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Glucocorticoids-free zone in SLE?

d Md Yuzaiful Md Yusof, MRCP(UK), PhD

For over 70 years, glucocorticoids, (GC) have been a part of standard therapy in SLE. They are classically used to not only induce remission or treat an acute flare, but also as maintenance therapy. They are a valuable 'friend' if used wisely, and can become a 'foe' if used excessively.

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Reduced-dose GC regimen in severe GPA or MPS (creatinine >300 umol/L, RTX as induction) associated with increased risk of death, ESKD, progression before remission requiring treatment modification or relapse, Nagle S Abst#0725 #ACR23 #ACRBest @RheumNow https://t.co/ZVZYRnSy3n

Dr. Antoni Chan  ( View Tweet)

#ACR23 Abstr#0782 Triple therapy in #lupus nephritis. Propensity match data AURORA vs ALMS showed pts treated with voclosporin+MMF+low dose GC vs MMF+High dose GC achieved earlier reduction in UPCR & fewer AEs. Cdnt control for everything e.g. HCQ but assuring @RheumNow #ACRBest https://t.co/dmriAyQPr0
Md Yuzaiful Md Yusof  ( View Tweet)
Differences in #glucocorticoid dosing. In #lupus #nephritis less steroids are the same as high dose steroids. Placebo arms of pooled data from #LN #RCTs. Less is equal! #ACRbest #ACR2023 ⁦@RheumNow⁩ ⁦@ACRheum⁩ abst0781 High dose steroids tended to have lower MMF doses https://t.co/XwTlsy4xKE
Janet Pope  ( View Tweet)
Sarilumab for relapsing of PMR. Any thing to to taper off prednisone quickly. #ACR23 , year in review. Lost of good studies and smart discussions @RheumNow at Make rheum for PMR month. https://t.co/VyRP8ls3OC
Nouf Al hemmadi  ( View Tweet)
Important plenary re:reduced vs standard GC for AAV... IRL PEXIVAS & recent guidelines supported low dose taper Real world data w/severe dx? Increased risk of death & ESKD for REDUCED pts Need full data but yikes... @RheumNow #ACR23 #ACRBest https://t.co/3S23O9d1ok
Mike Putman EBRheum ( View Tweet)
Abst#0725 #ACR23 @RheumNow PEXIVAS Real life data! GPA & MPA pts - Retrosp observ study ⭐️Reduced-dose GC regimen ass w/ INCREASED risk of death, ESKD, progression Greatest risk: pt w Cr levels >300 umol/L, RTX induction Rx ⚠️Caution w/ reduced GC, RTX, severe kidney dis #ACRBest https://t.co/7qI5c1ZiqO
Eric Dein  ( View Tweet)
Interesting study on PEXIVAS reduced steroid use from today's plenary session! Reduced steroid dose in GPA/MPA pts associated w/ INCREASED risk of death, ESKD, progression of dz Even greater risk in pts with higher Cr lvls or RTX induction use @RheumNow #ACR23 Abs#0725 #ACRbest https://t.co/frsOrANKhf
Robert B Chao, MD  ( View Tweet)
Real world data on low dose PEXIVAS steroid by Nagle et al. Increased risk of progression/relapse/death/ESKD in those with severe GPA/MPA HR 1.72. More marked in those with creat>300 or with RTX induction Abstr#0725 #ACR23 @RheumNow https://t.co/vTXVZfjbXx https://t.co/4FuMjxOuyB
Richard Conway  ( View Tweet)
#ACR23 Real-world multicentre study showed steroid-sparing effect of Belimumab in #SLE. At 2 years, proportion of patients on =>10mg/d decreased from 52% to 3%. 18% and 13% achieved LLDAS and DORIS remission. Support its use esp. in those relying on glucocorticoids @RheumNow https://t.co/ad5XH3pmYc
Md Yuzaiful Md Yusof  ( View Tweet)
YR in Review: Dr. Seo 🚩GLORIA Trial RA pts > 65yo: prednisolone 5 mg/d x 2 yrs vs PBO + std care ➡️decr dz activity (DAS ⬇️0.37) but 24% incr ADE 🚩Extension: ➡️Tapered off pred over 3m and.. ⭐️NO ADRENAL INSUFF But, small incr in dz activity (DAS ⬆️0.23) #ACR23 @RheumNow https://t.co/YQbS6C8ZT5
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Revisiting question in #painful #knee #osteoarthritis Which #steroid to inject - esp with #triamcinolone #hexacetonide shortages which is superior to #acetonide. New extended release #fluticasome #propionate > #placebo ? Is how about vs IA steroids LB04 @RheumNow @ACRheum #ACR23 https://t.co/qJazwihSe0
Janet Pope  ( View Tweet)
PEXIVAS results: the reduced-dose GC regimen associated w/ ^ death, ESRD, and uncontrolled dz risk in severe GPA/MPA pts. Even greater risk in pts w/ creatinine levels > 300 μmol/L & in those tx w/ RTX induction. #ACR23 Plenary 0725 https://t.co/mBMrEaGj5k @rheumnow https://t.co/flAfYEKSXJ
Dr. Rachel Tate  ( View Tweet)
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ACR Convergence Preview (11.10.2023)

d Jack Cush, MD

Dr. Jack Cush reviews this past week's news on RheumNow.com and suggests a learning plan for those wanting to consume the upcoming ACR Convergence 2023 meeting. 

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Incidence, Microbiological Studies, and Factors Associated With Prosthetic Joint Infection After Total Knee Arthroplasty

d Jack Cush, MD

A study of nearly 80,000 US veterans who underwent primary knee joint arthroplasty (TKA) showed  the incidence of prosthetic joint infection (PJI) was highest in the first 3 months and remained elevated through 12 months compared with 12 months or more after surgery.

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Late Should Not Be Less (11.3.2023)

d Jack Cush, MD

Dr. Jack Cush reviews the news, journal reports and regulatory approvals from the past week on RheumNow.com.

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Steroid (GC) use is increasing - Claims data from (US, Taiwan, Denmark; n=54,630,437; 2009-2018), GC use increased from 6.4 to 7.7% USA, 16.6 to 18.7% Taiwan, & 1.7 to 2.9% Denmark. Most Rx by PCP to healthy adults; 20-25% Rx for URI. https://t.co/GkQR0hcys1 https://t.co/5fpBv2Kyo8

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Dr. John Cush RheumNow ( View Tweet)
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Optimal Management of de Quervain Tenosynovitis

d Jack Cush, MD

The treatment of de Quervain tenosynovitis (DQT) was examined  by systematic review in JAMA, suggesting that local (US-guided) corticosteroid injection plus a thumb spica immobilization was associated with significant pain-relieving and functional benefits. 

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Choosing steroid sparing therapies in #PMR We have no evidence-based alternative treatment to glucocorticoids in PMR. Few disease-modifying anti-rheumatic drugs, such as methotrexate and leflunomide, are used in daily clinical practice in PMR. https://t.co/zvfAwc7t1z https://t.co/pAJFHF6hOn

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Dr. John Cush RheumNow ( View Tweet)
Choices

Choosing steroid sparing therapies in PMR

d Maria Sandovici, MD, PhD

Despite the official recognition of PMR as a distinct disease more than 60 years ago, patients with PMR are still largely treated with steroids (glucocorticoids, mostly prednisone). The persistent broad use of glucocorticoids in PMR is related to their quick initial efficacy in the majority of patients with PMR, their low price and the lack of alternative treatments and paucity of glucocorticoid-sparing treatments.

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