Pre-ACR25 (10.24.2025) Save

It's 10/24/2025. This is the RheumNow podcast. Hi. I'm doctor Jack Cush, executive editor of rheumnow.com. It's the day before ACR twenty five begins in Chicago, and we'll talk a little bit about that at the end.

I have a full report today, but I wanna remind you, registration for RheumNow Live twenty twenty six is now open. It's February seventh and eighth in Dallas. We expect to see you there. Fabulous conference. Look at the agenda.

The people on here, the program really looks exciting. Mortality in RA, mucosal hypothesis of RA, ILD in RA, obesity management, perioperative management, paradoxical psoriasis. Do you do X rays in psoriatic arthritis, IL twenty three versus IL seventeen, history of gout, H. Pylori in rheumatoid arthritis, a fabulous section on diagnosing and treating spondyloarthritis, asymptomatic CK elevations and myositis antibodies, the SMILE study, Sjogren's update, and, Mike Putman talking about GCA and PMR. It's a great program.

Again, rheumnow.live. Go there to register. Today, we'll begin with a, FDA report. The FDA did approve obedentuzumab, a drug previously only approved for hematologic cancers. It's an anti c d 20 monoclonal antibody.

The phase two, phase three data looks really good. It gets approved based on the phase two nobility study, phase three regency study, wherein obinutuzumab plus standard of care out performed the standard of care alone in complete renal response forty six percent to forty three percent. No new safety signals. This will be a great new addition to our lupus treatment arsenal. An interesting report on, lupus nephritis.

Patients three hundred twenty patients with lupus nephritis follow for almost ten years. They these are all patients who had biopsy proven lupus nephritis. They found that nine point three percent of them developed a venous thromboembolic event. This included DVTs and PEs and more serious VTEs over time. The meantime from the diagnosis of lupus nephritis to the first VTE event was four point four years.

Predictors of getting a VTE was high activity as measured by the SLEED I two k and proteinuria. These are facts that you know. Lupus patients are at risk. Proteinuria patients at risk. Lupus nephritis with proteinuria is certainly at risk for VTE.

It's something you need to worry about. Another new regulatory announcement on lupus is safnello, the anifrolumab monoclonal antibody against alfinterferon is up for consideration in the EU. The CHMP, has recommended to the EMA that this drug be approved for SLE along with standard of care therapy using a once weekly prefilled pen. This, the CHMP is a lot like the FDA advisory committees who recommend the FDA, approval, and that's where it stands right now with the regulatory agencies in The EU. A big study this week was announced by AbbVie, their select switch study of phase three b, study of patients who had RA, active RA, having failed the TNF inhibitor were then randomized to either receive Humira or RINVOQ, four hundred ninety two patients.

This is a long trial. Primary endpoint was achieving a low disease activity with a DAS CRP of less than 3.2. That was achieved, more likely when they were randomized to upa rather than adalimumab. So it's enough failures. They're gonna go on another drug.

They either get the JAK inhibitor upadacitinib or they get another TNF inhibitor adalimumab. UPA was better than adalimumab forty three percent to twenty two percent in low disease activity as highly significant. And then for remission, DAS less than point two point six, twenty eight percent versus fourteen percent, also highly significant. No new safety signals. It does help in making that big decision.

What do I do when things don't work? Right? Other decisions about difficult to treat was studied by a Czechoslovakian registry, the ash the ATRA registry of almost 8,500 patients. When they looked at their population, seven point five percent met criteria, the EULAR criteria for d two TRA. Twenty one percent of their patients had achieved remission.

When they looked at you know, could they identify d two TRA earlier? They could when they use machine learning. Machine learning was very successful, when it used the predictors of CDI dash 28, TJC HAC, its CRP, and steroid use. Though these are all kind of risk factors for developing d two TRA. And when they did the you know, accuracy was over 60%.

Area of the curve was, point six five to point eight three depending on the model that they use. Again, machine learning AI is gonna be useful in the future in telling you who's at risk and either for great outcomes or for poor outcomes like difficult to treat RA. We do know that fatty liver disease, NAFLD is a complication seen up to a third of our of our RA patients. A study of a hundred and seventy patients on biologics, found that thirty six percent of them had NAFLD. Methotrexate use was not a risk factor.

Biologic use was not a risk factor for developing fatty liver. It was, however, linked to having metabolic syndrome, obviously, BMI being high, waist circumference, and also having elevated AST and ALT. Well, that's a duh, is it not? But those are significant risk factors for developing, fatty liver in RA. Another study in RA looked at the evaluation of smoking cessation.

This is a study where they had patients who were either given a program, a twelve week program with six weeks of active intensive counseling as far as smoking cessation, and they looked at what happened to them. Well, the one three months later, the ones who underwent the smoking cessation intervention had a significant reduction in actually stopping smoking, but interestingly, did not get better clinically. ULAR response rates, TJC, CRP didn't really change. But then again, the people that entered the study had low disease activity. Their DAS 28 CRP mean was 2.9.

So they were already in mild activity. So what we don't know is if you stop smoking, will it improve disease activity? I would think it would, and we have only a little bit of indication that's the case. This study does not say that. Interesting.

Another study on, seropositive RA finds that, in four hundred twenty three patients with RA that twenty one percent of them will develop ILD, over ten years. Turns out the predictors of developing RA ILD were not RF and CCP as has been shown in other studies, but was instead high monocyte counts. Monocyte counts high monocyte counts is a bad marker for RA activity. It's not something that we typically look at, but it's free. It's on the CBC.

Why not check it out? You know what to do with your COVID patients who have long COVID symptoms? I don't. I call Lenny Calabrese for advice, but there are studies underway to see if you might do better if you give them COVID drugs or anti inflammatory drugs. JAMA published a study of colchicine intervention in long COVID.

A lot of patients, colchicine versus not, no difference. No difference in COVID outcomes, and they were mainly functional outcomes. We still don't know what to do with long COVID. Another interesting report this week was on, SGLT two inhibitors, which we know are good in diabetes. We know that they are good at weight loss.

We know that there's evidence that SGLT two inhibitors will reduce mortality rates in lupus and autoimmune disease, compared to DPPI four drugs. In this study, they looked at whether diabetics who are on SGLT twos, what was their frequency of developing an autoimmune disease, and it was lower. So these drugs are actually they're not great at weight loss like the GLP ones are. They do, but not as much. The weight loss in these people was, you know, six to 10 pounds, I think, was the average.

But they were significant at lowering the risk of developing future autoimmune rheumatic disease, mainly inflammatory arthritis, suggesting that these drugs may have immunomodulatory effects directly or indirectly. Anchovasculitis and poor predictors. A small study, seventy eight patients, that had poor outcomes and that the poor outcomes being either end stage renal disease sixteen out of seventy eight or death fifteen out of seventy eight. That's not good. Right?

I mean, that's thirty one patients or thirty patients out of seventy eight with horrible outcomes. The risk factors for these poor outcomes either being end stage renal disease or death was an elevated BUN, and an elevated WBC count at baseline. The risk for death were about the same being on plus antiplatelet drugs and a neutrophil to lymphocyte ratio and also prior cardiovascular disease. A study from Southern Sweden looked at the, risk of IBD amongst patients with axSpA. We know that depends on how you do it.

Clinically overt IBD and axSpA patients is a minority, probably less than ten percent. You know, microscopic, IBD is as high as fifteen percent. In this study from Southern Sweden, a hundred and fifty two radiographic and non radiographic axial spondyloarthritis patients were studied with fecal calprotectin levels. And the ones who had fecal calprotectins had more evidence of damage and progression of the spine as measured by MSAS values. So, again, fecal calprotectin being above fifty micrograms per kilogram, had a twofold higher risk, and that was in all XBA and a 2.9 fold higher risk in radiographic XBA.

It was even higher there. Maybe we should be looking for a cold IBD. If they have symptoms, I would do a camera study or refer them. You certainly might order fecal calprotectin levels. I like to study on, diagnostic, tips in patients with systemic sclerosis.

A twelve year study of a 115 patients shows that finger to palm difference, distance. That's the tip of your fourth finger to the distal palmar crease, you know, from here to here. And it's useful in predicting who's at risk in the future for progression of their systemic sclerosis measured by skin thickening and also for the development of digital ulcers. Cool. Well, that's it for this week's report.

Make sure you come by the RheumNow booth. We'd love to talk to you, take a picture with you, hear what you think, about what we should be covering and what was good at the meeting. It's gonna be a really exciting meeting. We'll be there. We'll be doing a lot of videos, a lot of tweeting.

Look for our daily recaps. You might wanna sign up and listen to those every day starting Sunday, Monday, Tuesday, Wednesday, a day one, two, three, and four recap at 5PM central time. It's gonna be livestreamed either on our website, the RheumNow website, or on YouTube, LinkedIn, Twitter, and also on Facebook, 5PM central time. And then after we get back from ACR, we'll be doing again more, reports at 7PM, eastern time, 6PM central time with topic reports on PSA, RA, etcetera, like four or five days in a row. We'll be doing that starting on Sunday night after ACR.

See you at ACR. It's gonna be a great meeting. Take care.