"Don't You Know Who I am?" (5.17.2024)
Dr. Jack Cush reviews the news and journal reports from the past 2 weeks. This week's question: can we prevent gout, ILD or psoriasis?
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Imaging-Only Diagnosis of Giant Cell Arteritis Is Feasible
Positive findings with color Doppler ultrasound were enough to diagnose GCA accurately without need for confirmation with TAB, a prospective study indicated.
https://t.co/DuYskHPY5m https://t.co/mHCaAu1Ust
Dr. John Cush @RheumNow( View Tweet )
Eosinophilic vasciitis is a rare disease w/ Symmetric (peau d’orange) skin thickening or early pitting edema of arms legs trunk. Raynauds absent & NL nailfold capillaroscopy. Complicated by Pulm HTN, VTE. Liver dz. Rx?? Maybe IVIG or IL-5 inhibitors? https://t.co/2UgVPmYobs
Dr. John Cush @RheumNow( View Tweet )
Imaging-Only Diagnosis of Giant Cell Arteritis Is Feasible
Positive findings with color Doppler ultrasound were enough to diagnose GCA accurately without need for confirmation with TAB, a prospective study indicated.
https://t.co/2b3y2OCENA https://t.co/4OOFo1hRCv
Dr. John Cush @RheumNow( View Tweet )
Imaging-Only Diagnosis of Giant Cell Arteritis Is Feasible
Medpage Today
Positive findings with color Doppler ultrasound were enough to diagnose giant cell arteritis (GCA) accurately without need for confirmation with temporal artery biopsy (TAB), a prospective study indicated.
Out of 165 older patients in whom GCA was strongly suspected, 73 (44%) had the
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In 530 #GCA pts, relapses seen in 46%; but severe relapse (ischemi/aortic events) in 3%. Severe GCA relapse pts more likely to be younger at Dx(P=0.02), w/ more limb claudication(< 0.0001), fewer GCA-related cranial Sxs (<0.0001); but not higher mortality https://t.co/k7wgU6oMcn https://t.co/BKOfGmZ27u
Dr. John Cush @RheumNow( View Tweet )
Study of f 234 AAV pts. 85 (36%) developed diffuse alveolar haemorrhage. Independent predictors of DAH: 1) Age [OR=1.037); 2) PLT # [OR=0.996]; 3) ESR [OR=1.028]; 4) HgB [OR=0.978]; 5) hematuria [OR=3.77] https://t.co/shI8RPZgcv https://t.co/dmceGvUuyR
Dr. John Cush @RheumNow( View Tweet )
Featured BSR Abstracts (5.2.2024)
Dr. Jack Cush muses on the news, journal reports, FDA announcements and the 2024 BSR abstracts just released.
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In 530 #GCA pts, relapses seen in 46%; but severe relapse (ischemi/aortic events) in 3%. Severe GCA relapse pts more likely to be younger at Dx(P=0.02), w/ more limb claudication(< 0.0001), fewer GCA-related cranial Sxs (<0.0001); but not higher mortality https://t.co/qyUpepmryA https://t.co/MJ9kAKl62r
Dr. John Cush @RheumNow( View Tweet )
Rheum Chapter Notes (4.26.2024)
Dr. Jack Cush reviews this past week’s news and journal articles from RheumNow.com.
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AbbVie announced preliminary positive results from phase 3 SELECT-GCA study showing remission in 46% of #GCA pts Rx w/ upadacitinib for 52wks (vs 29% PBO); RCT included a 26-wk steroid taper regimen https://t.co/DIstJ4hazo https://t.co/VXc7rj0REJ
Dr. John Cush @RheumNow( View Tweet )
GPA Management in 2024
https://t.co/qTwI7oVMBI https://t.co/Tr0eVmcgNN
Dr. John Cush @RheumNow( View Tweet )
Pregnancy in vasculitis checklist:
- goals and timeline
- disease activity in 12 mos
- is there end organ damage?
- Review Rx
- h/o clots/miscarriages, APLS?
- Check Ro/La
- Role for ASA?
- Refer to MFM
Catherine Sims #RNL2024 @RheumNow
Dr. John Cush @RheumNow( View Tweet )
#RNL2024 @RheumNow
@philseo: I now give Tociliizumab for nearly all patients with GCA
GiACTA shows we weren't doing well enough with steroid monotherapy
GiACTA shows dosing frequency does not make a big difference in new diagnosis, but makes a difference in relapsing disease
Dr. John Cush @RheumNow( View Tweet )
#RNL2024 @anisha_dua
Throwing the kitchen sink in severe GPA
CYC + RTX combo - sick population (median GFR 9, 47% on HD, 52% DAH, all received PLEX too)
- 85% survival, 69% not ESKD, low rates of relapse (13% at 36 mos)
But, prolonged B cell depletion, aggressive Rx
Dr. John Cush @RheumNow( View Tweet )
Canary in a Coal Mine (4.19.2024)
Dr. Jack Cush reviews regulatory reports, news and novel journal articles - this week focusing on Sjogren's, ILD, Gout and Uveitis.
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PJP PPx in AAV
@anisha_dua #RNL2024 @RheumNow
919 GPA pts on RTX - only 31% on TMP/SMX
13 pts devel PJP, not on PPx
Overall decreased serious infections (HR 0.5), outpt infections HR 0.7
Adverse effects on TMP/SMX 29.6 vs 13.4
For every serious ifn avoided, 2-3 pts will have AE
Dr. John Cush @RheumNow( View Tweet )
ICYMI: Vasculitis Pearls
https://t.co/7z6b0Wj37X https://t.co/PHlOvFG9qQ
Dr. John Cush @RheumNow( View Tweet )
ICYMI: Vasculitis Pearls
Once again RheumNow Live 2024 really delivered with high impact learning packed into short sessions. As someone with an interest in vasculitis it was fantastic to see four of my favorite speakers in the Vasculitis Mavens and STEP talks. They gave us what we really want from these talks –
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Join us 4/16 for Tuesday Night Rheumatology at 6:30pm ET. This week we'll be focusing on Vasculitis Mavens with:
Vasculitis & Pregnancy - Catherine Sims, MD
GPA Management in 2024 - Anisha Dua, MD, MPH
Treat to Target in Vasculitis - Philip Seo, MD
https://t.co/6IaCdCodGf https://t.co/HlZ8OiZWc4
Links:
Dr. John Cush @RheumNow( View Tweet )
Best Imaging in Giant Cell Arteritis - US, PET, MRI?
Imaging is often instrumental in diagnosing and staging patients diagnosed with giant cell arteritis (GCA).
https://t.co/LXVB6cHDfO https://t.co/ArLNdEPuVx
Dr. John Cush @RheumNow( View Tweet )
Best Imaging in Giant Cell Arteritis - US, PET, MRI?
Imaging is often instrumental in diagnosing and staging patients diagnosed with giant cell arteritis (GCA). A new study compared the diagnostic performance of Colour Duplex Ultrasound (CDUS), Fluor-18-deoxyglucose Positron Emission Tomography Computed Tomography (FDG-PET/CT) and
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Serious Infections in Takayasu arteritis
The large vessel vasculitis, Takayasu arteritis (TAK), carries a significant morbid risk and a cohort analysis shows these patients are also at high risk of serious infection with resultant higher risk of death.
https://t.co/qqtpCMYnZf https://t.co/ZlxATKVQIA
Dr. John Cush @RheumNow( View Tweet )
TAPIR study shows that GPA patients treated with rituximab can be safely weaned off low dose prednisone. But. 20% risk of relapse in those treated with non-RTX regimens @VasculitisBCN24 #vasculitis https://t.co/jDy0lOQQIP
Catherine Hill @CatherineL_Hill( View Tweet )
Seasonal Pathogens and Henoch-Schönlein Purpura
Epidemiologic studies of Henoch-Schönlein purpura (HSP) have suggested seasonal variation in occurrence rates (higher from September-April, lower in June-August), suggesting a role for infectious triggers. The importance of infection was recently shown with nonpharmaceutical interventions (
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