Anti-Rheumatic Rx

Say Goodbye to Methotrexate in PMR? Despite mixed results on its clinical efficacy in three previous randomised controlled trials (RCTs)1-3, methotrexate is considered the most widely used GC sparing agent. #ACR24 https://t.co/Q5Sw9dvYqJ https://t.co/jvEmg6aPcq

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Dr. John Cush @RheumNow( View Tweet )
Best of

#ACR Best 2024 - Day 4

Jack Cush, MD

Although the last day of ACR Convergence 2024 was but a half day - it was chock full of gems, many coming from the late breaking abstracts presented today.  As chosen by the RheumNow faculty, here are some highlight presentations you need to know about.

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Methotrexate to Prevent RA, Clear as Mud

Richard Conway, MBBChBAO, PhD

Intervention in individuals predisposed to develop RA, with a holy grail of prevention of RA, has long been a hot topic. The 4-year results of the TREAT EARLIER study, presented at Tuesday’s oral abstract session, show that methotrexate appears to prevent the development of RA in high risk

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artificial intelligence machine learning computer

Predicting flares in rheumatic diseases with machine learning

Antoni Chan, MD, PhD

Rheumatic diseases, such as axial spondyloarthritis (axSpA) and rheumatoid arthritis (RA), are marked by unpredictable disease flares that adversely impact quality of life and long-term outcomes. Advances in machine learning (ML) provide a promising avenue for predicting these

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Prgnancy,outcome

Improving fertility in women with RA

Jiha Lee, MD

For many women, the journey to motherhood brings a sense of anticipation and joy. However, for those with rheumatoid arthritis, this journey presents unique challenges. At ACR Convergence 2024, researchers discussed how advancements in reproductive medicine and RA management are paving the way

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Time the💉 Response to pneumococcal vaccine better when given before starting MTX. Stay updated on ACR and EULAR vaccination recommendations! #ACR24 @RheumNow ABST#2676

Jiha Lee @JihaRheum( View Tweet )

Hypoxia seems to exacerbate neutrophil activation by ANCA - enhanced F-Actin polymerization - enhanced NET formation Could hypoxia predilection in certain tissues (kidney, lung) lead to the AAV phenotypic disease patterns? @RheumNow #ACR24 https://t.co/KxaeMvkd2t

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Brian Jaros, MD @Dr_Brian_MD( View Tweet )
Increased risk of mortality related to negative effects of GC use persists long after stopping and never return to pre-GC levels. #GCStewardship #ACR24 @RheumNow ABST#2673 https://t.co/5AwHDmvQGf

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Jiha Lee @JihaRheum( View Tweet )
Wt ⬇️ = Better #PROs in 👇autoimmune #rheumatic #diseases if > 5% wt loss. #ACR24 ⁦@ACRheum⁩ ⁦@RheumNow⁩ Didn’t work for non overwt Ex Normal BMI and T2DM 🤷 https://t.co/81OuTfZ0Nx

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Janet Pope @Janetbirdope( View Tweet )
In this study by Dr CArriens et al, there was no difference between the vaccine response to Influenza by either HAI or Ab levels in Anifrolumab-treated pts. AEs - mild, moderate No serious aEs 💉#vaccinate your pts on anifrolumab with influenza @RheumNow #ACR24 abs2424 https://t.co/XPwlzUS02i

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sheila @RHEUMarampa( View Tweet )
Hydralazine - known culprit of drug-induced AAV How does hydral (H) AAV differ from primary (1) AAV? 💥 High dual positivity MPO/PR3 💥 DAH / pleuritis more common in H-AAV 💥 ENT, constitutional, nervous, ILD in 1-AAV 💥 More 6mo remission in H-AAV @rheumnow #ACR24 Abst 2496

Brian Jaros, MD @Dr_Brian_MD( View Tweet )

Weinblatt et al. AMPLIFIED trial. No difference in response rates of RA to adalimumab or abatacept based on dual seropositivity/shared epitope status. Fits with my priors and refutes a previous pilot study. @RheumNow #ACR24 Abstr#2671 https://t.co/OUwnlsP6jU https://t.co/RBN6ivSKDr

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Richard Conway @RichardPAConway( View Tweet )
Dumoulin et al. 4 year results of TREAT EARLIER trial of 1 year MTX in CSA. In high risk ACPA- group, reduced risk of RA development, 8.6% vs 29%, HR 0.27. No difference at 4 years in ACPA+ or low risk ACPA- @RheumNow #ACR24 Abstr#2672 #ACRbest https://t.co/S2yJm196UV https://t.co/bJ9JySteUs

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Richard Conway @RichardPAConway( View Tweet )
SELECT-GCA suggests JAKis may be the new kid on the block Clinicians treating giant cell arteritis (GCA) have long had to contend with a disappointingly limited selection of drugs from which to select. https://t.co/vtJzwFZMBq https://t.co/dikMRwjIZY

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Dr. John Cush @RheumNow( View Tweet )
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Up-front Secukinumab in PsA?

Richard Conway, MBBChBAO, PhD

We now have an absolute plethora of agents available for use in psoriatic arthritis (PsA). In contrast we have an almost complete lack of understanding of how best to optimise use of these agents – what is the right agent at the right time for the right patient. A study presented this week has

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Is Pregnancy Truly the Solution for RA? Pregnancy is perhaps the oldest treatment in rheumatoid arthritis (RA) and has been associated with a natural improvement in disease control in 50-75% of patients. Others, however, are not as successful with unchanged disease activity or… https://t.co/MesVIUl0fC https://t.co/760i5znmeu
Dr. John Cush @RheumNow( View Tweet )
Conaghan et al. LEVI-04, neurotrophin-3 inhibitor in knee OA. 518 patients. Significant improvements in WOMAC pain and function, and PGA. So sign of any increase in rapidly progressive OA (as with NGF inhibitors) @RheumNow #ACR24 Abstr#L15 https://t.co/qud4wTAikY https://t.co/0wjjG4U4bf

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Richard Conway @RichardPAConway( View Tweet )
#Positive #RCT of #Nipocalimab a FcRn receptor inhibitor in #Sjogrens #Disease 👏Phase 2 +RCT ESSSDAI and ESPRI both improved 🤷‍♀️what it means to lower #antibodoes #Ro #La Excited for Phase 3 results #ACRBest #ACR24 @RheumNow @ACRheum abst#2527 https://t.co/NeeYT7VR16

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Janet Pope @Janetbirdope( View Tweet )
@drceowen @TheLancetRheum @RheumNow Efficacy in newly diagnosed & established PMR is not necessarily interchangeable different treatment paradigm ?different immunologically Many other diseases have different Rx for induction vs maintenance, early dx vs established. Having said that: doesn't look great for MTX. https://t.co/89lByaYdYq

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David Liew @drdavidliew( View Tweet )
Lot said about #ACR24 ABST1697: MTX in newly diagnosed PMR, neg RCT Many have said no hope for MTX in PMR now Agree doesn't bode well However, MTX may still have role in established PMR @drceowen & I have made that call a priori @TheLancetRheum https://t.co/ywCJc0zHzC @RheumNow https://t.co/JUXk2tDNyR

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David Liew @drdavidliew( View Tweet )
It is NO LONGER a ACCEPTABLE To NOT consider #MMF or #Cyclo + another proven #Rx Added to #HCQ and #tapering /limiting #glucocorticoids RCTs in #lupus #nephritis support this ? Is which to add #belimumab #CNI #volclosporin #obinutuzimab #ACR #ACRbest @RheumNow @ACRheum https://t.co/a7WMFfCyXl

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Janet Pope @Janetbirdope( View Tweet )

JAK-pot! How fast do DMARDs work? Dr. Mike Putman interviews Dr. Kim Lauper about abstract 0501, How Fast Do JAK-inhibitors, TNF-inhibitors, Abatacept and IL-6 Inhibitors Act in Rheumatoid Arthritis? An International Collaboration of Registers of Rheumatoid Arthritis Patients… https://t.co/GO9EwyrVpV https://t.co/lELE5SJW5i
Dr. John Cush @RheumNow( View Tweet )
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ACR 2024 - Day 3 Report

Jack Cush, MD

Highlights from Day 3 at ACR24 included the plenary session presentation on Nipocalimab (previously reviewed), but the big highlight was the Lupus Nephritis guideline recommendations.

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PMR spotlight

JAKs and Other Drugs in PMR

Richard Conway, MBBChBAO, PhD

This has been an interesting ACR meeting in terms of PMR updates. I would argue that we are still far too wedded to glucocorticoids only in the management of PMR. Yes, some patients will do fine with just glucocorticoids but we persist far too long with a glucocorticoid only strategy in others

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Continuing or Stopping Low Dose Glucocorticoids in GPA Dr. Mike Putman reports about plenary session abstract 0774 (the TAPIR study) about how and when patients can stop steroids in GPA. #ACR24 https://t.co/OWqN0jmkc1 https://t.co/foOaVRtGiV

Links:

Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

Overlap Syndrome with ILD

Jack Cush, MD
Cush RheumThought ILD

How would you manage a patient with Overlap (anti-synthetase) syndrome, ILD, polyarthritis and myositis?

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Best of 2023: New ACR RA-ILD Treatment Guidelines – What Were They Smoking!?

Richard Conway, MBBChBAO, PhD
Lungs ILD
Rheumatoid arthritis related interstitial lung disease (RA-ILD) is common, with symptomatic RA-ILD affecting approximately 8% of RA patients. There is a very limited evidence base supporting treatment and therefore the recent release of ACR guidelines is to be welcomed. However, the published guidelines appear discordant with the best available evidence base.  Read Post

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