ICYMI: Top 5 Clinical Pearls in RA Management Save

Editor's note: This article originally published on February 15, 2024, and is being shared again as we start our Tuesday Night Rheumatology series, featuring select lecture excerpts from RheumNow Live 2024.

RheumNow Live 2024 provided a wealth of clinical insights, particularly in the realm of rheumatoid arthritis (RA) management. Here are the top five clinical pearls from the event's opening session, "Success in Rheumatoid Arthritis."

Dr. Brittany Weber explored the vast field of cardio-rheumatology. Our patients are at increased CVD risk. In fact, this is so important that “inflammatory diseases” were added to the 2019 ASCVD list of risk enhancers. 

Clinical Pearl #1: Patients with SLE have a 50-fold increased risk of an MI compared to age-matched norms. In RA, the risk of CVD is 1.5 times that of the normal population and patients with PsO and PsA are also at higher CVD risk comparatively. It is important to discuss disease state specific risk for CVD with patients.

Clinical Pearl #2: The gold standard for evaluating coronary microvascular dysfunction is the coronary flow reserve calculation (CFR.) This can be done with nuclear stress testing or cardiac catheterization. Coronary Microvascular Dysfunction is associated with poor prognosis/outcomes in our systemic inflammatory disease patients.  

Clinical Pearl #3: Remember, identifying plaque is important because most stress tests are normal, most events occur in patients with normal studies, and plaque burden better predicts risk.

Dr. Monica Guma gave a fascinating talk about nutrition in RA. You are what you eat. 

Clinical Pearl #4: ICYMI, the ACR developed a guideline for diet, exercise, and rehabilitation, and additional integrative interventions in RA. The guideline conditionally recommends the Mediterranean diet which maintains/shapes gut microbiota, enhances anti-inflammatory metabolite production, and maintains intestinal barrier integration. 

Dr. Connie Weyand discussed immunosenescence in RA. This was a key reminder of normal aging changes and how they can affect us. 

Clinical Pearl #5: “As we age, we gain not just wisdom, but all “inflammaging.”” Our immune system changes lead to poorer vaccine response, higher risk of infections, CVD and autoimmunity. “The goal is to protect our aging patients without over immunosuppressing them.” Dr. Weyand.