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Update on Myositis

d Nicole Bitencourt, MD

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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MTB screening in patients on TNFi When to re-screen? Neg to pos conversion discovered in a small number of cases Often in patients with risk factors Cush: Annual testing “makes no sense at all" Abs 1234, Rochester NY Roundup - Cush, Kavanaugh #ACR18 @RheumNow

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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

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Biosimilars in Sweden Rx patterns (originator vs biosimilar) follow prices - back and forth Abs 1175 Roundup - Cush, Kavanaugh #ACR18 @RheumNow

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Gout Remains under-treated Higher success when pharmacists and RNs manage ULT Abs 2220, 1247, 1272 Roundup - Cush, Kavanaugh #ACR18 @RheumNow

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Enthesitis, in particular supraspinatus tendinopathy IL-17A as a target of therapy Abs 404 Roundup - Cush, Kavanaugh #ACR18 @RheumNow

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MTX helpful for granulomatous mastitis Can be recurrent; sometimes seen by rheums Rule out cancer, infection Abs 2264 Roundup - Cush, Kavanaugh #ACR18 @RheumNow

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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

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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

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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

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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

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Top Influencers of #ACR18 👉 @RheumNow @CreakyJoints @ACRheum @ArthritisFdn @psufka @DrJuanOvalles https://t.co/9ouTIWOqac via @symplur

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Dr. Berent Prakken reviews. IL18 may be a diagnostic biomarker for MAS in systemic JIA (compared to familial or primary HLH) #pedsinreview #ACR18 @rheumnow

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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

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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
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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
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#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

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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
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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
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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
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