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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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Systemic polyarteritis nodosa looks creepily/scarily beautiful on PET/CT. Look at that Christmas tree!
but sensitivity can be affected by pred, & isn't great even without (48%).
By itself, a good rule in test, but not a good rule out test.
#ACR24 ABST1962 @MayoClinic @RheumNow https://t.co/y28J6VKja4
David Liew drdavidliew ( View Tweet)
The TAPIR study presented at #ACR24 may not be as attention grabbing as others like SELECT-GCA, but in my opinion it is arguablyone of the most important ANCA-vasculitis studies ever. I've shared some further thoughs in an article on @RheumNow https://t.co/mImAE8ezSQ
Richard Conway RichardPAConway ( View Tweet)
de Boysson et al. RCT anakinra in GCA. 30 patients. Week 52 relapse 53% in anakinra vs 46% in placebo. @RheumNow #ACR24 Abstr#1699 https://t.co/sqDWUlkXAX
Richard Conway RichardPAConway ( View Tweet)
Safer and less relapses in
#Takayasu’s #arteritis
In
#MTX + #MMF
Vs
#Cyclo ➡️ #azathioprine
@RheumNow #ACRBest @ACRheum abst#1696
WOW 😮 Amazing! https://t.co/y3BDjdAa6P
Janet Pope Janetbirdope ( View Tweet)
#Upadacitinib rises ‘ Up’ in all subgroups of #GCA Subset of overall #RCT of #rinvoq w more reduction of #steroids vs placebo+ slower #prednisone taper Consistent results best in UPA 15 mg >UPA 7.5mg/d > #placebo #ACR24 #ACRBest @RheumNow @ACRheum abst#1695 https://t.co/dA7RkNmWFd
Janet Pope Janetbirdope ( View Tweet)
Brenac et al. Orbital MRI to distinguish GCA AOIN/CRO from non-arteritic. @RheumNow #ACR24 Abstr#1641 https://t.co/qIwaX3qp02 https://t.co/5CIZ0aV98Z
Links:
Richard Conway RichardPAConway ( View Tweet)
Cowley et al. US pattern in Subclinical GCA in PMR vs GCA. Subclinical GCA has more isolated axillary artery involvement. Severity of US inflammation significantly higher in GCA than subclincal GCA @RheumNow #ACR24 Abstr#1629 https://t.co/6Iyx76YgkS https://t.co/DxzTEwE5J5
Links:
Richard Conway RichardPAConway ( View Tweet)
At "Envisioning a Steroid Free Future" talk
Angelo Gaffo at the mic: "Are there any situations you would do induction therapy for AAV without steroid?"
John Stone: [pause] "No." 😄
#ACR24 @RheumNow
Mike Putman EBRheum ( 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)
Reason for consult: aortitis- evaluate for systemic causes
Abstract 1638: Kmetova et al highlight the promising clinical utility of calprotectin as a marker for clinically isolated aortitis
@RheumNow #ACR24 https://t.co/2qPaAqWswG
Akhil Sood MD AkhilSoodMD ( View Tweet)
John Stone
Steroid-free AAV
CYCLOPS: steroid tox like “wallpaper on room”
WGET (ETN for GCA) - taper off by 6 mos - neg trial but started tapers
RAVE - low doses 8-9 mg/d over 18 mos
LoVAS - low dose steroid equally eff
ADVOCATE - AVA one month taper, tox score
#ACR24 @RheumNow https://t.co/C7eLK5UNPM
Links:
Eric Dein ericdeinmd ( View Tweet)
#Blinded by results? 😊
#Ocular #involvement in #GPA
👇
Helped by #rituximab
👁️ #GPA
Difficult
Proptosis
Pseudotumour
Conjunctivitis
Scleritis
Vasculitis
Ocular muscles - diplopia
Small case series ‘author defined’ remission in
80% 👍 #RTX
#abst0726 @rheumnow #ACR24 https://t.co/GHptelOTyv
Janet Pope Janetbirdope ( View Tweet)
"We look forward to Carol Langfords upcoming leadership at ACR and its newfound focus on ANCA vasculitis as the most important disease" 😆😂
-Phil Seo
#ACR24 @RheumNow
Mike Putman EBRheum ( 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
Links:
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Should we screen new #PMR pts for #LVV?
Pts with PMR had lower risk of aortic complications vs #GCA & similar risk as gen pop
BUT if they developed GCA later, the risk was same as those with new GCA
➡️Screening recommended in new GCA but not PMR pts
Ab0859 #ACR24 @RheumNow https://t.co/HsHPGlt5A9
Links:
Mrinalini Dey DrMiniDey ( View Tweet)
@abdelhamed012 @RheumNow Same https://t.co/uScez6UwBp
Richard Conway RichardPAConway ( View Tweet)
🤵♂️Results from BACHELOR
➡️34 PMR pts
➡️18 BARI, 16 PBO
➡️Primary endpoint: CRP PMR-AS≤10 w/o oral GC rescue from W0 to 12
78% BARI pts reached primary endpoint vs 13% PBO
No new safety signals
BARI 4mg 12W, then 2mg 12W➡️36W low disease activity in PMR
Ab0858 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
