Safety and Immunogenicity is one of nine educational videos available in the "Therapeutic Update: Biosimilars in Rheumatology" video series, sponsored by Sandoz, Inc. and now available on RheumNow. https://t.co/1vmnEJqOSi#biosimilars
— Dr. John Cush (@RheumNow) October 25, 2018
IgG4-related disease… almost completely unknown 10 years ago.
"It is a perfect disease for rheumatologists to take care of." – Dr. John Stone #ACR18 @RheumNow— Brittany A (@MissbeeMD) October 24, 2018
IgG4-RD histopathology consistent across organs: lymphoplasmacytic infiltrate, obliterative phlebitis, storiform fibrosis. #ACR18 @RheumNow
— Brittany A (@MissbeeMD) October 24, 2018
Pearls regarding IgG4-RD. Depressed complements commonly seen in renal involvement. #ACR18 @RheumNow pic.twitter.com/m3oM4Aiuny
— Brittany A (@MissbeeMD) October 24, 2018
#IgG4 RD is an indolent disease but can present with severe weight loss (>20 pounds), largely due to pancreatic destruction. #ACR18 @RheumNow
— Brittany A (@MissbeeMD) October 24, 2018
Therapeutic potential of “glycoengineering" in autoimmune disease.
Alter glycoforms of endogenous IgG -> reduce pathogenic impact of antibodies.
Cell paper by Pagan JD et al https://t.co/UbBsE1jV4L
Year in review basic science #ACR18 @RheumNow— D White (@WIRheum) October 21, 2018
TLR8 aberrantly expressed on pDCs (cells that make type-I IFN) in SSc patients
Depletion ameliorates disease https://t.co/SmDdpIU2I1
Ah Kioon et al
Year in review basic science #ACR18 @RheumNow— D White (@WIRheum) October 21, 2018
Stop by the @RheumResearch booth to get your @alhkim autographed flyers!!! #acr18 #rheumrockstars pic.twitter.com/kVR4XB6ynO
— Mary J. Wheatley (@MaryJWheatley) October 22, 2018
Anti-GBM positivity did not predict relapse in Goodpasture's
(but ANCA did predict relapse in GBM disease)
Abs 826, Cleveland Clinic
Roundup – Cush, Kavanaugh
#ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
Toci in SSc
failed to achieve primary endpoint (modified Rodman skin score)
Abs 898
Roundup – Cush, Kavanaugh#ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
Canabinoids in vitro
CB2 receptor drives inflammation
Set the stage for discovery/development of future antagonists?
Danger of over-interpretation on the street
Abs 1068
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
MTX for OA of the knee
12 months, 155 pts, endpoint=pain
statistically significant improvement, probably not clinically meaningful
consistent with prior reports
Abs 428
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
B cell immunology
New therapies directed at B cells
Overlap with therapies for myeloma
How to target long-lived (CD20 neg) plasma cells?
Session: ACR immunology update
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
Session on draft ACR reproductive health guidelines
Three manuscripts in preparation
This effort is a response to a tremendous need for info and guidance
Estimated half of pregnancies are unplanned, so ask patients often
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
MTB screening in patients on TNFi
When to re-screen?
Neg to pos conversion discovered in a small number of cases
Often in patients with risk factors
Cush: Annual testing “makes no sense at all"
Abs 1234, Rochester NY
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
DIP involvement in RA
12k patients in Japanese registry
2% incidence, 2-3 joints in each pt with involvement
associated with higher disease activity
Abs 221
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
Biosimilars in Sweden
Rx patterns (originator vs biosimilar) follow prices – back and forth
Abs 1175
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
Gout
Remains under-treated
Higher success when pharmacists and RNs manage ULT
Abs 2220, 1247, 1272
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
Enthesitis, in particular supraspinatus tendinopathy
IL-17A as a target of therapy
Abs 404
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
MTX helpful for granulomatous mastitis
Can be recurrent; sometimes seen by rheums
Rule out cancer, infection
Abs 2264
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
Chronic back pain in patients with a FHx of ank spond
More psoriasis and heel pain
Undiagnosed SpA?
Abs 637
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
High- vs standard-dose influenza vaccination in pts on DMARDs and biologics
High-dose quadrivalent version more effective (seroconversion) except in rituximab population
Abs 837
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
MTX vs etanercept vs combo in PsA
ACR20 at 24 wks: 50%, 60%, 65%
Contrast TEMPO study in RA where combo therapy was better than monotherapy
Also: MTX monotherapy effective
Abs L11
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
Plasma exchange in AAV (GPA or MPA) with severe disease
PLEx did not reduce ESRD or death
Reduced-dose glucocorticoids did not increase risk of death or ESRD (but did have fewer infections)
Abs 2788
Roundup – Cush, Kavanaugh #ACR18 @RheumNow— D White (@WIRheum) October 24, 2018
Top Influencers of #ACR18 👉 @RheumNow @CreakyJoints @ACRheum @ArthritisFdn @psufka @DrJuanOvalles https://t.co/9ouTIWOqac via @symplur
— ǝlʇʇıɥʍ ɯɐs (@samwhittle) October 25, 2018
Dr. Berent Prakken reviews. IL18 may be a diagnostic biomarker for MAS in systemic JIA (compared to familial or primary HLH)#pedsinreview #ACR18 @rheumnow
— Nicole Bitencourt (@NicoleBitencou5) October 21, 2018
Use of antiTNF in childhood does NOT appear to increase risk of malignancy in adults according to Medicare claims data, but possibly a malignancy signal seen related to underlying disease. #ACR18 #pedsinreview @rheumnow
— Nicole Bitencourt (@NicoleBitencou5) October 21, 2018
In pts with #dermatomyositis, extracellular vesicles (EVs, released from almost all cells) induce secretion of important pro-inflammatory cytokines. #ExtracellularVesicles are likely important in the #pathogenesis of DM. Abstract1335 Dr. Krisha Desai #ACR18 @RheumNow pic.twitter.com/naMIRuq8JQ
— Nicole Bitencourt (@NicoleBitencou5) October 22, 2018
Lysinuric protein intolerance, a urea cycle disorder, can #mimic #SLE with #lupusnephritis and #MAS. #osteopenia also seen. Need high index of suspicion. #GeneticMimicsOfRheumaticDisease #ACR18 @RheumNow pic.twitter.com/sx2cUPgH73
— Nicole Bitencourt (@NicoleBitencou5) October 23, 2018
#DownsArthritis (often an erosive polyarticular arthritis of small joints) is distict from poly #JIA by analysis of #synovialBx. More CD3+ cells, macrophages, and CD20 cells in joints of kids with Down's arthritis. Abstract2024 Dr. Charlene Foley #ACR18 @RheumNow
— Nicole Bitencourt (@NicoleBitencou5) October 23, 2018
45% of pts with #MAS and 62% of pts with #secondaryHLH carry a heterozygous variant of a gene generally associated with #primaryHLH. Having multiple variants assoc w worse and recurrent MAS or HLH. Abstract 2014 Drs. Passarelli and Bracaglia #ACR18 @RheumNow0 pic.twitter.com/t0AGzQ8c7r
— Nicole Bitencourt (@NicoleBitencou5) October 23, 2018
Among 14 pts with #JIA #ERA (enthesitis related arthritis) who failed 1+ antiTNFs, #secukinumab led to some improvement in the JADAS 10 score at 6 months. The 300 mg dose required in over half of pts. Abstract2386 Dr. Ivan Foeldvari #ACR18 @RheumNow pic.twitter.com/cnVBqreGEG
— Nicole Bitencourt (@NicoleBitencou5) October 23, 2018
Compunded triamcinolone hexacetonide (the steroid formerly know as #Aritospan) showed significantly lower rates of joint flares compared to triamcinolone acetonide in #JIA20% vs 72%. Abstract2387 Dr. April Bingham #considercompunding #ACR18 @RheumNow pic.twitter.com/BMBa4Z2p3t
— Nicole Bitencourt (@NicoleBitencou5) October 23, 2018
Secondary tumoral calcinosis in #SLE. A benign condition characterized by massive periarticular #calcification and associated with CTDs. Image by Dr. Leslie Anne Cassidy #ACR18 @RheumNow pic.twitter.com/gs9YwwFQ3a
— Nicole Bitencourt (@NicoleBitencou5) October 23, 2018
#GPA with vanishing retro-orbital mass in the nasopharynx compressing eyeballs. Image by Dr. Hiroiuki Yano. #ACR18 @RheumNow pic.twitter.com/1irkBkFvLd
— Nicole Bitencourt (@NicoleBitencou5) October 24, 2018
In pts with #SystemicSclerosis, cardiac MRI with T1 mapping sequence revealed microscopic #MyocardialFibrosis in 53% of pts and was associated with #cardiovascular events (7 heart rhythm disorders, 2 heart failure, 1 unstable angina) Abstract2934 Dr.Terrier #ACR18 @RheumNow
— Nicole Bitencourt (@NicoleBitencou5) October 24, 2018
In #SystemicSclerosis, pts with esphageal erosions on EGD had a greater decline in FVC and progression of #ILD. Emphasizes role of micro-aspiration of gastric contents in #pathogenesis of #ILD in #scleroderma. Abstract 2936 Dr. Silvia Laura Bosello #ACR18 @RheumNow pic.twitter.com/20hOAfS6rw
— Nicole Bitencourt (@NicoleBitencou5) October 24, 2018
Abstract 648 OptiRef self report questionnaire for early diagnosis of a spa – 19% had confirmed diagnosis vs 40% ref from Dr. Looks useful! #AS @rheumnow #ACR18
— Philip Gardiner (@PhilipGardiner) October 21, 2018
Abst 651 Baraliakos MRI reports on SI joints in #AS differ between radiologists and rheumatologist: edema+erosion works best @RheumNow
— Philip Gardiner (@PhilipGardiner) October 21, 2018
Abstr 837 Dr Colmegna: Should we use high dose Infleunza vaccine in #RA? Vaccines less effective in RA DB RCT low vs. High dose in 279 RApts. Showed sig. better immune response with high dose vaccine. #ACR18 @RheumNow
— Philip Gardiner (@PhilipGardiner) October 21, 2018
Abstr 838: Anti-MDA5 pos DM-ILD has a poor prognosis. survival at 6mo 89% vs 33% with combo imsuppressive (Pred 1mg/kg/d tapering, IVCYC 500-1g/m2; Tacrolimus through 24 wk. 29 pts, historic controls. Hi risk of CMV activation #ACR18 #Myositis @rheumnow
— Philip Gardiner (@PhilipGardiner) October 21, 2018
Plenary Abstract 839: Dr Schmukler Chicago. Can we use MDHAQ (multi-dimensional) to identify FM? 84% agreement with 2011 FMS questionnaire – so the answer is Yes! (But what is the ‘gold std’?) @RheumNow #FMS #ACR18
— Philip Gardiner (@PhilipGardiner) October 21, 2018
Checkpoint inhibitors
explosion of papers in 2018
New and/or exacerbated arthritis, myositis, lupus, sarcoidosis, sjogrens, vasculitis
How to treat? – still unknown
Year in review – clinical #ACR18 @RheumNow— D White (@WIRheum) October 21, 2018