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Nov 11 14 tweets 10 min read
.@DrLisaCS on statin myopathy

autoimmune necrotizing myopathy vs self limited toxic myopathy -- learn this table!

#ACR22 #ReviewCourse
@DrLisaCS 🔑 difficulty swallowing seen in autoimmune myopathy
🔑 autoimmune version can occur years after statin start

🔑 the Ab is important and helpful for dx

🔑 If you stop the statin and CK still ⬆️⬆️it's almost always the autoimmune version

#ACR22 #ReviewCourse
Consensus for statin associated muscle sxs (SAMS)?? #ACR22 #Reviewcourse
Lipophilic vs hydrophilic statins, does it matter? Data suggests no

#ACR22 #ReviewCourse
Statin compliance is poor (~50% adherence in studies).
Why? Intolerance!

👉Make sure to r/o hypothyroidism

👉Make sure you understand the DDIs with statins

#ACR22 #Reviewcourse
What do we understand about exercise, statins, and CK?

We don't understand enough.

#ACR22 #Reviewcourse
SAMSON trial:
🔍nocebo effect (more sxs if you know you are on statin?)
🔍n of 1 trial (person serves as their own control)

👉empty bottle, low sx severity score
👉no sx difference btw statin & pbo; but this was lower than if empty bottle

#ACR22 #Reviewcourse
Another n of 1 statin trial, STATINWISE

👉didn't detect difference in muscle sxs between statin and pbo

Good data to decide if ok to restart/rechallenge statins!

Rechallenge does not apply to those with HMG-COA reductase Ab ❗️

#ACR22 #Reviewcourse
Quick points:

👉Ok to use statins in other neumomuscular disorders

👉Muscle bx for statin myopathy? Not needed. Esp don't do it if acute rhabdo

👉Check CK at statin start: No need

#ACR22 #ReviewCourse
Check CK if ⬆️LFTs

#ACR22 #ReviewCourse
Clinical recs for statin intolerance?

💡Take away statin & wait & reassess
💡Try your own n of 1 with rechallenge

Intolerance despite this? See cards guidelines
#ACR22 #Reviewcourse
What about CoQ10?

Statins ⬇️CoQ10 but no clear dose response

Small RCT: CoQ10 improved perception of sxs in pts with prior statin intolerance

Party line? May work, may not. Only harm is $

#ACR22 #Reviewcourse
8 (!) arm RCT of supplements: SPORT

Bottom line: no supplement lowered LDL greater than PBO

#ACR22 #ReviewCourse
Some of my favorite speakers deliver content faster than I can type, and that pantheon includes @AlexisOgdie & @kidneydoc101 😂

#ACR22

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More from @rheum_cat

Nov 13
#ACR22 social media talk, very meta Image
Part 1️⃣: optimize your conference tweeting
If you're reading this you probably know all of this!

The first pro-tip was figure out the conference hashtag
The second? Engage with others in rheum
#ACR22 Image
What else?

👉amplify your group
👉amplify speakers and sessions of interest
👉amplify your colleagues so they will amplify you in turn

#ACR22
Read 10 tweets
Nov 13
#ACR22 infection (COVID) posters Image
Abs 0784 @CCalabreseDO

Cleveland Clinic breakthrough infections, including data on n=21 who received Evusheld

📌Publication here: pubmed.ncbi.nlm.nih.gov/35791921/

#ACR22
@CCalabreseDO Abs 0779 @CCalabreseDO

Experience with evusheld PrEP with IMID on BCDT at Cleveland Clinic

📌Publication here: pubmed.ncbi.nlm.nih.gov/36123015/

#ACR22
Read 13 tweets
Nov 13
The EULAR e posters were tiny (bad) but speakers could zoom in and out (good)

That would have been nice for #IgniteTalks #ACR22
The sound is adequate though. EULAR issue was that the sound was poor in their (smaller) poster tour stages #ACR22 #IgniteTalk
Read 4 tweets
Nov 13
#ACR22 epidemiology posters Image
Abs 0700 @zach_wallace_md
💻Using NLP, ML algorithms to identify ANCA vasculitis cases

They also looked at the difference in performance metrics with/without filtering keywords

An explosion of NLP studies in rheum! #ACR22
@zach_wallace_md Abs 0732 Ho, et al. @JYazdanyMD @MilenaGianfran
💻Part of the explosion of NLP studies in rheum

Here the UCSF group aimed to capture VZV cases (differentiate from vaccination); and to capture active vs historical cases

See their diagrams explaining the steps!
#ACR22
Read 13 tweets
Nov 13
We have learned quite quickly that a virtual ONLY poster hall mixed into a hybrid meeting doesn't work well.

Poor wifi and the crashing platform compound the problem

And if it's online ONLY, is that truly hybrid?

#ACR22
This is not a complaint thread. I am hoping we can have discussion about what works/doesn't work, and what could be done next year for #ACR23
It goes without saying that an in-person poster hall is the most requested item on the wishlist for #ACR23

@GrantSchulert @Tuhina_Neogi
Read 5 tweets
Nov 13
Biostatician @MikeLaValley8 @BU_BMC_Rheum presents a quick overview on how to appropriately interpret results from studies #ACR22

Of course this is not an exhaustive deep dive, but covers some common errors of interpretation Image
@MikeLaValley8 @BU_BMC_Rheum First, what is your research question? What is the question you are trying to answer with t he study?

👉Does this exposure CAUSE this outcome?

#ACR22 Image
@MikeLaValley8 @BU_BMC_Rheum What are common observational study designs and what are big issues to watch out for?

These are issues that can affect the validity of their results.

There are more potential issues within these study designs that is beyond the scope of this table

#ACR22 Image
Read 15 tweets

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