Eric Dein

Aggarwal #RNL26 @RheumNow Most common antibody in myositis? ANA 2/3 pts have myositis-specific antibody (MSA), 1/3 sero-neg Each MSA highly specific (95%), not sensitive. Overall Myositis Panel 70% sens Can help phenotype of disease, cancer risk/screening

High CK: Truly abnormal? Non-Gaussian distribution - should not use 95% cut-off 97.5% cut-off preferred by gender, race, & ethnicity From exercise? Exercise can increase by 10-30x. Avoid exercise for 1 week & repeat Non-neuromusc causes: Endocrine, meds, MacroCK @RheumNow #RNL26

Other options in AxSpA Filgotinib: not approved in US due to male repro concerns Brodalumab: warning for suicidality Izokipep: fusion protein, nanobody, similar efficacy to IL-17Ai, may be lower cost Sonelokimab, another IL-17A nanobody TYK2 - Deucr, zasocitinib @RheumNow #ACR26

ADAS-CRP Score Formula looking at back pain, duration of morning stiffness, pt global assessment, peripheral jts, and CRP Low or high disease activity - no moderate range to encourage getting to disease control TICOSPA did not show clear T2T benefit #RNL26 @RheumNow

Blakewell: There is not one agent that is superior between TNF, IL-17, JAKi Patient characteristics and manifestations can help make decision Some meds clearly shown to be not helpful @RheumNow #RNL26

Advances in SpA #RNL26 @RheumNow Uveitis: Adalimumab, bimekizumab, and upadacitinib reduce uveitis flares in SpA Ada and MTX have data for efficacy in non-infectious posterior uveitis (NIPPU) Brepocitinib study ongoing for NIPPU

Arthroplasty in AxSpA #RNL26 @RheumNow Effective surgery - 10 yr survival 90% THA, 88% TKA Higher complications at 2 yrs- jt infection, dislocation, fx Incr risk of MI, CVA, DVT, PE, UTI, wound, AKI, phnumonia, sepsis, transfusion, falls Higher infection risk continuing biologi

Knee involvement in AxSpA #RNL26 @RheumNow 15-50% of pts Adults <50yr - 2.7x higher risk of AxSpA Risks of large jt involvement: Early age of AxSpA RIsk for THA - male Risk for TKA - obesity & smoking, h/o THA Decreased risk with b/csDMARD

Complications of SpA #RNL26 @RheumNow Hip involvement common in AxSpA - 10-60%, up to 40% of pts with minimal symptoms THA risk: 3-4x higher in r-axSpA Xr-ay: concentric jt space narrowing (not superolateral), collar of osteophytes at head-neck junction (not marginal osteophytes)

Update of 2025 ASAS-SPARTAN Revised Classification Criteria for AxSpA @RheumNow #RNL26 Notes must exclude mimics MRI findings involve active & structural lesions, not just bone marrow edema Difficult to meet clinically without any imaging criteria (xray or MRI) Pub pending

AxSpA Imaging @RheumNow #RNL26 Xray SI jt - 1st line in most pts, but young pts short duration can consider MRI as 1st-line Challenge in imaging: SI jt edema in athletes/postpartum Mimics like osteitis condensans ilii - diff by anterior localization, absence of erosions

Poddubnyy at #RNL26 @RheumNow: "Treating spondyloarthritis is easy, the challenge is when the diagnosis is not correct" PROCLAIR Study: mean diagnostic delay 5.7 yrs Prevalence of axSpA in pts w chronic back ~5% ASAS endorses early referral recommendations for higher risk pts

Can you predict Allopurinol Hypersensitivity (AHS-SCAR) with HLA screening? #RNL26 @RheumNow Not completely - only 2/3 predictable by HLA-B*58:01 screening Others like HLA-A*34:02 also associated, but unable to commercially test for Treatment: Marked response to JAK inhibitor Rx

Terkeltaub on improving gout in real world #RNL26 @RheumNow -Earlier switch to 2nd line febux -More T2T ULT gout clinic -Broader colchicine PPx -Better co-manage links to metab, CVD, renal dis -Phamacogenomics (eg HLA-B58:01) -ULT, drug pipeline TRUST: primary care T2T ULT trial

Where is gout in the real world? @RheumNow #RNL26 -Healthcare disparities -Failure of T2T -Poor urate control worsens CVD, mortality -Recent gout flare, gout dx, ULT initiation markedly increase CVD events

DEPAR study: Early PsA patients have low rate of radiographic progression, esp if dx is controlled Kavanaugh: Are Xrays needed in PsA? - Changes minimal in PsA, only in few pt, seen w active synovit - Short trials won't see diff -Newer imaging modalities better @RheumNow #RNL26

Upcoming H2H studies in PsA 2 studies of IL-17A/F vs IL-23 BE-BOLD: Bimekizumab v Risankizumab IZAR-2: Sonelokimab v Risankizumab in TNF failure Will provide useful info in differentiating new IL17 mechanism v IL23 #RNL26 @RheumNow

IL-17 v IL-23 #RNL26 @RheumNow Axial domain- good IL-17 data as well IL-23 post-hoc data Both show data of prevention of damage Real-world data suggest IL-23 longer persistence Safety: higher candidiasis and IBD risks w IL17

Super Bowl Battle: IL17 vs IL 23 in PsA? #RNL26 @RheumNow Andre Riberio Severe skin: IL17 & IL23 both show superiority over TNFi for plaque PsO IL17 quicker, IL23 show superior or non-inferiority skin Bimiekizumab (IL-17A/F superior to other IL17)

Dupilumab-associated arthritis #RNL26 @RheumNow Onset wks to mos Diffuse/symm jt pain Trigger IL23/IL17 mediated inflamm MSK syndrome Resolves with cessation of dupilumab, but can Rx through with NSAIDs, steroids, MTX, JAK May have enthesitis/tenosynovitis/arthritis phenotype