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New Biomarkers and Therapeutics Show Potential in Still's Disease
Adult-onset Still’s disease (AOSD) is a rare complex, sporadic, systemic autoinflammatory disease similar to systemic juvenile idiopathic arthritis (sJIA) characterized by sustained fever, salmon-colored rash, and arthritis.
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Lessons for #CVD in #inflammatory #rheumatic #diseases #ACR23 @RheumNow @ACRheum #ACRbest
-Negative #coronary #calcification doesn’t r/o presence of #microvascular #dysfunction
- work w #cardiologist for@proper@imaging for #Dx
-for #CAD or #pericarditis #Colchicine is GOOD https://t.co/dMO1FpoA2a
Janet Pope ( View Tweet)
TM13 @ #ACR23
64 yo F w/ CHF p/w dyspnea, palpitat, chest tight
EKG: monomorph VT
- Prior EKG: intervent conduct delay, LAD
TTE: ant wall abn, EF 35-40%
LHC: LV aneurysm, nonobst CAD
cMRI: abn LV wall thickening
PET: hypermetab LV
Endomyo Bx: necrot granuloma
DX?
@RheumNow
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
TM06 @ #ACR23: A Force Awakens
86 yo retired attorney w/ HTN, HLD p/w F, chills
4 mo ago:
- mild MDS on BMBx, cytogen neg
- new rash + Cr rise to 3 mg/dl, resolved w/ pred
3 mo ago: wt loss
1 mo ago: chondritis (ear, nose)
1 wk ago: b/l eye red + pain
DIAGNOSIS?
@RheumNow https://t.co/PdtAxnkXaJ
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Editorial position on the use of AI in publishing. AI cannot be listed as an author ✍️ Smolen J, #ACR23 @RheumNow https://t.co/P2eOmi6W5c
Dr. Antoni Chan ( View Tweet)
TM15 @ #ACR23
26yo pregnant F w/ unilat painful breast mass. US resembled abscess. Resolved on 💉aspirat but recurred post-part b/l despite abx & I&D
Coe Needle Bx: multifocal acute abscess w/ foreign body GC reaction on lymphoplasmacytic mastitis
Diagnosis?
@Rheumnow
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Prof Schett provides #ACR23 a wonderful, easy to digest, review of how CAR-T works. @RheumNow https://t.co/y5HZVAvvhy
Dr. Rachel Tate ( View Tweet)
In case you missed it! Watch our ACR Monday Recap of the meeting with me, @RheumNow @EBRheum and @ericdeinmd. #ACR23 @uptoTate https://t.co/GpMdev0Yk7
TheDaoIndex KDAO2011 ( View Tweet)
@lastwalsh @KyleWalkerM @RheumNow Second question: do you ever give a PEXIVAS-standard style steroid taper?
I'm 100% in agreement that we should favor PEXIVAS over observational data in most cases
In practice it seems like some patients need a bit more immunosuppression, though
Curious to hear your thoughts!
Mike Putman EBRheum ( View Tweet)
Abst #1584 TMP-SMX⬇️PJP ⬇️SIE,⬇️outpt infx in GPA on RTX. 919 patients: 31% had TMP-SMX, 40% on pred >20 mg/day followed median 496 days. SIE (aHR 0.5, 95%CI 0.3-0.8), outpt infx (aHR 0.7, 95%CI 0.5-0.9), & PJP. Thirteen PJP (all not on TMP-SMX). #ACRbest #ACR23 @rheumnow
TheDaoIndex KDAO2011 ( View Tweet)
Trimethoprim sulfamethoxazole (TMP-SMX) negatively associated with serious infections. Rates for adverse events possibly attributable to TMP-SMX per 100 person-years were 29.6 during and 13.4 post exposure. Mendel A, Abst#1584 #ACR23 #ACRBest @RheumNow https://t.co/hHY2bZXrkS https://t.co/2YMoCi1zrx
Dr. Antoni Chan ( View Tweet)
Ultrasound (and specifically intima-media thickness) might not just be for diagnosis in GCA - it might be a GCA disease activity measure for monitoring:
- improves over time
- increases with flares
Valentin Schaefer #ACR23 ABST1649 @RheumNow https://t.co/QWdIVGrHbn
David Liew drdavidliew ( View Tweet)
Ross et al. Ultrasound assessed Optic nerve sheath measurement in GCA. Previously shown increased in GCA. Here decreases with treatment shown in 9 patients Abstr#1650 #ACR23 @RheumNow https://t.co/fcrS4tT6U0 https://t.co/ylnPKzdUe0
Richard Conway ( View Tweet)
FDG-PET uptake at baseline in GCA predicts future risk of future thoracic aneurysm
In print here: https://t.co/2SQm18y6zP
Could this help stratify aneurysmal screening?
#ACR23 ABST1647 @RheumNow https://t.co/p1Dhkm2WTX
David Liew drdavidliew ( View Tweet)
PET/CT real-world performance in GCA diagnosis, Sydney @tonysammel:
comparable to other modalities
can optimize for sen or spec based on managing equivocal results
?some steroid confounding
but definitely one of 3 complementary imaging options for GCA
#ACR23 ABST1646 @RheumNow https://t.co/FvdLMvpqEU
David Liew drdavidliew ( View Tweet)
#ACR23 Abstr#1634 Promising therapy for two #Sjogren groups: 1 (high ESSDAI & ESSPRI) & 2 (low ESSDAI, high ESSPRI). Phase 2 RCT of Iscalimab (anti-CD40ab) showed more ISC-treated pts met the primary endpoint (ESSDAI and ESSPRI changes at WK24) vs PBO. Going to Phase 3 @RheumNow https://t.co/3bN3IS1zCO
Md Yuzaiful Md Yusof ( View Tweet)
Dr. AMendel et al:TMP-SMX prophylaxis assoc w⬇️serious infexns in RTX treated GPA pts; BL (aHR 0.5;95%CI 0.3-0.8) & time-varying exposure (aHR 0.5; 95%CI 0.3-0.9)
A good thing to consider but weigh benefits/harms w/TMP-SMX prophy. More studies req'd?
#ACR23 ABST1584 @RheumNow https://t.co/dfsfpcQu2A
sheila ( View Tweet)
TMP-SMX in AAV with RTX. 919 patients. Only given to 31% (40% on steroid>20mg), what!? TMP-SMX aHR 0.5 for serious infection, aHR 0.7 for minor infection. PJP 13 vs 0. Abstr#1584 #ACR23 @RheumNow https://t.co/4YQELIC82F https://t.co/U5l5KzSkB5
Richard Conway ( View Tweet)
TMP-SMX PPx in GPA
A#1584 @RheumNow #ACR23
919 pt analyzed
TMP-SMX ass w/ decr serious ifn (HR 0.5), less outpt ifns (0.9)
Rates for AEs attrib to TMP-SMX per 100 py: 29.6, wo TMP-SMX: 13.4
13 PJP, all in non-TMP-SMX pts
Should we use Bactrim to prevent ifn beside PJP? GC effects
Eric Dein ( View Tweet)
#ACR23 Abstr#1584 Data N=919 pts with GPA vasculitis treated with rituximab showed Septrin prophylaxis (+/- 28days of RTX) reduced serious & any infection. PJP=1.4% not on septrin. Question remains re: how long for in those receiving repeat cycles & steroid confounding @RheumNow https://t.co/81f8hbMids
Md Yuzaiful Md Yusof ( View Tweet)
