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Articles By Richard Conway, MBBChBAO, PhD

Conway RheumThoughts

Should You De-escalate DMARDs in RA?

I'm here to talk about de-escalation of DMARDs in patients who are in remission. Should you do it? Here's what I think.

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Lungs ILD

New ACR RA-ILD Treatment Guidelines – What Were They Smoking!?

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. 

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Lungs breathing

RA-ILD takes centre stage

Interstitial lung disease is common in RA, occurring in approximately 8% of RA patients. It is associated with a poor prognosis, and a median survival of 3 years. This important condition has often been neglected within the spectrum of RA research. That is changing, with excellent research initiatives presented at ACR22. I am going to highlight two select abstracts from Monday’s dedicated RA-ILD session.

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Puzzle pieces

Where are we with treating Pre-Rheumatoid Arthritis?

The ability to prevent RA in individuals at risk is a holy grail in rheumatology. There is a long history dating back to the PROMPT trial of methotrexate and PRAIRIE trial of rituximab. Both otrials showed an effect, but it seemed more likely to be a delaying of RA than prevention or modulation. Framing it another way, there were better outcomes in pre-RA because we were actually treating RA as it emerged with a proven effective treatment. It is in this setting that three trials of ongoing studies in RA preventative therapy are presented at ACR.

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Avoid Abatacept in RA patients with a history of cancer?

The management of RA patients with a history of cancer continues to be an area of concern. General recommendations are to treat patients with a history of solid organ cancer as no different to any other RA patient. Recently, the ORAL-Surveillance study demonstrated evidence of a greater risk of cancer with tofacitinib than with TNF inhibitors. In this setting, two posters both reassure and raise a new cause for concern.

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ice cubes

Topical therapies take centre stage

Topical treatments have so often been the low level “sure you can try this” option. However there are exciting data that these approaches may become part of our main armamentarium. 

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A Big Leap in Modulating Rheumatoid Disease

Intervention in individuals predisposed to develop rheumatoid arthritis (RA), with a holy grail of prevention of RA, has long been a hot topic. It is well known that seropositivity for rheumatoid factor and antibodies to cyclic citrullinated peptides (ACPA) can precede RA disease by many years. Many, but by no means all, patients also seem to go through a pre-RA arthalgia phase of varying duration characterised by the presence of increasing joint pain without frank arthritis.

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GCA temporal artery

Giant Cell Arteritis Novel Treatment Options

Giant cell arteritis is associated with significant treatment related morbidity due to the dependence on glucocorticoids as a treatment option. After sixty years of therapeutic stagnation, these are exciting times in the management of GCA. At this year's ACR Convergence meeting, encouraging data will be presented on options for GCA.

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bathroom scale

The Influence of Obesity on Choice of Biologic in Rheumatoid Arthritis

In rheumatoid arthritis we have a wide range of options available to us when we progress to a biologic treatment option. We have little to differentiate between these agents based on the clinical trials.

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The Need for Comparative Treatment Trials in Psoriatic Arthritis

Psoriatic arthritis is currently experiencing a burgeoning selection of treatment options. While this is a very welcome development in a disease which has had less treatment options compared to RA, it leaves us with a difficult conundrum: which agent to choose for an individual patient.

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