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Rheumatoid Arthritis

Tofacitinib May Reduce Interstitial Lung Disease Risk in RA

MedPage Today
Mar 23, 2023

Tofacitinib (Xeljanz) in patients with rheumatoid arthritis (RA) stood out among several other biologic and targeted synthetic disease-modifying antirheumatic drugs (sDMARDs) when it came to the incidence of interstitial lung disease (ILD), a retrospective cohort study showed.

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What to do about pre-clinical RA?

Mar 20, 2023

RheumNow Live’s 2023 conference led with this year’s hot topic of rheumatoid arthritis, and in particular, what to do regarding pre-clinical RA.

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Biosimilars are coming! Multiple adalimumab biosimilars this year - will we see a dramatic price difference? @RheumNow #RNL2023
Will be begin using sputum instead of blood serologies to detect RA? - sputum seropositive CCP may be associated with development of clinical RA - 4 fold higher risk if (induced) sputum CCP+ @RheumNow #RNL2023
#RNL2023 Year in Review Sputum antibody predicts future development of RA Hazard ratio 4.2 if any sputum antibody positive (CCP IgG/IgA, RF IgM and IgA) Strongest association with CCP IgA Supports pre-RA as mucosal disease @RheumNow
Smoking *may* only ⬆️ risk of #RA if shared epitope present AND double positive By @Janetbirdope #RNL2023
Could MTX every other week dosing be an option in patients with stable disease..? #RNL2023
Long live the GOAT Rx: MTX 🐐🐐 History of usage dating back to 1950 Use 1st-line Optimize dose Supplement folic acid Split dose Give SQ Use in combination therapy Dr Joel Kremer #RNL2023 @RheumNow
#ClinicalPearl #Methotrexate weekly May reduce side effects in rapidly dividing cells vs using it daily or every few days. GI, oral, bone marrow side effects should be less if once a week. Joel Kremer ⁦@RheumNow⁩ #RNL2023
How is a biosimilar approved? Comparative effectiveness study for the reason that the medication was initial approved required, not for other indications Jonathan Kay shows ex of ETN-ykro vs reference ETN in RA Non-inferior in immunogenicity, safety, efficacy @RheumNow #RNL2023
Was amazed at the tons of biosimilar TNF options @_connectedcare uses in Australia... coming soon to the US! Jonathan Kay #RNL2022 shows the lists of biosimilar May be w/in batch-to-batch variability, unintended drift, or deliberate process changes (evolution) @RheumNow
Jonathan Kay on #RNL2023: Biosimilar is well-researched with cost savings These savings should benefit the patients Incentives for physicians as well in form of decreased prior auth burdens @RheumNow
RBC MTX polyglutamate levels may be the “truth serum” for those pts stating they are taking their MTX but you question it. Dr. Kremer @RheumNow #RNL2023
MTX is a prodrug! MTX polyglutamate is true active ingredient 1/2 of MTX PG is 60 days, compared to only 6-8 horus for MTX Steady state is not until 27.5 weeks! Joel Kremer at #RNL2023 @RheumNow
Do you stop MTX on patients on bDMARD? MTX decrease anti-drug antibodies on patients on infliximab - increases drug duration. Similar seen with new combination usage with pelogloticase Joel Kremer MD #RhuemNow @RheumNow
How do you wean MTX? Consider every other week dosing as options - supported by 2 randomized studies from 1995 and 1999 Option to lower weekly dosing in patients that want to take less often Joel Kremer #RNL2023 @RheumNow
MTX lung disease: Presents at 6-12 months Baseline CXR is key to know if lung infiltrates are new #RNL2023 @RheumNow
Do and don’t around MTX , Dr.Kremer approach to MTX #RNL2023 ⁦@RheumNow⁩
@Janetbirdope at #RNL2023 RA is not a disease of young Incidence increasing in elderly population, not often offered the full range of medications due to co-morbidities, despite safety data Higher DAS, seroneg Co-morbidities decrease outcomes @RheumNow
Myths of RA by Dr. Janet Pope - RA development should have ACPA years before? - there is a significant minority of early RA patients who are seronegative! @RheumNow #RNL2023
How much of RA risk is attributed to lifestyle? @Janetbirdope presents Nurse's Health Study showing 35% BMI and smoking increase risk of RA... in patients with ACPA positivity #RNL2023 @RheumNow
@Janetbirdope #RNL2023 Benefit of intra-articular jt injections in early RA Injection of 6-12 swollen joints (!) vs systemic glucocorticoids -- FAR better ACR20 and ACR50 with less side effects @RheumNow
Can we prevent RA, Kevin Deane #RNL2023 ⁦@RheumNow⁩.
Upto 30% risk of #RA within 5 yrs if anti-CCP positive #RNL23
Stop RA trail: Plaquenil didn’t prevent RA in patient with pre clinical RA. Kevin Deane #RNL2023 ⁦@RheumNow⁩