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ACR 2022 Appraisal, Praise & Critique (11.18.2022)

Jack Cush, MD

It was great to be back at an ACR annual meeting, this one in Philadelphia – Philly was great. A walking town, rich in culture, history and good places to meet and mingle. 

I loved the city, but not the convention center (not easy to navigate). 

The meeting itself was very good. Be sure to logon and listen to the Year in Review (Drs. Langford and Varga) and the Keynote address from Dr. Abraham Verghese (Stanford) – both are well worth your time.

If you want to get an overview of the meeting I can suggest that you look for RheumNows coverage (Videos or Podcasts), especially the Daily Faculty Recaps (3), Topic Panels (4), Rheumatolgy Roundup (Drs. Kavanaugh & Cush) and next week there will be four TOPIC specific podcasts (RA, SLE, PsA, SpA).

Heres a few abstracts that I thought you should know about:

  1. Abst 0338  Yang et al from Mayo #ACR22 Transition from CLE to SLE. 324 cases of incident cutaneous lupus, mean f/u 8 years; 26 pts (11.8%) developed SLE. 5.2% transition by 5 years, <3% risk every 5 yrs from 5-20 years
  2. Abstr #0246  Crowson et al. RA stratification into 4 clusters. Each cluster = different outcome, younger cluster w/ few comorbidities = no > mortality A group of older patients w/ multimorbidity (5+) drives higher mortality risk in RA.
  3. Abstr# 0344  Therapeutic Thresholds of Hydroxychloroquine Blood Levels: Physiologic and Social Determinants of Low Hydroxychloroquine Blood Levels  HCQ levels < 500 >750   >1000  >1500 ng/ml . Patients with CKD stage ≥2 predicted 4-fold higher odds of supratherapeutic levels (≥1500 ng/mL)
  4. Abstr #1604 Stop RA: RCT HCQ vs. PBO in pts at-risk for RA. Study ended for futility. Among 140+ CCP3+ pts, RA development HCQ 34% vs. PBO 36%
  5. Abstr #1117 Deucravacitinib: TYK2 inhibitor vs PBO in active SLE (SLEDAI>6). Phase 2, 48 wk study; 363 ANA+ SLE pts : DEUC 3 mg BID, 6 BID, 12 QB vs PBO: @32wk: DEUC 3BID & 6BID > PBO, sustained at 48wk. No VTE or Safety signals
  6. Abst #L12 – First line anakinra in Systemic JIA.  65 sJIA (age 7.4; 1-16), @6mos 72% complete response, maintained out to 12 mos. Substudy found no utility for genotyping to predicted either outcomes or SJIA lung disease (DRESS, HLA DRB1*1501)

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