Eric Dein @ericdeinmd
#RNL2025 Treatment of sclerosing skin conditions: Active inflammation? Sclerotic? Atrophic? Target based on activity, depth of involvement and other disease involvement
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Hashtag
#RNL2025
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Eric Dein @ericdeinmd
How do you know if Morphea is active? -Erythema -Peripheral induration -New lesions in the past few month Non-active damage? - Dermal atrophy -SQ atrophy -Hyperpigmentation -Skin thickness center #RNL2025
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The POWER of #plaquenil
#Hydroxychloroquine works in #rheumatic #diseases by
Old answer
👇
Alters liposomal membranes 🤷♀️
NEW ANSWER
Inhibits TLR signalling 🔥
#RNL2025 Mary *Peggy Crow #SLE #systemic #lupus #erythematosus
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TheDaoIndex @KDAO2011
A practical clinic-based approach to assessing CVD, CA screening, lung disease, infections for rheums by Dr Bryant England who offers us menus.. start by asking about symptoms. #RNL2025
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RT @AdelaCastro222
Multimorbidity in Rheumatoid Arthritis:
-Affects >75% of pts
-Reduces quality of life and increases mortality
-Highly associated w/ D2T RA
-Requires multidisciplinary care teams (PCP, specialists, case management, PT)
-Management should start early in the disease
#RNL2025
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Jeffrey Curtis @RADoctor
Great talk at #RNL2025 by Dr Una Makris on managing geriatric rheumatology patients. How often do we under-treat #Rheumatoid arthritis patients with advanced therapies because we fall into the trap of ageism?
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Janet Pope @Janetbirdope
Dispel the #myth #rheumatoid #arthritis is NOT Just a disease of Young and middle aged Elderly PREVALENT #RA Pts and 👇 INCIDENT Pts in >65yrs is skyrocketing 🚀 Need #Rx goals and equitable #Rx Uma Makris #RNL2025
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TheDaoIndex @KDAO2011
@UnaMakris wants us to shift our approach to #GeriRheum. #RNL2025– remember the 5 M’s Multimorbidity Mind Medications Mobility what Matters most
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Adela Castro @AdelaCastro222
Are your patients aging with RA, or are they diagnosed with Late Onset RA (LORA)? -LORA pts tend to present acutely -High inflammatory markers~PMR Like -Seronegative/Decreased titers of RF/CCP @UnaMakris #RNL2025
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@ericdeinmd
J Curtis #RNL2025 AI Will Not Replace You - AI cannot replace human interaction, examination, procedures, interpreting guidelines for an individual, providing empathy, and facilitate good patient education Will become a tool... but not a replacement to a good clinician
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@ericdeinmd
AI models require good Positive Predictive Value (PPV) But: PPV decreases as prevalence decreases - In choosing a successful biologic: Harder to predict more challenging patients (multiple failures, co-morbidities, etc) - ACR50 non-response is higher J Curtis #RNL2025
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@AdelaCastro222
How can AI be useful for RA pts and rheumatologists? -AI models have the potential for improving diagnosis, management and outcomes in RA pts. -Can also improve efficiency and clinic workflow. -Not so perfect as it sounds (hallucinations, limited accuracy) #RNL2025
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@ericdeinmd
🏈Kick-off of @RheumNow w Jeff Curtis #RNL2025 🏈 AI in RA? Can help with Rheum Boards Questions, though AI is not confident in answers May not be better than paper charts for triage Other roles: pt chatbot, AI scribe, research populations, generate DDx, consume guidelines
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TheDaoIndex @KDAO2011
Potential uses of #AI for #RA -office workflow (scribe, triage) -research (match eligible pts for trials) -help with diagnosis (and likelihood of risk) -consume guidelines for disease mgmt @RADoctor #RNL2025
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Great weekend #RNL2025
Speaking about geriatrics concepts we can integrate into our care to improve outcomes for older adults with rheumatic disease.
Thank you to this engaged audience early Sat morning 🙌🙌
@rheumnow.bsky.social @kwyshammd.bsky.social
Credit to #gerirheum for moving us forward
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80% #hydradenitis suppurativa pts are smokers or former smokers, smoking can predate #HS by 4-5 years. Other associations: DM-2, Spa, obesity, SAPHO, PCOS eval for SCC (squ. cell CA) #RNL2025
@rheumnow.bsky.social
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"Tombstone comedones" (2 comodones together) are pathognomonic of #Hydradenitis - Dr. J Cather #RNL2025
@rheumnow.bsky.social
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"Vinegar water or 1 tbs bleach to 1 gallon water can help with the odor from #Hidadrenitis" - Dr. J Cather reviewed goals of therapies and Rx's (while laser hair removal can help, it also can cause problems; intralesional steroids can cause atrophy)
@rheumnow.bsky.social
#RNL2025
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Dr. C Bakewell's PEARLs on imaging in #ankspond & #PsA:
- PsA may have +HLA-B08 and B28 (esp if it looks like candle drip--not just B27)
- for PsA, up to 30% of pts will have spinal lesions without Si joint changes
- for AS, MRI SI joints, xray the spine #RNL2025
@rheumnow.bsky.social
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Can NSAIDS reduce the risk for progression in #ankylosingspondylitis? - Dr. Van Der Heidje #RNL2025
@rheumnow.bsky.social
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"NO guidelines address RA flares!" - @rheumnow.bsky.social
on how flares are perceived as bad and important, but yet, no standard definition, guidance on this #RNL2025
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#RNL2025. RA flare definition differs w/ clinical trial. Pt's flare definition is even more different. Recent study defined flare as sDAI >=4.7 or CDAI > =4.5. a longer flare is worse than a shorter flare. Can't rely on DAS28 & low correl w/VECTRA or biomarkers. @rheumnow.bsky.social
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Giles #RNL2025
@rheumnow.bsky.social
ORAL Surveillance - 3 Yrs Later
How do interpret in care of pts?
Pts with known hx of ASCVD have higher risk w TOFA v TNF. If no hx ASCVD, no increase risk even w risk factors
Statins were underused in study pts at risk or w CVD, may help mitigate risks
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#RNL2025 @rheumnow.bsky.social on SGLT2/GLP-1 helpful for PsA, PsO... likely Rheums will be more comfortable writing these Rx's given the benefits seen for the inflammatory disease. Make sure you know side effects and how to titrate them.
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B England
75% of RA pts have multi-morbidity
Pts develop multi-morbidity BEFORE the onset of RA
Should we have different goals: Prioritize LDA over remission in pts w multimorbidity
Collaborate w PCP: one size doesn't fit all, do something better than nothing!
@rheumnow.bsky.social #RNL2025
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3 Questions To Ask in Clinic
@unamakris.bsky.social on STEADI Questions
1 Have you fallen in past year?
2 Do you feel unsteady when walking or standing?
3 Are you worried about falling?
#RNL2025 @rheumnow.bsky.social
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Review Med Lists in Rheum
- ~40% of pts w RA/SLE on Potentially Inappropriate Meds (PIM)
-Review Beers Criteria for Rx to avoid in older pts
- Include: antidepress, benzo, steroid + NSAID, gaba, nifed, PPI, mm relax
@unamakris.bsky.social at #RNL2025 @rheumnow.bsky.social
@JihaRheum @NamrataRheum
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