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Update on Myositis
The ACR/ARHP 2018 national meeting in Chicago presented us with opportunities to learn more about inflammatory myositis. A particularly interesting lecture was HOT topics in myositis. There were a few abstracts on MDA-5 related disease and a few on new or repurposed medications for dermatomyositis which will be covered here.
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DIP involvement in RA
12k patients in Japanese registry
2% incidence, 2-3 joints in each pt with involvement
associated with higher disease activity
Abs 221
Roundup - Cush, Kavanaugh
#ACR18 @RheumNow
D White WIRheum ( View Tweet)
Biosimilars in Sweden
Rx patterns (originator vs biosimilar) follow prices - back and forth
Abs 1175
Roundup - Cush, Kavanaugh
#ACR18 @RheumNow
D White WIRheum ( View Tweet)
Gout
Remains under-treated
Higher success when pharmacists and RNs manage ULT
Abs 2220, 1247, 1272
Roundup - Cush, Kavanaugh
#ACR18 @RheumNow
D White WIRheum ( View Tweet)
Enthesitis, in particular supraspinatus tendinopathy
IL-17A as a target of therapy
Abs 404
Roundup - Cush, Kavanaugh
#ACR18 @RheumNow
D White WIRheum ( View Tweet)
MTX helpful for granulomatous mastitis
Can be recurrent; sometimes seen by rheums
Rule out cancer, infection
Abs 2264
Roundup - Cush, Kavanaugh
#ACR18 @RheumNow
D White WIRheum ( View Tweet)
Chronic back pain in patients with a FHx of ank spond
More psoriasis and heel pain
Undiagnosed SpA?
Abs 637
Roundup - Cush, Kavanaugh
#ACR18 @RheumNow
D White WIRheum ( View Tweet)
High- vs standard-dose influenza vaccination in pts on DMARDs and biologics
High-dose quadrivalent version more effective (seroconversion) except in rituximab population
Abs 837
Roundup - Cush, Kavanaugh
#ACR18 @RheumNow
D White WIRheum ( View Tweet)
MTX vs etanercept vs combo in PsA
ACR20 at 24 wks: 50%, 60%, 65%
Contrast TEMPO study in RA where combo therapy was better than monotherapy
Also: MTX monotherapy effective
Abs L11
Roundup - Cush, Kavanaugh
#ACR18 @RheumNow
D White WIRheum ( View Tweet)
Plasma exchange in AAV (GPA or MPA) with severe disease
PLEx did not reduce ESRD or death
Reduced-dose glucocorticoids did not increase risk of death or ESRD (but did have fewer infections)
Abs 2788
Roundup - Cush, Kavanaugh
#ACR18 @RheumNow
D White WIRheum ( View Tweet)
Top Influencers of #ACR18 👉 @RheumNow @CreakyJoints @ACRheum @ArthritisFdn @psufka @DrJuanOvalles https://t.co/9ouTIWOqac via @symplur
ǝlʇʇıɥʍ ɯɐs samwhittle ( View Tweet)
Dr. Berent Prakken reviews. IL18 may be a diagnostic biomarker for MAS in systemic JIA (compared to familial or primary HLH)
#pedsinreview #ACR18 @rheumnow
Nicole Bitencourt NicoleBitencou5 ( View Tweet)
Use of antiTNF in childhood does NOT appear to increase risk of malignancy in adults according to Medicare claims data, but possibly a malignancy signal seen related to underlying disease. #ACR18 #pedsinreview @rheumnow
Nicole Bitencourt NicoleBitencou5 ( View Tweet)
In pts with #dermatomyositis, extracellular vesicles (EVs, released from almost all cells) induce secretion of important pro-inflammatory cytokines. #ExtracellularVesicles are likely important in the #pathogenesis of DM. Abstract1335 Dr. Krisha Desai #ACR18 @RheumNow https://t.co/naMIRuq8JQ
Nicole Bitencourt NicoleBitencou5 ( View Tweet)
Lysinuric protein intolerance, a urea cycle disorder, can #mimic #SLE with #lupusnephritis and #MAS. #osteopenia also seen. Need high index of suspicion. #GeneticMimicsOfRheumaticDisease #ACR18 @RheumNow https://t.co/sx2cUPgH73
Nicole Bitencourt NicoleBitencou5 ( View Tweet)
#DownsArthritis (often an erosive polyarticular arthritis of small joints) is distict from poly #JIA by analysis of #synovialBx. More CD3+ cells, macrophages, and CD20 cells in joints of kids with Down's arthritis. Abstract2024 Dr. Charlene Foley #ACR18 @RheumNow
Nicole Bitencourt NicoleBitencou5 ( View Tweet)
45% of pts with #MAS and 62% of pts with #secondaryHLH carry a heterozygous variant of a gene generally associated with #primaryHLH. Having multiple variants assoc w worse and recurrent MAS or HLH. Abstract 2014 Drs. Passarelli and Bracaglia #ACR18 @RheumNow0 https://t.co/t0AGzQ8c7r
Nicole Bitencourt NicoleBitencou5 ( View Tweet)
Among 14 pts with #JIA #ERA (enthesitis related arthritis) who failed 1+ antiTNFs, #secukinumab led to some improvement in the JADAS 10 score at 6 months. The 300 mg dose required in over half of pts. Abstract2386 Dr. Ivan Foeldvari #ACR18 @RheumNow https://t.co/cnVBqreGEG
Nicole Bitencourt NicoleBitencou5 ( View Tweet)
Compunded triamcinolone hexacetonide (the steroid formerly know as #Aritospan) showed significantly lower rates of joint flares compared to triamcinolone acetonide in #JIA20% vs 72%. Abstract2387 Dr. April Bingham #considercompunding #ACR18 @RheumNow https://t.co/BMBa4Z2p3t
Nicole Bitencourt NicoleBitencou5 ( View Tweet)
Secondary tumoral calcinosis in #SLE. A benign condition characterized by massive periarticular #calcification and associated with CTDs. Image by Dr. Leslie Anne Cassidy #ACR18 @RheumNow https://t.co/gs9YwwFQ3a
Nicole Bitencourt NicoleBitencou5 ( View Tweet)