Cardio/Pulmonary

Shedding Weight and Pain: The Promise of Anti-Obesity Medications in RA For years, rheumatologists have championed weight loss as a cornerstone of care for patients with rheumatoid arthritis (RA) and obesity. RA is an independent risk factor for cardiovascular disease (CVD), a… https://t.co/iozo0FQFzj https://t.co/93e4nZMHJo
Dr. John Cush @RheumNow( View Tweet )
ICYMI: Precision medicine in Ssc ILD? Yes! -Watch and wait approach can cause irreversible lung damage. -⬆️CRP: biomarker of response (predicts mortality) -⬆️KL-6: biomarker of severity (predicts progression of fibrosis) -FAPI-PET: can eval disease activity vs response to ttx.… https://t.co/bTepwrsuNN https://t.co/e6xjtuquka

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Adela Castro @AdelaCastro222( View Tweet )
Does CVD mortality risk change after stopping GC in RA? ➡️28078 incident GC users ➡️Incr mortality risk from CVD &infections persists post-cessation ➡️Risk never returns to pre-GC level after prolonged use ⏩Use GC at lowest dose for shortest time possible Ab2673 #ACR24 @Rheumnow https://t.co/dtLU8obLke

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Mrinalini Dey @DrMiniDey( View Tweet )
Yes No

Playing it Safe with RA? JAK vs. TNF Debate

Brian Jaros, MD

Reported safety signals, at odds with the efficacy of these medications, have left rheumatology clinicians in a difficult position when considering when during a patient’s treatment course and in which patients, specifically, JAKi should be used. Two abstracts from ACR convergence 2024 further

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#PAH in #SSc still has a poor #prognosis 👎 Esp #ILD with PAH - a double whammy But also group 1 PAH And Some are unclassifiable ▶️also bad px Need Earlier detection More interventions ?prevention Abst#0678 #ACR24 @RheumNow @ACRheum @sclerodermaUM https://t.co/AEQsTC1pzQ

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Janet Pope @Janetbirdope( View Tweet )
Loiseau et al. 4700 pSS, 47000 comparators. pSS associated with increased risk of every CV/VTE outcome. Did not have that in my priors! @RheumNow #ACR24 Abstr#2631 https://t.co/QKemUhbcG8 https://t.co/twpjdS2L63

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Richard Conway @RichardPAConway( View Tweet )
Triboulet et al. JAKi in RA-ILD. 42 patients. Stability of PFTs over median 21 months. HRCT stable in 62%. Progressive ILD on HRCT in 19%. @RheumNow #ACR24 Abstr#2249 https://t.co/PY9BrCfNHc https://t.co/r8fIgrjyDu

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Richard Conway @RichardPAConway( View Tweet )
Cardiology is on! Dr. Olin discusses Fibromuscular Dysplasia findings on imaging Definite: string of beads and/or focal narrowing in right setting / location Possible but nonspecific: dissection, ecstasia, aneurysm, and tortuously @RheumNow #ACR24 https://t.co/Dr81KQfLSf

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Brian Jaros, MD @Dr_Brian_MD( View Tweet )
#2222 📊 New data on #RA-ILD: 🔴In early RA, ILD prevalence hits 21.4% after 10 years, with 8.2% cumulative incidence at 5 years (IR 14.9/1000 PY). 🔴ILD often precedes or coincides with RA onset. 🔴NSIP > UIP 🔴airway involvement less common than expected. #acr24 @RheumNow

Caoilfhionn Connolly @CaoilfhionnMD( View Tweet )

statin

ORAL Surveillance - Is Statin Use the Problem/Solution?

Eric Dein, MD

The findings from ORAL Surveillance Study have been a dominant conversation at recent ACR Convergence, with the seminal findings and subsequent analyses a target of debate. Subsequent post-hoc analyses, follow-up studies, and claims data analyses have been used to further interpret the data,

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The 🫀is muscle‼️ 💥From the maestro herself @JuliePaikMD underscores why cardiac involvement in myositis can't be overlooked. 🔥Crucial insights with major implications for patient care and outcomes #acr24 @RheumNow @HopkinsMedicine @jhrheumatology https://t.co/mw6BvkdF2w

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Caoilfhionn Connolly @CaoilfhionnMD( View Tweet )

Risks for HCQ cardiotoxicity: 👉>5 yrs use 👉>5 mg/kg/d (cumulative dose >500,000 mg) 👉CKD 👉use NSAID 👉preexisting heart dz 👉presence of ocular, derm, SkM toxicity - Dr M Garschik #ACR24 @rheumnow https://t.co/LFobgls4jm

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TheDaoIndex @KDAO2011( View Tweet )
heart,CV,MI.cardia,

Addressing CV Risk in RA: Are we doing enough?

Mrinalini Dey, MD

ORAL surveillance was a post-authorisation safety study of tofacitinib 5mg and 10mg versus TNF inhibitors, focusing on rates of adverse events, including MACE. A higher incidence of MACE was observed with the use of tofacitinib. Statins are recommended in patients with a history of

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Dentition is important in RA, but it's easy to forget it's a matter of life or death. NHANES data shows fewer teeth strongly correlates with higher mortality (esp cardiovascular). Missing teeth = CV death HR >30 Holistic dentition is holistic RA care #ACR24 ABST1325 @RheumNow https://t.co/Z40bSFybuS

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David Liew @drdavidliew( View Tweet )
Conv3.jpg

ACR 2024 - Day 2 Report

Jack Cush, MD

Plenary sessions began the day, followed by thousands on the abstract floor. Here are a few of my favorite presentations from day 2 at ACR 2024.

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Dr. BDinneen et al reported predictors that can help screen axSpA pts w/o traditional CV RFs for carotid doppler utz: - shorter dse duration - no family hx of IHD - HLAB27+ - ⬆️ dBP, WHratio, ferritin, TC, LDL and TC:HDL ratio Small size, more data reqd @RheumNow #ACR24 abs1440 https://t.co/3pZxFmutJz

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sheila @RHEUMarampa( View Tweet )
Wallace et al. Case control study. 648 cases 1241 controls. Cumulative glucocorticoid dose and risk MACE. Dose dependent increase in risk, OR 1.01 for 10% increase GC, 1.21 for 10-fold increase GC. @RheumNow #ACR24 Abstr#1719 https://t.co/wraiWOl1dv https://t.co/feht58RDNc

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Richard Conway @RichardPAConway( View Tweet )
A#1694 To get one or two lungs for lung transplant? 🫁 Autoimmune related ILD transplant outcomes? 145 single (SLT), 461 double (DLT) Similar 1 yr mortality - HR SLT 1.19 unadjusted, 1.49 adj - not statistically significance @RheumNow #ACR24 https://t.co/uo8WbrNFAm

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Eric Dein @ericdeinmd( View Tweet )
#Gout attack is assoc w 1.5 X MI, MACE in next 30 days @ACRheum @RheumNow #ACR24 https://t.co/7IeFbW6xW8

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Janet Pope @Janetbirdope( View Tweet )

A#1693 Change in FVC @ W12 or 24 has progn value @ w52 in AI-ILD Study SENSCIS (SSc) & INBUILD (SARD) trial PBO gps SENSCIS: OR for ILD progression 1.9 @ w12, 2.5 @ w24 INBUILD: OR 2.2 @ w12 & w24 Early PFTs predict outcomes @ 1 yr, short trials may be feasible #ACR24 @RheumNow https://t.co/8cICAeG0nr

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Eric Dein @ericdeinmd( View Tweet )
RA-ILD: 💡Lifetime prevalence seems low but ~40% can have subclincal. 💡Screen early in symptomatic pts. 💡RA disease control decreases ILD progression and mortality. 💡RA-ILD UIP pattern seems to respond to immunosuppression. #ACR24 @RheumNow https://t.co/q3iACMeYVU

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Adela Castro @AdelaCastro222( View Tweet )
A#1690 fibroblast activation protein inhibitor (FAPI)-PET in SSc ILD Introduces FAPI quantification algorithm FAPI uptake predicts greater rate of FVC decline. Trend for DLCO, not statistically signif FAPI volume & intensity both predict accel lung decline #ACR24 @RheumNow https://t.co/YA2ptLDaMy

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Eric Dein @ericdeinmd( View Tweet )
#1689: race-neutral 🫁 function equations in SSc improve equity: 🔹 Race-specific equations underestimate disease severity in Black patients. 🔹 Switching to race-neutral reclassified 45% of Black patients to more severe, 16% of White patients to less severe @RheumNow #acr24 https://t.co/BfK2PsCMX5

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Caoilfhionn Connolly @CaoilfhionnMD( View Tweet )
More data from PAISLEY, deucravacitinib in SLE Small but significant benefit w/respect to joints, a little disappointing tbh Would like to see this for all manifestations ie pericarditis, pleuritis, etc Anyone have an infographic or useful chart? #ACR20 @RheumNow Abstr#1552 https://t.co/tXUoUtssxo

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Mike Putman @EBRheum( View Tweet )
Study on cardiovascular deaths in SLE: - Analyzed 1999-2020 data - Overall decline in mortality rates, but recent increase since 2014 - Higher rates in women and African Americans - Geographic disparities noted #ACR24 abst#0998 @rheumnow https://t.co/dpjsl0gI0x

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Bella Mehta @bella_mehta( 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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