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Plenary II: pregnancy in RA When a treat to target approach is used to achieve remission, pregnancy rates nearly similar to general population! Time to pregnancy less than half that of non-T2T comparators Dr. John Cush #ACR24

Very neat simulated model of GC regimens in AAV pt on fixed RTX by Zach Wallace and co Over 5 years: - No difference in relapse btwn standard GC vs. minimal GC + avacopan - Higher DMII rates in standard group Adds to trial + real world data Dr. John Cush #ACR24 Abst 1598

Which subsets of GCA pt might benefit most from upadacitinib? Sub-analysis from SELECT-GCA presented today: 💥Both relapsing and refractory disease 💥Pt w hx of PMR 💥Non-smokers 💥No hx ischemic eye dz In general, most subgroups still favor UPA Dr. John Cush #ACR24 Abst 1695

Choose Rheum! Hart & Kumar interviewed trainees about picking rheumatology... major themes: ▶️ exposure prior to medical training ▶️ mentorship/sponsorship ▶️ long-term self-reflection ▶️ chance! How can we optimize first 3 to build our workforce? Dr. John Cush #ACR24 Abst 1738

On now: The Great Debate - is MCTD a distinct clinical entity? LisaChristopherStine reviews the history of MCTD classification criteria and its evolution Kasukawa criteria may be most sensitive in one cohort Dr. John Cush #ACR24

The anti-MCTD group strikes back Of cohort of over 1,000 RNP+ pt, only 17 clinically diagnosed with MCTD Majority of patients, despite potential overlap, treated for other primary rheum dz Dr. John Cush #ACR24

What a result!!! Crowed split 49% against and 51% for MCTD as a unique disease entity Given pre-debate poll of >70% for MCTD, looks like an overall win for the “NOT” group Fantastic session from all the presenters Dr. John Cush #ACR24

Would be helpful for us (and pts) to better understand rimmunotherapy agent specific risk on subsequent GCA/PMR AFTRER propensity matching of >7k pt on combo nivolumab/ipilimumab compared to pembrolizumab: - PMR RR 3.8x N/I vs. P - no diff in GCA risk Dr. John Cush #ACR24

We saw evidence for JAK use in GCA this conference... what about IL-1 inhibition? Double-blind RCT: Anakinra vs. PBO w/ similar GC taper in GCA pt NO difference in relapse rate at 26, 52 wks despite addition of Anakinra Dr. John Cush #ACR24 Abst1699

VERY exciting SLE update from Fava et al. Machine learning used to generate urinary protein panel predictive of intra-renal inflammation BETTER than serum biomarkers C3, C4, dsDNA Also monitoring tool for renal response. Outstanding. Dr. John Cush #ACRbest #ACR24

Will be covering some TAK pearls and pitfalls from today’s session! Renal dz stratified by location of vessel inflammation: - TAK = proximal (off aorta) - FMD = mid-section, beading - PAN = distal arterial branches Dr. John Cush #ACR24

We love a good summary slide All the ways we can think about incorporating imaging modalities in the various stages of TAK dx/tx Dr. John Cush #ACR24

Non-pharm tx in TAK - not something we always think about but… Impressive effect of resistance exercise!! Not just in symptoms but also inflammatory markers Per Dr. Springer - even a stress ball could be enough for UE vascular health in these pt Dr. John Cush #ACR24

If you’re starting with DMARD (according to ACR/VF guidelines) tx in TAK - MTX and AZA are probably equivalent options… MMF not so much Dr. John Cush #ACR24

Early observational data suggesting JAK inhibitors can play a role in TAK tx We have seen this with UPA in GCA this conference… time for SELECT-TAK ! Dr. John Cush #ACR24

Cardiology is on! Dr. Olin discusses Fibromuscular Dysplasia findings on imaging Definite: string of beads and/or focal narrowing in right setting / location Possible but nonspecific: dissection, ecstasia, aneurysm, and tortuously Dr. John Cush #ACR24

Congratulations to our very own Brian Jaros, MD (Brian Jaros, MD), recipient of American College of Rheumatology’s 2024 Distinguished Fellow Award, presented during #ACR24 in Washington, DC. Congratulations, Dr. Jaros! rheumatology.org/acr-awards

Risk stratification of GCA pts: who might lose vision? Cranial MRI with vessel wall enhancement used to calculate additive score... # of vessels affected Higher scores a/w ocular GCA > non-ocular GCA > no GCA and decreased w/ tx Dr. John Cush #ACRbest #ACR24

Hydralazine - known culprit of drug-induced AAV How does hydral (H) AAV differ from primary (1) AAV? 💥 High dual positivity MPO/PR3 💥 DAH / pleuritis more common in H-AAV 💥 ENT, constitutional, nervous, ILD in 1-AAV 💥 More 6mo remission in H-AAV @rheumnow #ACR24 Abst 2496

Hypoxia seems to exacerbate neutrophil activation by ANCA - enhanced F-Actin polymerization - enhanced NET formation Could hypoxia predilection in certain tissues (kidney, lung) lead to the AAV phenotypic disease patterns? Dr. John Cush #ACR24