cush with RheumNow. This is the RheumNow preview. We've been sending you a lot of information in the weeks up to this meeting, and now the meeting is here. I want you to know about a few things that may be of value to your interest to you while watching our content dedicated to ACR twenty twenty. First on the list is if you go to our website from this day forward, you'll see something in the right sidebar called ACR IQ.

ACR IQ you say, yes, you can check your ACR IQ with a daily quiz. This will be on average five to eight questions a day. True, false, easy to answer. Just scroll to the right, keep answering, and then look for the solutions or answers and see how many you got right. You can do this every day, see how you compare to your peers, it's kind of a fun thing.

And we're going to teach you something about what was important that was presented at ACR twenty twenty. The second item that you should look at is ACR chat. On every page on our website, you'll see this little pop up, know, that little circle above the head where I'm speaking, and it says ACR chat. Click on that and you can join the discussion regarding whatever the topic is, whether it's psoriatic arthritis, rheumatoid arthritis, plenary sessions, etc. Should be interesting there.

I think what I want to see there, what I'm going to ask for all of you to put in, what's the burning question? What is a burning question in RA? What's the burning question in spondyloarthritis? What's the burning question in gout? Because we'll pose your burning question to the KOLs and leaders in those areas as we interview them throughout the meeting.

And the last thing is going to be the ACR playbook. Actually, it's called the Virtual ACR 2020 Playbook. And we published that yesterday. You can go on the email or the website, click on that, download that, you got to sign in. For all these things, should sign in and you'll stay signed in.

And that makes your life easy on the RheumNow website. The ACR playbook is sort of giving you ideas about things that you should see, but it's more about how you're going to learn in this new crazy virtual environment. This is the big challenge. I would say that the two things you have to master to learn virtually is number one, time management. And that means that you need to schedule time to do this.

Think about it, you're saving time and money and hotel fare and taxis and Uber and registration even to not go to the meeting. So it doesn't mean that you could squeeze it in between commercials when you're watching Mannix. That's a reference for the past. But instead, it means that you should dedicate the time and effort to learn as you would if you're going to attend the meeting. Time management, build a schedule, live by it.

You can't do five hours, eight hours in front of a computer. So two hours at a time, then do what I do, go for a bike ride or go for a walk or run down to Taco Bell and get grande nachos or whatever's on sale. Second issue, tech comfort, meaning you got to have your technology down and you got to be comfortable. So in my setup, I'll show a picture. My setup's got two and maybe three screens running at a time.

I've got cameras, microphones, etc. But you need to open up multiple screens if you can. That's the best way to navigate. You can have one open where you can watch a video or listen to a podcast or actually just read abstracts. And the other one might be your navigation for what's coming up later that day.

And you can move around and find what you want to find. I think you need to vary your levels of engagement. So use the multi modalities we propose to you or offer to you, our videos, our podcasts. You can read our tweets, you can read our articles, you can scan our website. A lot of these things, I think spicing it up makes it really easy for you to consume the content.

And lastly, you should try something new, meaning you haven't done it before, maybe you should because you know what? This COVID thing is not going away. This is going to be the new way we're going to learn in the next few years, maybe forever. So now's the time to get it right. And I think it's getting it right for the future that's really, really important.

There are a few things that I want you to be on the lookout for. Obviously, that would be things like the great debate, the year end review. That's on the ACR website. On our website, Rheumatology Roundup, Cavanaugh and I are going do that. And then on Saturday night, we're going to do a mid meeting recap, having a few guests on.

We're going to take questions and spend an hour doing that. We'll send you rheumatologists invites to those two events on Saturday night, Monday night. For the rest of you who want to look at it, can see it on our YouTube channel live, or you can watch it streamed on our website live. That's the preview. Tune in for more at ACR twenty twenty.

Hello everyone. I'm Olga Petrina from New York City. Today I'm reporting from the virtual ACR meeting twenty twenty and I would like to share some updates about psoriatic arthritis and issues of inadequate response as well as issues of adequate response in ankylosing spondylitis patients. So I picked two abstracts that I found particularly interesting. I would start with abstract three fifty nine.

This is the study evaluating clinical characteristics of patients with psoriatic arthritis and axial involvement and their response to treatment based on the HLA B27 status. So in this review of the patients from the corona psoriatic arthritis spondyloarthritis registry, they selected one hundred and seventy three patients who initiated biologic and among those patients about thirty percent were HLA B27 positive and sixty nine percent were HLA B27 negative patients at the baseline. Over the six months period patients were treated with IV biologics and it's been eighty five percent of patients with HLA B27 were in biologics, eighty percent of HLA B27 negative, and the remainder of the patients were on traditional conventional DMAR therapy. After six months of treatment they were reassessed in terms of clinical treatment response by VASDAA score, modified VASDAA score and ASDAA CRP scores and the authors found that the treatment response was very mild by all those measures after six months of treatment regardless of the HLA B27 status. And it points out to the issue of poor treatment response in this category of patients with axial disease and calls for a need for more effective and safe mechanisms of action in this indication.

Another interesting abstract that speaks about the inadequate response and actually points out to the reasons of inadequate response is the abstract three seventy one, which speaks about patients with antherosclerosis spondylitis. And in this retrospective cohort study, authors analyzed the frequency of adequate inadequate response after one year of treatment with biologics and in this group patients were initiated either on a TNF inhibitor or on IL-seventeen inhibitor with or without concomitant use of conventional DMARDs And then the inadequate response was considered as disconation or not adherence to treatment. Also switch from one biologic to another, from biologic or adding conventional DMARDs and use of systemic steroids to treat the manifestations. And interestingly enough, a very high percentage of patients, were considered inadequate responders. So more than sixty nine percent of ankylosing spondylitis did not respond to treatment according to this study, to the first line biologic.

And then the most common reasons were patients on non adherence is fifty six percent of patients with ankylosing spondylitis were found to be non adherent to their treatment regimen. Fourteen percent switched to a different biologic, eight percent added a new DMARC, and four percent went for dose increase or addition of steroids. So interestingly, they find that patients who were considered treatment non responders were mostly female. They also suffered more from anxiety, depression, and mental health issues. There was more patients in the Southern States who were considered non responders and on the other hand, patients who were on methotrexate in addition to their biologic tend to respond to treatment better.

So, this study points out to the reasons why inappropriate response or inadequate response in ankylosing spondylitis happens and something that we should probably be working on with our patients in our practices. I hope you find this information interesting and if you would like to learn more, please follow us on the room now and it will give you more updates on this interesting virtual meeting. Thank you.

I'm Maral Remahi from Cleveland, Ohio reporting to you live for RheumNow prior to the start of ACR convergence twenty twenty. I'm excited to be interviewing a former colleague, doctor David Leverans. Doctor Leverans completed his internal medicine residency at Vanderbilt University Medical Center, a chief year at Vanderbilt and his rheumatology fellowship at Duke in 2019. He's currently an assistant professor of medicine in the division of rheumatology and immunology at Duke. David, it's such a pleasure to have you with us today.

Thanks, I'm really happy to join you and thanks for inviting me.

Well, let's get started. You are no foreigner to virtual platforms as you previously created an internal medicine residency podcast while at Vanderbilt to enhance the educational experience of medical residents. Are you just as excited for this year's virtual ACR?

I'm really excited for this year's ACR convergence meeting. I, you know, I think we're all craving connection right now and we're craving that professionally and personally and I really am excited to see this platform. I think it's gonna be really unique way to connect with colleagues and explore what's happening in rheumatology right now. So I'm excited.

So what's your plan of attack to absorb as much as you can at ACR this year?

Yeah, that's a good question. So I actually went through the agenda and I saved about a million abstract sessions and poster sessions and all kinds of things. And I don't know that I am going to be able to fit it all into a live session. My plan of attack really is to try to pick some of the sessions to attend live that I really think are people that I want to interact with and places where I wanna ask questions and really get to know what's happening with those projects. For example, I'm really interested in medical education.

That's a lot of what I do. I'm also interested in quality improvement. And so for me, those are the big sessions that I wanna attend and see what other people are asking and go to those poster sessions. And then the rest, I'll just have a Netflix version of ACR Convergence that I can stream later.

So beyond those sessions you've mentioned, which sessions are your cannot miss sessions this year?

Yeah, well, I think really, I think everybody's excited for Doctor. Fauci's session and the great debate's always wonderful. I mean, I think those are the big sessions that everyone really enjoys. But for me, with my personal interest, some of the can't miss sessions are the medical education year in review, which in part is going to be presented by one of my friends and mentors, Doctor. Lisa Crisioni, who is just a phenomenal educator.

So much has happened in the world, but so much has happened in medical education in rheumatology over the last year. And it'll be really fun to see that. I'm also really interested in some of the sessions looking at quality of care and also what's happening with telemedicine in rheumatology, both how that's impacting medical education and also our practice. So there's a session in particular on telerheumatology, how COVID-nineteen changed it and what's in the future. There's also a quality of care, session called Everything I Do Counts.

And those are sessions that I'm really excited to see what's gonna happen in those sessions and see what others are working on. So many colleagues are doing so many great things. It's kind of hard to figure out what to attend, but those are the big ones for me.

A lot of exciting things to look forward to, certainly. So from a survey of four forty seven rheumatologists published on RheumNow on October 30, it was discovered that more than half intend to get their ACR content from other sources beyond website, with RheumNow leading the way as another source for reference. What sources will you use to help you stay abreast of the latest at ACR?

Yeah, that's a great question. It's been really fun. I mean, the ACR has done such a fantastic job, but also there's also wonderful organizations like RheumNow and other organizations where the opportunity to explore rheumatology is exploding. That's so fantastic. For me, the other big one is Twitter.

So there are ACRE ambassadors that have been tweeting out about this and they've been tweeting out some sessions that I had not known about that kind of hit my radar. Other people have been tweeting out about sessions. I saw Doctor. Anisha Dua, who I've looked up to as a wonderful educator for a while, but also a wonderful vasculitis person, who tweeted out about a large vessel vasculitis and imaging session. I'm not sure I'm going to be able to attend it live, but, I really want to know what they have to say, because that's a diagnostic conundrum we come on, quite a lot.

That's a big place where I'm going to find what other people are doing. I don't know, we'll see if there's a lot of people talking on those sites. But really it's also I want to attend the posters, talk to some of the people that's doing the work, and hear what they're gonna do. I mean, that's what I'm gonna do is I'm gonna go to the academic medicine hub and I'm gonna ask some of my medical education colleagues, what are you gonna do in this meeting? What are you excited about?

So it'll be a virtual meeting, but probably some more traditional networking hopefully happening.

Well, that's actually a perfect segue into the next question I had, because certainly there are positive aspects to a virtual platform, including like saving on costs of travel, time for travel and hotel accommodations, which we know can be costly around the time of ACR. But one of the most valuable aspects of our annual conference is the network repeating that occurs. In fact, the ACR rebranded the meeting as ACR Convergence noting that the greatness of our annual meeting results from the convergence of colleagues. So how are you planning to network this year in the virtual platform beyond the avenues you've already discussed? So Twitter being one, but what other ways are you going to explore?

Yeah, so it is going to be interesting and different and it'll be challenging. I mean, I think it'll be hard not to see somebody in the hallway and say, Hey, do you want to grab lunch? It's hard to replace that. But then on the flip side, there will be more opportunities to connect in that we don't have to walk from one side of the conference hall to the other to see our colleagues' posters or those kinds of things. Really, I think one of the most fun parts of ACR is connecting with people you've worked with before, like yourself.

That's what I want to do, is I want to look up what are some of the posters of my former colleagues. I want to support them. I want to go to their posters, and all I have to do is unclick one poster and go to the next one, and I get to say hi and see what they're doing. Then I get to do that with some of the posters and other sessions of people that I really look up to and maybe I'll get a chance to meet somebody that I'll learn something from. So that's the plan, just to hop around, try to support some people that I've known, and maybe explore some new professional relationships that way.

Yeah, still maintaining some form of interconnectedness despite the virtual aspect. I like all those points. So you are the last author of three abstracts at ACR this year. Do you have any strategy in choosing other abstracts? Is that beyond focusing on your areas of interest?

Yeah, well, I love all of rheumatology, so this is a problem. Because the ACR for me is kind of like being a kid in the candy store, I really wish that I could learn everything about lupus and vasculitis and just everything that's happening. So I know that I can't do that, but I really love these little video promos that people are putting together on their abstracts. I really love that and so what I'm planning to do is for some things where I'm like, well maybe I would want to go see this poster, I might just watch the video and see if that's someone that I want to ask questions of. As I've already mentioned, for me, the biggest priorities are medical education and quality improvement.

Those are the big ones that I'll be exploring and really just kind of hop in through those posters. There's so much new stuff. There's new treatment guidelines for rheumatoid arthritis. There's new gout guidelines that we're talking about at this meeting, there's COVID data, there's telemedicine data, there's stuff on Avacopan for ANCA vasculitis, and there's so much that I want to learn, So we'll see how I can I'm not sure how I'm going to do it. We'll see.

I'm sure you'll find a way, David. You're always great at doing that. And something you're always good at doing as well is staying abreast of the literature and rheumatology. So what PERLS can you give current fellows on staying up to date on the literature and rheumatology?

Yeah, so I'm not sure I could give PERLS as I just mentioned that I tend to just kind of dive into overwhelming amounts of data and see how it goes. But I could say that someone I've respected for a while is Mike Putman, who's put together a really wonderful podcast, the EV Room podcast. I'm a listener. And he's giving a session on keeping up with the literature in rheumatology and I've highlighted that on my schedule as something to attend. So I'm not sure I can give pearls.

I'm actually in the same boat of trying to learn how to do this myself because the literature is absolutely exploding. And so I'm trying to learn that as well. So that's another session I have highlighted.

Well, do you have any pearls to give on making a successful transition from fellowship to junior faculty for our current fellows?

Yeah, well, you know, at least in terms of the meeting itself, you know, the meeting is a different experience, I think, as a junior faculty than as a fellow. You know, as a fellow, I think the main difference is you're trying to learn and maybe make connections for jobs, whereas as a junior faculty, you're trying to collaborate and you're trying to form professional relationships and connect. And so I really think that for me is the main advice that I have for fellows, is to really try to explore those connections during this meeting. There's so much to learn. We are all learning.

We will be learning so much for the rest of our careers, and I'm excited about that. But this meeting for fellows is such a wonderful opportunity for you to connect with people you did residency with and are now fellows at other institutions, or to connect with people who are doing really interesting work. I would just say for fellows, don't be afraid to hop into a poster session of somebody doing amazing things and ask them a question. Think most faculty really love having the chance to interact with trainees. Then if you do that, even as a fellow, you'll be set up for success in attending this meeting as a junior faculty.

All great advice, David. Thank you so much for your time today. For more, follow us on roomnow.com. I'm Mural Remahi from Cleveland, Ohio reporting to you live for RheumNow prior to the highly anticipated kickoff of ACR Convergence twenty twenty at 2PM Eastern today. I am very excited to be interviewing a former colleague, Doctor.

Kevin Byram. Doctor. Byram completed his internal medicine residency in rheumatology fellowship at Vanderbilt University Medical Center, in addition to a vasculitis fellowship at the Cleveland Clinic. He is currently an assistant professor of medicine in the division of rheumatology and immunology and the associate director of the rheumatology fellowship at Vanderbilt. He also founded and directs the Vanderbilt Vasculitis Clinic.

It is such a pleasure to have you with us today, Kevin.

Awesome, thank you for having me here, Merle. Excited Thank to be you.

So Kevin, we have been treading in some unprecedented times with the COVID-nineteen pandemic. ACR has accordingly accommodated to such times by transforming our premier annual conference to an entirely virtual experience. A survey of four forty seven rheumatologists published on RheumNow on how they intend to consume and partake in ACR twenty twenty revealed that two thirds of rheumatologists still plan to participate. Forty one percent plan to do so live and twenty three percent will do it after hours. Are you just as excited for the conference this year and how are you planning to participate?

Oh, absolutely, very excited. It is, as you say, unprecedented and tend to view an experience like this as an opportunity. I think the ACR is gonna do a really good job innovating. I'm gonna do kind of both, much like I do at a regular ACR. Know, I go to sessions live, but in terms, at an in person ACR I'm meeting folks and there are other obligations and so many times the week or two after I'm consuming recorded sessions.

I plan to do a very similar thing here. I think it's gonna be really important to participate as much live as possible because I think that between Twitter, RheumNow and some other sites and things, I think the live in person participation, it's gonna provide a lot more interaction. So I think I'm gonna do both.

Okay, so generally the ACR is known to be a very large meeting with over 2,000 presentations, over 15,000 attendees from over 106 countries. To conquer the ACR each year, it's often necessary to have a strategy. What has been your strategy in years past and how has that evolved to accommodate this year's virtual platform?

Yeah, I've done it a couple different ways. I think it's an evolving strategy. I think what's important to understand is there are sessions that don't really translate very well to watching it afterwards. Mainly the posters and abstract sessions. Know, that's cutting edge science, cutting edge clinical research and many times in years past they've not even been available in terms of a video or audio recording.

So I think those are the sessions really to prioritize if you're into clinical research and cutting edge research and finding other collaborators participate in that portion live so that you can interact with the abstract authors, ask questions and really consume that in real time. There are others that I think are more exciting in real time as well. Knowledgeable is of course one of those. And there are others but I think I'm gonna try to do it very similarly to what I've done in the past. Prioritizing the posters live, abstracts live and

kind of

finding those high yield sessions that I'm interested participate in live.

Okay, so what would you categorize as your top three must see sessions at ACR this year?

It's a really difficult question. I think this year, I'm really excited about the great debate this year. That's another one that probably could be watched in hindsight, assuming they recorded it and it's presented well, but it's a really awesome topic this year about JAK inhibitors and where they fall in the treatment algorithm of rheumatoid arthritis. I think the year in review is always really awesome. It's always early in the meeting and it gets people excited recapping the year past in terms of high yield abstracts both in clinical research and basic science.

And then I think if I can lump them all together into one session at the plenary sessions are always those have become my favorite because of how you can almost feel the excitement in the room of when those abstracts are presented and they tend to be really cutting edge in terms of clinical practice and basic science. I think those are the three I would highlight.

Okay. Are there any late breaking abstracts that you have your eye on?

Sure, I think the one, you know, there are definitely several COVID-nineteen papers that I think are interesting. I think John Stone has one that is Tocilizumab and COVID-nineteen. There's also I think another MassGen one looking at and it's very you know it's as high yield as it can get for us. Outcomes in patients with rheumatic disease and COVID-nineteen, I think those will be really interesting to hear. There are several vasculitis ones that I'm also interested to hear at least in the plenary sessions.

The maverilizumab, it's a new biologic therapy being used in giant cell arteritis so it's a phase two study being presented. But there are others, mean the late breaking ones are very interesting and they do a really good job again of finding those, the basic science ones for that crowd and then the more clinical research ones for those that cut that direction.

Okay. Can we expect any practice changing guidelines in the world of vasculitis this year to be released at the ACR?

Yeah, think so. The, so the manuscripts for the ACR and Vasculitis Foundation guidelines have been finalized and they're being ratified by those two governing bodies and those should be published at some point. And those were those were presented at last year's ACR and pampered out over this past year. So in terms of the session vasculitis sessions this year, the two that really caught my eye are Sharon Chung from UCSF who led the guidelines effort is giving an ANCA vasculitis management talk. You know, she's really second to none in terms of the way she presents.

It's usually case based. I think it will be extremely high yield for those that participate in that session. And then there's a I'm really excited about large vessel vasculitis imaging session by Doctor. Peter Grayson and Doctor. Anisha Dua the NIH and Northwestern respectively.

You know those two those are both personalities full of charisma. You've got this really pragmatic clinical prowess of Doctor. Dua and the scientific rigor of Peter Grayson. I think that's gonna be a really high yield talk for that topic and I'm excited about it.

Yeah, great. I'm looking forward to that as well. Any pearls for rheumatology fellows in particular and how to make the most of ACR and their fellowship?

Yeah, so in terms of the ACR, it can be really overwhelming for those that it's their first or second ACR meeting. And this almost feels like everybody's first meeting because of the format. I think the best pro I can give is to be familiar with the schedule. You know it's worth sitting down for thirty or forty five minutes and just looking at the schedule front to back and really prioritizing those three to five sessions a day you want to go to and making the time of course to do that. I think and again there are high yield sessions that I think everybody on their first ACR probably should should prioritize.

The Great Debate, Year in Review, Knowledge Bowl, I think there's just a lot of excitement around those and I think it's infectious so to speak. The fellowship, I think this is a really more general question of course, but I think meetings like the ACR, SODA in the spring and others are really good sources to maintain your enthusiasm about rheumatology and about learning. And so I think these are times and spaces in which the fellow really should make the time to read a lot and absorb all the information coming into them.

Okay, well that's a wrap on questions I have for you. I want to thank you Doctor. Byron for your time today. More helpful pearls on how to navigate ACR twenty twenty, download the virtual ACR twenty twenty playbook on RheumNow. I'm Maral Remahi from Cleveland, Ohio reporting to you live for RoomNow prior to the kickoff of ACR Convergence twenty twenty.

I'm excited to summarize for you the high yield points from the virtual ACR twenty twenty playbook authored by ACR Conference veteran and RheumNow's very own Doctor. Jack Cush. High yield point number one, figure out what type of learner you are and build your ACR agenda based on that knowledge. High yield point number two, streamline your schedule. Allow time to complete one to two hour sessions at a time and prioritize sessions that are most important to you.

Point number three, there are definitely some don't miss sessions and that includes an opening lecture by Doctor. Anthony Fauci, the ACR Year in Review, the Great Debate, and plenary sessions. Figure out what your must see sessions in addition to the aforementioned sessions are by navigating the ACR agenda and also navigating any late breaking abstracts. High yield point number four, time efficient, high impact content can be found on the RheumNow website. The RheumNow website will feature daily podcasts on the meetings, ACR IQ quizzes, ACR topic chats, perspective videos on important topics and topic reports.

Also, another important thing to do is follow the ACR20 on Twitter for some high yield information and late breaking news on the conference. High yield point number five, networking is still possible despite the virtual platform. There will be an ACR chat on the RheumNow website, which is gonna be a bulletin board that will allow you to discuss the meeting with others. And on the ACR website, you can locate a colleague's profile, add them to your want to meet list, and actually send them a message to schedule a one on one or a group video chat. High yield point number six, have fun and learn.

Download the virtual ACR twenty twenty playbook on RheumNow for further reference.

Hi there. This is, Eric Ruderman, from Northwestern University, and I'm coming to you from ACR Convergence twenty twenty, reporting for RheumNow. Tonight, I wanted to start by, bringing up an interesting topic in the, area of psoriatic arthritis. I'm focusing on psoriatic arthritis at this meeting and there are a number of new and interesting abstracts, but I wanted to talk about the idea of axial involvement in psoriatic arthritis. It's becoming a pretty important theme in the last few meetings, and something that, I think is raising a lot of very interesting questions.

For many years, we've treated the axial involvement in psoriatic arthritis very much the same as AS or axial spondyloarthritis, but we're starting to wonder whether there are differences there. And there's some interesting abstracts at this meeting that begin to look at that. I think that's one of the themes that's threading through the meeting. We've known for a very long time that psoriatic arthritis patients have axial disease. In the original Mullen Wright criteria, five percent of patients had primarily axial disease.

More recently, there's data that suggests that perhaps forty percent of people have at least some element of axial involvement. We don't know how significant that is in everybody. Is it clinically meaningful? And how do we define it? Other questions that keep coming up are, how does this roll into the idea of composite outcomes in psoriatic arthritis?

Psoriasis and psoriatic arthritis, as you know, are diseases with a bunch of different domains that can be involved. And as we think about treatments and thinking about subsetting patients, we think about, you know, oligarthitis or more diffuse arthritis, about enthesitis, about dactylitis, about nail changes, about skin disease, and about axial disease. There's an interesting abstract that brings this up and raises this question at this meeting, some data from the psoriatic arthritis research consortium that looks at improvement in the BASDAI score, which is typically thought of as an axial composite score, but they looked at psoriatic arthritis patients with and without axial involvement by a variety of definitions and the improvement in the BASDAI score was similar in both groups, which suggests that what we think of as an axial score may not be fully axial and may reflect peripheral arthritis. And that, becomes interesting as we start to think about how people respond in psoriatic arthritis. Number of abstracts at this meeting and other meetings on different treatments in axial disease.

Most of these are post hoc analyses, so there's an abstract on axial disease with upadacitinib therapy of psoriatic arthritis. Not a primary study design element, but they looked after the fact at patients who had been defined as axial disease and looked at whether upadacitinib worked as well in those patients as others. There's another abstract looking at axial disease in the guzelkumab clinical trials for psoriatic arthritis. And then there's data from the MAKSIMIZE study, which is actually the only study we have that looks primarily at axial psoriatic arthritis. This study involved secukinumab and looked at patients with spinal involvement with MRIs and plain film imaging in the study and looks at outcomes in those patients.

Again, they suggested improvement, but the issue is that they use axial measures that may or may not fully reflect axial disease. So I think these bring up a lot of interesting questions, and I think they bring up the question that we're gonna be struggling with at this meeting and for many meetings and in the literature in the next few years to come, does axial involvement distinguish different medications? Are there different treatments that are gonna be more useful in patients with axial disease? And should be selecting those drugs in those patients, much like we've stayed away from methotrexate for psoriatic arthritis in patients with axial involvement and moved to biologics, but are there specific biologics or JAK inhibitors gonna be the way to go? How is this gonna sort of intersect with the concept of treat to target, which is becoming an important concept in psoriatic arthritis, much like it's been in rheumatoid arthritis?

Where does axial response fit into important part of the target? And again, how do we separate that out? And finally, how is this gonna reflect what we have in terms of treatment recommendations? The GRAPA group is currently revising their treatment guidelines and they made a very clear effort in the previous two iterations of these to separate people out by domains. So where do we put the axial domain?

And are those patients the same as patients with AS or AXPHA? In the past, that's the data we've had to go on, but now as we start to have data from psoriatic arthritis trials, can we look at it differently? A lot more questions than answers, but I think this is an area to focus on, I think it's gonna be an area of increasing interest at this meeting and the next few meetings to come, so I'd urge you to take a look at it. If you wanna look at this and other areas, I'd urge you to to log in to RheumNow. Lots of information about ACR Convergence twenty twenty.

Hello, ACR Converge twenty twenty. I'm doctor Rachel Tate, and I'm coming to you from my family's home outside of beautiful Louisville, Kentucky. I just reviewed several abstracts today and I wanted to share with you regarding non radiographic axial SpA. So, as you know, as of October 2020, we now have an ICD-ten code for non radiographic axSpA. That's M46.8.

But prior to this, our patients were generally lumped in AS for coding purposes. However, there remains a great debate regarding classification and ultimately qualification of this disease. Is non radiographic axSpA its own separate entity? Is it early AS? What is it?

So in order to kind of answer these types of questions, we really need to evaluate it on multiple levels. It's really not enough to take it at face value. So for this video, I am going to ask you to think about patient characteristics as they relate to these two terms and diagnosis. So in an ixekizumab study, Abstract eight seventy six, which reviewed the COAST trial series cohorts, both in axial SpA as well as non radiographic axSpA, a total of five seventy four patients. This of course is a descriptive difference, but it found that baseline characteristics based on gender, not on radiographic versus non radiographic evidence of disease.

But in both cohorts, women were found to be older at disease onset. They experienced longer duration of symptoms, including peripheral joint symptoms, and they had a lower prevalence of a positive HLA B27 than men did. And this was in both the non radiographic axSpA as well as axSpA. So similarly, a Spanish study, this is abstract four forty eight, it showed no difference in cardiovascular risk in eight zero six patients in either axSpA or AS patients. So kind of with these in mind, I actually make the argument that non radiographic axSpA is part of the spectrum of AS.

So despite having a new ICD-ten code, it won't change the way I approach a patient. But in theory, I'm hopeful that it will help my patients to get therapies they need sooner. For this and more coverage of ACR twenty twenty, check this out at roomnow.com and follow me at Twitter UpToTate.