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Say Goodbye to Methotrexate in PMR?
For decades, glucocorticoids (GCs) have formed the backbone of polymyalgia rheumatica (PMR) management.
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JAK inhibitors in GCA?
The SELECT-GCA study, looking at upadacitinib in GCA, anchored the ACR 2024 opening plenary for a reason - it is highly notable and badly needed.
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Are Emulation Trials a Fantasy?
Are emulation ‘trials’ helpful, despite the biases that occur with observational data, or do they truly mimic the results of randomized controlled trials (RCTs)?
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Further evidence for risk of #MACE with cumulative GC use in RA
In a national cohort of pts with RA: ⬆️cumulative GC exposure associated with ⬆️odds of MACE, regardless of baseline MACE risk
Ab1719 #ACR24 @RheumNow https://t.co/RmxokfBXYX
Mrinalini Dey DrMiniDey ( View Tweet)
STAR trial of GC w/d in RA LDA
SEMIRA of GC w/d controlled RA on Toci
Very slight disease activity increase, but higher flares
No symptomatic adrenal insufficiency, but data of abnormal ACTH stim
No good evidence of steroid w/d symptoms
Beth Wallace
@RheumNow #ACR24 https://t.co/j6UPWlVNIu
Eric Dein ericdeinmd ( View Tweet)
Great table re:side effects of even low dose steroids in RA
Likely generalizes to other diseases ie PMR, SLE
P in prednisone stands for poison!
#ACR24 @RheumNow https://t.co/0opDEtzm9E
Mike Putman EBRheum ( View Tweet)
How do we prevent SLE flares requiring steroids?
Petri:
Background medication!
HCQ adherence is key
-check WB levels to measure
EULAR recs early addition of immunosuppress/biols
“Taper quickly, withdraw slowly”
Come down quick, then slowly off
@RheumNow #ACR24 @jhrheumatology
Eric Dein ericdeinmd ( View Tweet)
How do you treat a flare of SLE with steroids?
@RheumNow #ACR24
Eric Dein ericdeinmd ( View Tweet)
Petri: 5 mg prednisone or less is our standard for lupus control
EULAR 23 recs - early addition of immunosuppressant and/or biologics instead to prevent steroids
@RheumNow
#ACR24 @jhrheumatology https://t.co/jhxEeboPu5
Eric Dein ericdeinmd ( View Tweet)
Reset the bar for remission (off steroids)!! Session #17S19
3% higher risk of organ damage for each 1mg of pred
Remission possible in rheum with lower dose GC regimen and faster taper #GCStewardship
#ACR24 @RheumNow @BethIWallace
Jiha Lee JihaRheum ( View Tweet)
Petri on Steroids in SLE
Steroid-related organ damage presents later
- organ damage is higher in African-Americans
Dose response for prednisone and CVD risk
Each 1 mg prednisone = 3% increase risk in organ damage!
#ACR24 @jhrheumatology
@RheumNow https://t.co/00S1mxrXJp
Eric Dein ericdeinmd ( View Tweet)
GILZ is a negative regulator of the GC receptor, a potential steroid sparer target.
Dr. Miceli et al identified an E3 ligase of GILZ "E3-X" where deficiency leads to ⬆️ GILZ & ⬇️ inflammation.
More studies needed but a promising steroid sparer option.
@Rheumnow #ACR24 abs1646 https://t.co/GuVMkgOTXT
sheila RHEUMarampa ( View Tweet)
Infertility in women with RA 2x higher
Risk factors
- age
- disease activity
- use of NSAIDs
- use of pred >7.5mg/day
With T2T aiming for remission, fertility improves and becomes similar to the general population
#ACR24 @RheumNow ABST#1647 https://t.co/B2Tx4dju4Z
Jiha Lee JihaRheum ( View Tweet)
17S19 session on steroid free future
@LesleyJacksonMD @EBRheum @BritAdlerMD
Is a (near) steroid free future for RA, ANCA, Lupus
#ACR24 @RheumNow
Eric Dein ericdeinmd ( View Tweet)
It's always so dispiriting to see PMR patients rack up steroid side effects in front of your eyes.
(the intense motivation to do better than pred for our PMR patients)
#ACR24 @SattuiSEMD @RADoctor ABST0975 @RheumNow https://t.co/FTsvrTIt2F
David Liew drdavidliew ( View Tweet)
New data to guide role of long-term, low dose GC in GPA
Active GPA s/p tx -> randomized to d/c pred within 1 mo or stay on 5mg daily
Fewer relapses on 5mg pred but w/qualifications:
👉 most flares = minor
👉 no difference in flares if RTX on board
@RheumNow #ACR24 Abst 0774 https://t.co/Jvc40QWLqM
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Hamroun et al. Meta-analysis of glucocorticoids in pregnancy and breast-feeding. Increase pre-term birth with GCs, adjusted OR 2.24. Dose-dependent effect. Minimal breastmilk transfer. @RheumNow #ACR24 Abstr#0810 https://t.co/H0o9ElsHmc https://t.co/uciFP6UOhF
Richard Conway RichardPAConway ( View Tweet)
Hamroun et al. Meta-analysis of glucocorticoids in pregnancy and breast-feeding. Increase pre-term birth with GCs, adjusted OR 2.24. Dose-dependent effect. Minimal breastmilk transfer. @RheumNow #ACR24 Abstr#0810 https://t.co/H0o9ElsHmc https://t.co/uciFP6UOhF
Richard Conway RichardPAConway ( View Tweet)
More steroid-sparing options for #IgG4RD!
Abstract 0775: In pts w/ IgG4:
- Inebilizumab (CD19-monoclonal ab) vs placebo associated with reduced risk of flare (HR 0.13; 95% CI 0.06, 0.28)
AEs: infections, infusion reactions, lymphopenia
#ACR24 @RheumNow https://t.co/Vr5hcd2E7E
Akhil Sood MD AkhilSoodMD ( View Tweet)
This abstract reports that patients with ESRD 2/2 to GPA have a higher risk of vertebral fractures compared to individuals with ESRD without GPA. Even low dose steroids (pred 5mg) taken during the first year of HD conferred an increase risk or facture! #ACR24 @RheumNow https://t.co/4xM3XTCHSH
Gabriela Martinez Zayas, MD MartinezZayasMd ( View Tweet)