ACR24: Rheumatology Roundup
Join Drs. Jack Cush and Artie Kavanaugh as they review 15+ presentations and abstracts from the 2024 ACR Convergence meeting in Washington, DC.
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JAMA Images in Dermatology - Palmar Fasciitis and Polyarthritis Syndrome -- 50yoM w/ 6 mo. hx of hand/finger swelling, stiffness, thickening, and erythema, impairing mobility. Also found to have hepato-/splenomegaly, WBC 151K, LDH 889; abnl BM Bx. Pt dx w/ palmar fasciitis & CML… https://t.co/1Z9Oz0sRa7 https://t.co/HRSJcv4lzZ
Dr. John Cush @RheumNow( View Tweet )
ANA+ and no Autoimmune Disease? Check the liver
Dr. Janet Pope discusses abstract 0627, presented at #ACR24.
https://t.co/4HV2kqjibL https://t.co/kmVcvUZtRQ
Dr. John Cush @RheumNow( View Tweet )
Differential diagnosis of ACA+
1. SSc
2. Sjogren Syndrome
3. PBC
4. Overalp syndrome https://t.co/JmqDaaZerJ
Dr. Dinesh Khanna @sclerodermaUM( View Tweet )
A#2647
DADA2 cohort 101 pts in India
Median delay dx 5 years - 5 pts of >20 yr
- 39 pts w GI involvement- bad outcomes
Skin most common - largely livedo, then ulcers/nodules
CNS common w ischemia
Many Rx before dx
12 deaths (11.8%) - 8 GI, 3 CVA, 1 suicide
#ACR24 @RheumNow https://t.co/Q8kiVbJq8I
Links:
Eric Dein @ericdeinmd( View Tweet )
The precise mechanism of action of GIOP is not known. Decrease in osteocyte LCN is observed. Abstr#2528 @RheumNow #ACR24 https://t.co/fazUUy03fQ
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
Shedding Weight and Pain: The Promise of Anti-Obesity Medications in RA
With the advent of FDA-approved anti-obesity medications such as semaglutide and tirzepatide, a new avenue for managing this challenging patient population has emerged. But how might these drugs impact the trajectory of RA, and are we on the cusp of a paradigm shift?
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Abstract 1686: Urinary proteomics reveals potential markers (MMP-13, M-CSF receptor, CD163, ALCAM, FOLR2) and pathways (neutrophil degranulation, ECM, tissue remodeling) involved in lupus nephritis Class II.
@RheumNow #ACR24 https://t.co/kufd2zl9yc
Akhil Sood MD @AkhilSoodMD( View Tweet )
#1330
🔬F-Calprotectin in Early RA
➡️ New-onset RA pts(n=104) had ⬆️ F-calprotectin vs controls(n=50)(71 v. 17µg/g; p<0.001)
🔑Higher F-calprotectin linked to ⬆️ DAS28 & NSAID use
⬇️levels @ 6 months Rx
❓Role of subclinical gut inflammation in early RA
#ACR24 @RheumNow
Caoilfhionn Connolly @CaoilfhionnMD( View Tweet )
If high +ANA and NO #rheumatic #disease LOOK 👀 at #LIVER #Autoimmune #hepatitis And #alcoholic #liver #dx #ACRBest #ACR24 @rheumnow abst#0627 https://t.co/EVLUyvpBfD
Links:
Janet Pope @Janetbirdope( View Tweet )
Difficult to Manage Axial Spondyloarthritis
Studies show that patients with difficult-to-manage axSpA have a higher disease activity; however, the lack of a consensus definition led researchers and clinicians to utilize their own proposed definition, resulting in variability of the characteristics of non-responders.
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Yokose et al. Population study using NHANES. Gout patients had 1.6 higher fold risk of gallstone disease. What? Why do we care? Well, GLP-1s associated with higher risk gallstones also... @RheumNow #ACR24 Abstr#0133 https://t.co/nf4R0hQe50 https://t.co/wDrEDeNbpT
Links:
Richard Conway @RichardPAConway( View Tweet )
Pharmacologics:
Cannabis absorption and metabolism is variable
Inhaled absorption 10-35%
THC is 97% protein bound, lipophilic and deposits in fat and spleen
Liver function is critical for THC metabolism
16S18 @BharatKumarMD
#ACR24 @RheumNow
Eric Dein @ericdeinmd( View Tweet )
The METEOR study reveals distinct clinical features in spondyloarthritis (SpA) patients with vs. without IBD.
Key features of those with IBD:
- Lower male prevalence
- Higher uveitis rates
- Lower psoriasis rates
- More structural damage in SI joints
Mirroring gut… https://t.co/EyBZQ91DDn
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
Data from the EISER study show that IBD was significantly more prevalent in pts with r-axSpA than nr-axSpA.
Makes sense in a way since longer dse duration may play a role.
🔶️THM - screen SpA pts for IBD; ask for GI symptoms
@RheumNow #ACR24 abs554 https://t.co/Q6jeDUFa8Z
sheila @RHEUMarampa( View Tweet )
Différent patterns of organ involvement in sarcoidosis @RheumNow #ACR24 #Sarcoidosis https://t.co/xigkS3vpUh
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
Sarcoid - diagnosis of probability!
Biopsy not required! Can be bx-supported, not confirmed!
Calcium in Sarcoid
10-20% hypercalcemic
30-50% hypercalcuria
Sc: polyuria, dehydration, confusion, depression, fatigue, n/v, anorexia, abd pain, hematuria
@RheumNow
#ACR24 Rev Course https://t.co/B1srD3saij
Eric Dein @ericdeinmd( View Tweet )
No Increase in Cardiovascular Events with JAK Inhibitors in IBD Patients
UMKC researchers have compared the use of JAK inhibitors versus tumor necrosis factor (TNF) blockers in inflammatory bowel disease (IBD) patients, but failed to see an increase in major adverse… https://t.co/XY0UVDTAI6 https://t.co/b09FB3niNP
Dr. John Cush @RheumNow( View Tweet )
Gut microbiome changes linked to onset of RA
Changes in the make-up of the gut microbiome are linked to the onset of clinically evident rheumatoid arthritis in those at risk of the disease because of genetic, environmental, or immunological factors, suggests research published… https://t.co/gUgYLOKrI0 https://t.co/d75NmKup2U
Dr. John Cush @RheumNow( View Tweet )
No Increase in Cardiovascular Events with JAK Inhibitors in IBD Patients
UMKC researchers have compared the use of JAK inhibitors versus tumor necrosis factor (TNF) blockers in inflammatory bowel disease (IBD) patients, but failed to see an increase in major adverse cardiovascular events (MACE) in JAKi vs TNFi use in IBD.
Findings of an abstract presented at
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Peptic ulcer disease is still assoc w/ signif. hospitalization & mortality (10K deaths in USA/Yr). PUD affects 10% of outpts w/ Upper GI pain. 42% are due to H.pylori, 36% from ASA NSAIDs. Complications bleeding (73%), perforation (9%), pyloric obstruction (3%)- JAMA review… https://t.co/1bgagFVlYN https://t.co/8i2j3r1puf
Dr. John Cush @RheumNow( View Tweet )
Advances in the treatment of autoimmune hepatitis
Autoimmune hepatitis (AIH) is a chronic, progressive liver disease caused by immune system dysregulation that targets the liver. If untreated, AIH can lead to severe complications, including cirrhosis and liver failure.… https://t.co/6GtWZ8tDDv https://t.co/YuJrcOyaGP
Dr. John Cush @RheumNow( View Tweet )
Gut microbiome changes linked to onset of RA
EurekAlert!
Changes in the make-up of the gut microbiome are linked to the onset of clinically evident rheumatoid arthritis in those at risk of the disease because of genetic, environmental, or immunological factors, suggests research published online in the
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Advances in the treatment of autoimmune hepatitis
EurekAlert!
Autoimmune hepatitis (AIH) is a chronic, progressive liver disease caused by immune system dysregulation that targets the liver. If untreated, AIH can lead to severe complications, including cirrhosis and liver failure.
An overview of AIH and treatment approaches was recently
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A Keto Diet for Autoimmune Disorders?
EurekAlert!
Scientists have long suspected the keto diet might be able to calm an overactive immune system and help some people with diseases like multiple sclerosis.
Now, they have reason to believe it could be true.
Scientists at UC San Francisco have discovered that the diet makes the gut
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