Robert B Chao, MD

Amateur chef. Liverpool supporter YNWA. Father. Cat dad. Husband. Rheumatologist. Views and opinions are my own.

[Robert B Chao, MD @doctorRBC]

Emerging therapies in the Allergy/Immunology world by Dr. Anna Postolova

Remiburtinib for Urticaria

Depemokimab (twice yearly administration) for eosinophilic asthma

@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Dr. Uma Mahadevan on PIANO registry and peri-partum recommendations
Continue biologics throughout pregnancy and breastfeeding
Avoid small molecules
Inactive and live vaccines, EXCEPT BCG vaccine should be given to infants exposed to biologics in utero

@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Is AI the future for axSpA imaging?

Overall close but still enough disagreement compared to human radiologist.

Perhaps not ready for primetime. Question is who is more accurate? Computer or human?

@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

NSAIDs has the term "Anti-Inflammatory" in it.

UK study showed axSpA pts with a positive MRI, who underwent a second MRI, while on an NSAID, 20% subsequently had a negative second MRI.

Consider a 2 week "wash-out" period of NSAIDs prior to imaging

@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

In axSpA pts who are incomplete responders to the first TNFi, how do you choose the next drug?

Hard to say. Should we consider another TNFi?

Switching to IL-17i was not superior to trying another TNFi.

@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Although seldom done, further proof to NOT use adalimumab drug levels or abs to predict tapering or discontinuation of adalimumab in PsA/axSpA patients
@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Extension study on secukinumab escalation to 300mg monthly in AS pts, did not show large difference.
Difficulty endpoint (inactive disease) however
Clinically, most doctors still increase dose
@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Dr. Arthur Kavanaugh and Dr. Eric Ruderman on new developments in axSpA

Improved sensitivity/specificity heavily reliant on radiographic findings
PsO and CRP included

@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Useful summary of PsA treatment options from GRAPPA based on disease characteristics

Note: nail disease -> skip straight to biologics

@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Dr. Ruderman and Dr. Kavanaugh on PsA

Reminding us the future may be combination biologics

Borrowing from GI colleagues’ IBD management with guselkumab+golimumab

@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

JAMA 2025 Algorithmic table on selection of treatment agents for osteoporosis

Note recommendation for indefinite use of denosumab
Very high risk - consider anabolic agents
@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Dr. Gina Woods on treatment targets for osteoporosis.
Target T score >-2.5
Great table on Lowest T score to achieve treatment success
@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Dr. Roy Fleischmann’s valiant points on CAR-T cell therapy
Excellent efficacy but what about tolerability, cost ($1M), access? And also who should be treated and at what stage?
@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Are CAR-T cell therapies the next step in SLE management?
70% achieved remission! Much better than existing therapies

50% developed cytokine release syndrome
@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Treatment of PMR still centers around steroids
Avg length one year
During relapse, return to previous dose
Consider IL-6i for difficult cases
@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Dr. Alisha Dua on PMR
More common in women, most common inflammatory rheumatic condition in ppl >50
Elevated APRs
Low dose steroids = rapid clinical and serologic improvement

@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Seroneg RA Tips from Dr. Cush
1) increased in post menopausal women
2) seroneg RA has more activity at dx
3) response to tx usually the same as seropositive
4) differential dx : ICI, Covid, infx

@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

What’s our drug choices for osteoporosis currently?

Stratify based on risk and especially fracture history

@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Don’t forget to incorporate resistance training AND balance training!

Resistance training proven to improve bone mineral density when compared to low intensity training.

@RheumNow #RWCS2026

[Robert B Chao, MD @doctorRBC]

Hot topic: gut microbiome

Also important in osteoporosis and muscle health

Increasing dietary fiber intake helps our muscle metabolism, driven by health gut microbiome.
@RheumNow #RWCS2026