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Join hands with big coffee, learn rheumatism academic feast together!
.
Here are some of the conference highlights:
methotrexate can improve the therapeutic effect
of pegolase in goutFor patients with refractory gout, pegololase combined with moderate-dose oral methotrexate therapy, It is more effective than pegolonase alone in reducing blood uric acid levels for up to 52 weeks
.
At the same time, pegolonase combined with methotrexate can also more effectively eliminate tophi and reduce infusion reactions
.
"You should have all looked at the preliminary results
of the 24-week MIRROR randomized controlled trial published last May.
" Alaskan orthopedic surgeon Dr.
Botson said
.
"The treatment group differences we saw early in the trial continued until month 12, and no new safety concerns
emerged.
These results confirm that pegolase combined with 15 mg of oral methotrexate per week can achieve better efficacy and safety in the treatment of gout
.
"
ACR speaker
pegloticase is a recombinant pegylated uric acid oxidase used to lower blood uric acid levels, but 89% of patients take pegolonase to produce antibiotic antibodies during treatment.
These antibodies limit the urate-lowering effect of pegolonase and increase the risk of
infusion reactions.
The MIRROR randomized controlled trial compared two weeks of intravenous pegolase 8 mg plus 15 mg orally methotrexate per week with pegolase monotherapy
.
After a 4-week methotrexate tolerability trial, a total of 100 patients were randomized to pegolase plus methotrexate and 52 patients to pegololase plus placebo
.
The primary endpoint was at least 80% of patients with a blood uric acid < 6 mg/dl
at 20 to 24 weeks.
At 6 months, 71% of patients in the combination of pegololase and methotrexate met the primary endpoint, compared with nearly 38.
5% (p<0.
0001)
in the pegolase alone.
At week 52, 60% of patients in the combination of pegololase and methotrexate had a serum uric acid < 6 mg/dl, compared with 30.
8% (p≤0.
003)
in the pegolase alone.
In patients with at least one tophi, treatment with pegololase and methotrexate resulted in complete resolution of more than 1 tophi in 34.
6% of patients, compared with only 13.
8%
of patients treated with pegololase alone.
By week 52, 53.
7% of patients in the combination of pegololase and methotrexate had completely resolved tophi, compared with 31% of patients treated with pegololase alone (both p≤0.
048).
The proportion of patients who produced new anti-PEG antibodies was also lower in the combination pegololase and methotrexate group than in the placebo group, at 31.
6% and 58.
3%, respectively; and the incidence of infusion reactions was lower, 13.
3% versus 32.
1%,
respectively.
There was no significant difference
in the occurrence of adverse events or acute gout attacks between the two groups.
New recommendations
for cancer screening for IIM patients "one in four idiopathic inflammatory myopathy.
" (IIM) Patients develop some form of cancer
within three years before and after the onset of myopathy.
The new consensus is expected to help clinicians stratify their patients' cancer risk and recommend specific screening methods
for high, medium, and low cancer risk.
"Malignant tumors are the leading cause of death in adults with myositis, and malignant tumors
are easy to be combined in the late stage of myositis.
" Alexander Oldroyd, Ph.
D.
, clinical lecturer at MSC, MBChB, NIHR, University of Manchester, UK, said
.
"Early diagnosis is essential to improve prognosis, and screening is essential
for early detection of cancer.
"
The ACR conference speaker
Dr.
Oldroyd discussed the latest consensus
published in Rheumatology in 2021 on cancer risk stratification and screening for myositis patients 。 Seventy-five rheumatologists and three co-patients from 22 counties evaluated 117 relevant studies using the Delphi assessment to arrive at these recommendations
.
Low risk factors for malignancy in patients with myositis include antisynthetase syndrome and clinically characteristic subtypes of connective tissue diseases such as Raynaud's disease and interstitial lung disease (ILD).
Intermediate-risk factors include clinical amyopathic dermatomyositis, polymyositis, and immune-mediated necrotizing myopathy in men
.
Risk factors include dermatomyositis > age of onset at 40 years, persistent high disease activity despite treatment, dysphagia, and skin necrosis
.
Basic screening for cancer includes a thorough history and physical examination, blood counts, liver function, erythrocyte sedimentation rate, C-reactive protein, protein electrophoresis test, urinalysis, and chest x-ray
.
Intensive screening includes CT scan of the neck, chest, abdomen, and pelvis, cervical screening and mammogram, prostate-specific antigen testing, CA-125, transvaginal ultrasound for ovarian cancer, and fecal occult blood tests
.
The frequency of screening for malignancy varies by risk, Dr.
Oldroyd said
.
High-risk patients with ≥ 2 high-risk factors should undergo basic and intensive screening
for malignancy for 3 years after diagnosis of myositis.
Intermediate-risk patients should undergo basic and intensive screening
at the time of diagnosis of myositis.
All other patients are low-risk and only basic screening
is required to diagnose myositis.
"I would like to emphasize that low risk refers to people with intermediate- to high-risk myositis, not to the general population
.
" Dr.
Oldroyd emphasized
.
"All people with myositis have an increased
risk of cancer.
"
Rituximab and cyclophosphamide have similar efficacy in the treatment of CTD-ILD
The RECITAL trial conducted in the UK compared rituximab and cyclophosphamide in connective tissue disease (CTD)-related ILD and found no difference
in outcomes between groups.
Subgroup analysis showed similar efficacy for myositis between the two agents, with rituximab more effective in mixed CTD
.
Toby Maher, a professor of clinical medicine at the Keck School of Medicine at the University of Southern California, introduced that the RECITAL trial is a basket trial for patients with various connective tissue diseases and has been published in The Lancet Respiratory Medicine
.
Speaker at the ACR Conference
At 24 and 48 weeks of treatment, the efficacy of rituximab and cyclophosphamide in the entire RECITAL population showed a similar improvement in vital capacity (FVC) than baseline
.
For patients with systemic sclerosis, both drugs appear to stabilize FVC within 48 weeks
.
For patients with mixed CTD and myositis, the two drugs produced similar improvements in FVC
.
Assessing skin thickness by the modified Rodnan Skin Score (mRSS) found that skin thickness improved in the systemic sclerosis subgroup of patients treated with rituximab, but cyclophosphamide had no such effect
.
"In patients with systemic sclerosis, we see little to no therapeutic effect of cyclophosphamide
.
" Dr.
Maher reported
.
"After treatment with rituximab, we observed improvements in patients' skin scores at 12, 24 and 38 weeks, p=0.
01
.
Both drugs are able to improve clinical and quality of life
.
Data suggest that rituximab may be an alternative to cyclophosphamide in patients with CTD-ILD
.
”
mTORC1 inhibitors have potential efficacy in patients with sJIA and MAS
Up to 30% of children with systemic juvenile idiopathic arthritis (sJIA) are complicated by macrophage activation syndrome (MAS).
Data from mice and humans suggest that sJIA progresses to MAS as a continuous disease process, using existing mammalian rapamycin target protein (mTOR) inhibitors against sJIA and MAS treatment may be effective
.
"We know that IL-1 is a key mediator that leads to the inflammatory response to sJIA, and that IL-1 antagonists are first-line therapies
.
" Dr.
Pui Y Lee, a professor of pediatrics at Boston Children's Hospital, said
.
"We used mouse models, transcriptome datasets, and human samples to better understand the pathogenesis of sJIA and its connection to
MAS.
"
Speaker at the ACR Conference
IL-1 receptor antagonist (IL-1Ra) knockout mice are a commonly used sJIA mouse model, and single-cell RNA sequencing shows that IL-1Ra knockout mice show mTORC1 pathway activation
, Dr.
Lee said.
Rapamycin treatment reduced arthritis and inflammation
in these mice.
mTORC1 pathway activation can also be seen in patients with
sJIA.
The mTORC1 pathway is further activated in patients with sJIA and MAS
.
Knocking out the Tsc2 gene in mice leads to overactivation of the mTORC1 pathway, spontaneous inflammation and MAS can occur in mice, and obvious hemophagogy can also be observed in bone marrow
.
This is similar
to the activation of the mTORC1 pathway in patients with MAS.
Suggest that overactivation of the mTORC1 pathway may be sufficient to cause MAS to occur
.
Rapamycin effectively reduces inflammation and MAS
in Tsc2 knockout mice.
"This increases the likelihood that mTOR inhibitors will be used to relieve inflammation and their MAS in sJIA patients," Dr.
Lee said
.
The study will be published
in Nature Communications.
The Rheumatology ECHO Project improves RA care for the Navajo Nation
Improving rheumatology care
for the Navajo Nation in Arizona, Utah, Colorado, and New Mexico through the Expanded Program for Rheumatoid Arthritis (RA)-Specific Community Health Care Outcomes (ECHO) to improve family physician education.
This group of 174,000 people is scattered across rugged areas five times the size of Connecticut; although the prevalence of RA is five times that of the general U.
S.
population, they are served by only one full-time clinical rheumatologist to serve them
.
"The entire United States is facing a severe shortage of rheumatology care," said
Dr.
Jennifer Mandal, assistant professor of medicine at UCSF.
"Shortages are much
worse in rural areas and in specific populations, including Native Americans.
The ECHO program improves care and outcomes for hepatitis C in people with medical shortages worldwide, and we wanted to see if the ECHO program could help improve RA
.
”
Speaker at the ACR Conference
Dr.
Mandal explained that the ECHO project aims to improve care in medically underserved communities by eliminating the monopoly on specialized care
.
For the Navajo Nation, this means a multidisciplinary team of RA experts and Navajo interpreters offering a 12-week RA course
to Navajo Area family physicians via Zoom webinar.
"RA guidelines call for patients with RA who do not respond well to routine DMARDs to upgrade to biological therapy, but approximately 25 percent of homes on the Navajo Reserve lack electricity, so patients may not be able to refrigerate their medications
.
" Dr.
Manda said
.
"Patients using methotrexate must have laboratory tests every three months, but roads in this area are often impassable during the winter, making disease surveillance difficult
.
And they have a deep but legitimate distrust of sharing private health information, which can take a long time to build trust
.
Evaluation of the first two ECHO cohorts showed significant improvements in RA knowledge scores in RA diagnosis and management by trainees of 47% and 72% and 60% and 86% (p<0.
0001, respectively
).
There was a similar improvement in trainer confidence scores, with RA diagnosed at 3.
25 to 4.
05 out of 5 (p<0.
0002) and RA administered at 2.
78 to 4.
01 (p<0.
0001)
around ECHO.
"ECHO is a low-cost and very effective training model that supports communities and improves rheumatic care
.
" Dr Mandal said
.
"Our next step is to expand it to other Native American communities in 2023 to roll out the Spondyloarthritis ECHO program for the Navajo Nation and assess patient outcomes
.
"
, USA.
More than 9,000 rheumatologists from 104 countries arrived and more than 4,300 rheumatologists gave online lectures, covering more than 30 Hot topic, showcasing high-quality research
in rheumatology.
This time, the Youth Committee of the Rheumatology Society takes you to see ACR
Initiated by the "Medical Community" media
Professor Zhao Jiuliang of Peking Union Medical College Hospital took the lead
10 youth committee members of the Rheumatology Branch of the Chinese Medical Association were invited
In-depth analysis of the essence of the conference
The content covers a wide range of disease areas
Includes the latest disease progression
Hot topics and other content forms
to convey the strongest sound in the field of rheumatology
Create a new academic style
The interpretation of this live broadcast includes:
Should subclinical patients be treated with DMARDs?
What are the health effects of refractory RA?
Diagnosis and treatment of cutaneous lupus erythematosus
Recent advances in the treatment of lupus nephritis
Standard-of-standard treatment for ankylosing spondylitis
How to differentiate between vasculitis and vascular lesions from discoloration of hands and feet?
Recent advances in imaging and treatment of Sjogren syndrome
..
.
.
.
.
At 7 o'clock tonight, Professor Zhao Yi of West China Hospital of Sichuan University and Professor Chen Zhu of the First Affiliated Hospital of China University of Science and Technology will bring the hot topic of rheumatoid arthritis
Scan the QR code below the poster to watch the live broadcast
