okay, so let's look at the #ACR21 plenary as we go so a reminder - FDA-mandated phase 3b/4 safety endpoint study specifically looking at patients >50yo with at least one other CV risk factor today we're looking at MACE: that's CV death (excl PE), MI, stroke ABST0958 @RheumNow https://t.co/9U8Sahb9Q7

Vitamin D ⬇️incident autoimmune diseases & so do fatty acids but latter is not stat signif. 25k older adults with factorial design, no interaction. ? Buy vit D stock @RheumNow #ACR21 #ACRBest VITAL trial abst#0957 https://t.co/Qk3VwNOZie

Can vit D, omega-3 fatty acids prevent autoimmune dx development, even in non-deficient people? (some plausibility, no other meds can) vit D *might* have an effect, esp post-2y cautious interest seems okay! extension worth looking at VITAL trial add-on #ACR21 ABST0957 @RheumNow https://t.co/H5aF8Vl79u

Can vit D and omega3 prevent autoimmune dz? 25,871 adult pts randomized:vit D 2000 IU daily, omega 3 (1 g/d), combo, PCB and followed 5 yrs Vit D & combo showed statistical sig over time, omega3 showed a favorable trend Abst#0957 #Plenary #ACRbest @rheumnow https://t.co/moMCm9IJmO

Take your supplements 🐠 fish oil and Vit D! VITAL RCT presented by @karen_kc123 shows Vit D +/-n-3 fatty acid ⬇️ incidence of AID compared to PBO. Promising although AID were self reported! @RheumNow #ACR21 #Abst0957 https://t.co/xdEdKuwXci #ACRBest https://t.co/zWrr9oC7F5

Interesting study with Dr. Julia Manasson on gut and skin microbiome in monozygotic twins discordant for psoriatic disease. (red = Psoriatic). Gut ruminococcus bromii virtually absent in psoriatic pts. Eager to see further studies! #ACR21 Abst#0944 @RheumNow https://t.co/zrZPBAjh5p

Clinical Pearl at @ACR21 Is patchy tongue erythema + angular chelitis representative of Sjogren's or oral candidiasis? Beware: Oral candiasis is a mimic of Sjogren's tongue. Differentiate by asking if burning of tongue. If so, not Sjogren's -- start PO antifungal! @RheumNow https://t.co/FbdiX8PFKV

I honestly find Vit D literature confusing! VITAL RCT omega3 and vit D in preventing autoimmune diseases. They seems to work?🧐The confidence intervals just shy of 1.00...I am still skeptical..but keeping vit D normal doesnt hurt I guess....#ACR21 @rheumnow abst#0957 https://t.co/QFcz2zK4Ic

Physician global score was the strongest predictor of future flares in AS patients with TNFi dose tapering. 29 (27%) flared at 2/3 of standard dose, 21 (20%) at 1/2 dose, 29 (27%) at 1/3 dose and 27 (25%) after discontinuation @RheumNow #ACR21 Abst#0929 https://t.co/pIzLgexe3k https://t.co/UM9cGLiYl7

Abst#0946 shows a distinct lipid profile in RA vs PsA synovium + synovial fluid. Sphingomyelins & phosphatidyl-cholines/ethanolamines had the greatest separation power to classify RA + PsA samples. These lipid markers may have clinical utility if validated. #ACR21 @Rheumnow https://t.co/ktKRypTtlE

SKIPPAIN results: Spinal pain response after 8 weeks of SEC showed notable differences between HLA-B27 subgroups. Can subtype pre-determine tx efficacy/response? Abs 0917 #ACR21 #RheumNow @RheumNow https://t.co/FKpCqXpobM https://t.co/WbjjyTIaiG

MCP, wrist, elbow, shoulder and ankle: Not common sites for #osteoarthritis so consider a metabolic disease like CPPD🧐 @RheumNow #ACR21 #RheumTwitter #MedTwitter https://t.co/utId4ljsZK