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Refractory of difficult to treat (D2T-RA) rheumatoid arthritis (RA) comprises a minority of patients that can be categorized by clinical and imaging parameters to formulate a better therapeutic approach.
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Approximately 12 million US adults in the US have gout. Two recent literature reports highlight contributors to gout flares.
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US commercial insurance claim analysis of laboratory screening and monitoring practices in chronic inflammatory skin disease (CISD) patients shows that < 60% received the recommended pretreatment testing when starting systemic immunomodulatory treatment.
Dr. John Cush
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Many #RA pts remain on Steroids despite b/tsDMARD use! Study 228 #RA pts, 68% Rx low-dose GCs (32% no GCs). After 3 yrsof b/tsDMARDs, 32% still on GCs, 23% D/C GCs, & 20% go on & off, 25% never took GCs. GCs use assoc w/ HTN (20 v 11%) & MI (2.3% vs 0) https://t.co/lWVfvJrAyp https://t.co/uTIWqDAjRG
Dr. John Cush
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Korean Database study of 1796 #AS pf (vs 7184 controls 1:4 ratio); 9.3% develeoped cancer; AS pts have no overall increase in cancer risk (aHR 1.1); AS pts had higher risk ofupper GI cancer (HR: 1.51) & hematologic CA (aHR: 2.36). Is there an NSAID effect? https://t.co/6W68upVQrn https://t.co/RWlhLFV9EJ
Dr. John Cush
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Since April 2017, DEA Take Back (drugs) campaign has spread to 17,000 locations where your patients can safely dispose of narcotics or unsafe drugs. Find your Everyday Drop-Off center by clicking here: https://t.co/uZPtFtXk6a https://t.co/dRalITYyfV
Dr. John Cush
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Dupilumab (IL-4/13 Inhib) may cause MSK Sxs. Study of 470 Atopic Dermatitis pts on dupilumab; 36 referred to rheum consult, 26 pts (14M/12F) had US/MRI proven enthesitis, arthritis, or tenosynovitis (16 mild, 4 severe). All responded to NSAID or DUP D/C https://t.co/S3ACOC4xUZ https://t.co/juAYbIxNZ6
Dr. John Cush
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FDA Safety Warning: denosumab now has a Boxed Warning for risk of severe hypocalcemia in CKD pts taking Prolia (usually seen 2-10 wks post injx). Pts may or may not be symptomatic. CKD pts should have Ca and Creatinine monitored. https://t.co/UMYxjWz9n4 https://t.co/AG5wzBrY1Y
Richard Conway
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Oh, snap! But this is true, a single course rituximab at baseline and none at 6 months (or anything else) as a comparator is just wild in a 12 month trial @EBRheum @RheumNow #RNL2024 https://t.co/wuIkuLzIpg
Eric Dein
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Vedolizumab-induced enthesitis
@lihi_eder #RNL2024 @RheumNow
11/90 (12.2%) of pts on VDZ for IBD w/ develop new-onset enthesitis
Is this true drug rxn or previously masked by prior meds (TNF)?
Usually unilateral +/- oligo, dactylitis
Most respond to NSAID or injxn, 27% change Rx
Dr. Rachel Tate
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MTX and cyclophosphamide are the two drugs @DrCassySims recommends holding during breast feeding in our vasculitis patients. #RNL2024 @RheumNow
Dr. Rachel Tate
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@DrCassySims checks APS ab on ALL pregnant (vasculitis) patients. "HCQ decreases neonatal lupus risk by half, meaning great reward for little risk." CS at #RNL2024 @RheumNow
TheDaoIndex
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While #dupilumab can be used for #EGPA, be careful about using it in pts with high eosinophilia; don't taper steroids too rapidly if you use this drug. - Dr P Seo @rheumnow #RNL2024 https://t.co/YKQdtvCS0M
TheDaoIndex
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Consider using IV Benralizumab (also an IL5 inhibitor) for #EGPA in pts where insurance won't approve SQ mepolizumab - Dr. P Seo #RNL2024 @rheumnow https://t.co/VFE76Uzb2S
Dr. Rachel Tate
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Do you have GCA patients on low dose prednisone? Feel reassured.
Dr. @philseo provides data showing that low dose prednisone may be helpful in remission maintenance. #RNL2024 @RheumNow https://t.co/oyOsczfkfv
Richard Conway
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Interesting nuance from @philseo re tocilizumab in GCA. For new onset disease, it may be appropriate to use every other week tocilizumab @RheumNow #RNL2024 https://t.co/moCvpQSkq0
Eric Dein
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Do you need to pulse steroids in GCA?
ACR 2022 abstract#0459 data says oral only may be sufficient
Oral vs IV MP - p=0.621
Still favor IV in severe cases
@philseo #RNL2024 @RheumNow
Eric Dein
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#RNL2024 @RheumNow
@philseo: I now give Tociliizumab for nearly all patients with GCA
GiACTA shows we weren't doing well enough with steroid monotherapy
GiACTA shows dosing frequency does not make a big difference in new diagnosis, but makes a difference in relapsing disease https://t.co/JBgUQtZSAr
Eric Dein
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Rapid GC taper in ANCA vasculitis
#RNL2024 @RheumNow
@anisha_dua
PEXIVAS - reduced GC is safe, decreased ifns
Retrospective real world - 234 pts. Reduced dose GC+RTX increased death/ESKD HR 2.42. No difference in infections https://t.co/SWIUSyVbWb
Eric Dein
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High risk medications for pregnancy:
MTX- 40% pregnancy loss, 6-10% birth defects
MMF/CYC - 40% pregnancy loss, 25% birth defects
Recommend 2 forms contraception on MMF
Change meds slowly to safe Rx and monitor disease activity at least 3 mos before pregnancy
#RNL2024 @RheumNow
