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When should we be starting therapy in GCA and PMR?

David Liew, FRACP

The problem with having therapies that work is that you then have to figure out what to do with them. You cannot hide behind a shrug of the shoulders, or the ambiguity of therapeutic inadequacy. The question that follows the presence of a therapy is the question as to how to best use it.

GCA and PMR are at the stage in the growth of their therapeutic development where this problem is moving to the front of mind, and it made for a fitting topic in the ACR Great Debate. Drs. Rob Spiera and Phil Seo - two luminaries in the vasculitis and PMR worlds - were pitted head to head to discuss.

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Checklist IgG4

IgG4 disease- the WInS withdrawal study results

Bella Mehta, MBBS, MS

IgG4-related disease describes a group of fibroinflammatory diseases whose features may include autoimmune pancreatitis, swelling of or within an organ system, salivary gland disease, swollen lymph nodes, skin manifestations, and symptoms consistent with allergies or asthma. While remission induction treatment with glucocorticoids has proven effective, the high relapse tendency is an ongoing challenge for clinicians.

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rare

Here at Last: Treatment Options for VEXAS

Michael Putman, MD, MSCI

We have known about the VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome for nearly 3 years, but there has been relatively little to say about how to treat it. To date there have been over twice as many publications about VEXAS (263 publications) as there have been patients described with respect to treatment strategies (116 patients). One of the late breaking abstracts may finally have rectified this imbalance.

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female with hands

Are Rheumatologists doing Enough for Cervical Cancer?

Eric Dein, MD

Should rheumatologists be counseling patients on cervical cancer prevention and screening?

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Risk of Hepatitis B reactivation is assessed by serology - Resolved HBV (low risk reactiv): HBsAg-neg, HBcAb–pos & Pos HBsAb - If HBcAb(+), HBsAb negativity incr risk; - HBsAg(-), HBcAb(+), HBsAb(-) negative= resolved infx, occult infx, chronic hepatitis https://t.co/91ZwqWkdvo https://t.co/c23nN8ER1Y

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Dr. John Cush RheumNow ( View Tweet)
Chemokine CXCL10 a potential biomarker for ILD in systemic sclerosis (SSc)? Study of 165 SSc pts (41 w/ SSc-ILD) found higher serum CXCL10 in SSc-ILD (126 vs. 78.5 pg/ml). Hi levels incr risk of ILD 2.74-fold. Most CXCL10 from inflammed lung tissues https://t.co/Z8pIAZYaC0 https://t.co/ErRsD9Msn1

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Dr. John Cush RheumNow ( View Tweet)
Study from British Columbia, Canada, showed between 2010 & 2020, they saw 31% more new pt rheum consults (149,902); 1st time consults for inflammatory arthritis incr 28% to 51%. While time to 1st visit decr. 35%, time to DMARD initiation was unchanged https://t.co/Et7GzxKeNe https://t.co/2as2YuIV4d

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Dr. John Cush RheumNow ( View Tweet)
National pharmacovigilance database review (1992 to 2021) identified 2217 "Falls", most serious, most in women (61%), & 38% in 18–64 yr olds. Falls attributed to immunomodulators (17%), 24% Fxs & 1 in 7 classified as adverse drug rxns (343) https://t.co/tpUPDc8x09 https://t.co/jdssH7oCjF

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Dr. John Cush RheumNow ( View Tweet)
"Protein kinases: drug targets for immunological disorders". Great full-read review from J Shea et al. Reviews Hx, biology, clinical use and safetey of Kinase targeted therapy. https://t.co/qBc0ng1Z9h https://t.co/Qm8PFpNxQF

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Dr. John Cush RheumNow ( View Tweet)
NEJM Clinical Images: Scleromyxedema (cutaneous mucinosis w/ a paraproteinemia).53-yoM w/ itchy rash, Raynauds, dysphagia, burning dysesthesia hands; Waxy papules across forehead & hands w/ skin thickening & finger contractures. Skin Bx & SPEP done https://t.co/vkpYGNd3Uw https://t.co/T5gVPRBrhh

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Dr. John Cush RheumNow ( View Tweet)
Are Rheumatologists doing Enough for Cervical Cancer? Should rheums be counseling patients on cervical cancer prevention and screening? The data from Abstract #1479 at #ACR23 suggests this should be an important conversation with our lupus patients. https://t.co/VFobM0T3u7 https://t.co/L45N3tsTdN

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Dr. John Cush RheumNow ( View Tweet)
Substudy of the ADVOCATE trial looked at 214 ANCA assoc vasculitis pts treated with #RTX; avacopan Rx showed improved recovery of renal function, faster reduction in albuminuria and lower glucocorticoid toxicity compared to a prednisone taper. https://t.co/91PtvQfoIr https://t.co/ZjYCVP5lqG

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Dr. John Cush RheumNow ( View Tweet)
Chikungunya - takeaway points 🪔Acute arthritis in large joints , polyarthritis and tenosynovitis in hands 🪔 Associated with travel history to Africa/Asia/Asia Pacific 🪔<5% develop chronic arthritis #ACR23 #ACRambassador https://t.co/yzZDpy70i3
Tanmayee Bichile, MD  ( View Tweet)
As per #ACR23 ABST0433, what % of RA patients on US Medicare are on a DMARD within 1y of diagnosis? I'm not talking your choice of b/tsDMARD. I'm talking any cs/b/tsDMARD of any sort. Hear from @JihaRheum to skip to the answer: https://t.co/lI2M20JWKC Truly stunning. @RheumNow

David Liew drdavidliew ( View Tweet)

INSIST trial: MMF vs Tac in SS-ILD N=25 pts 👉No significant diff between MMF & TAC in mean change in FVC at 24 weeks [2.52%, 95% CI (-10.3 to 5.18)p=0.500] 👉No SAEs noted in both grps Larger studies w/ longer ffup needed. #ACR23 ABST2595 @RheumNow https://t.co/cqpnxyMDmv
sheila  ( View Tweet)
Dr. @Janetbirdope has the best quotes ever ‘ if its ain’t broke, don’t fix it, just leave it alone’ 🤷🏻‍♀️ IGg4 is very interesting , could just be reacting / secondary to an underlying phenomenon? https://t.co/hueCJuYI32 @RheumNow #ACR23, Daily recap.

Nouf Al hemmadi  ( View Tweet)

Is MSOT the New Ultrasound? Dr. Aurelie Najm reports on oral abstract 0750 presented at #ACR23 https://t.co/okbGHTR0i3 https://t.co/9zkHPiFl74

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Dr. John Cush RheumNow ( View Tweet)
A randomised clinical trial show improvements in clinical outcomes CDAI, VAS for both the ITIS diet and the Med diet. Baseline differences in the microbiome between responders and non-responders were seen. Sala Climent M, Abst#2124 #ACR23 @RheumNow https://t.co/tiyNcV7cmD https://t.co/EEP4zrwjXs
Dr. Antoni Chan  ( View Tweet)
Fecal transplant for treatment of GI complications of systemic sclerosis? No change in those who received transplant... Overall procedure safe @RheumNow #ACR23 Abs#2597 https://t.co/TEdeGHuzpi
Robert B Chao, MD  ( View Tweet)
What's the long-term mainentance game plan in IgG4-RD? WInS IgG4-RD study China, n=146 IgG4-RD stable disease >12mo Withdrawing both IM+GC completely has much higher relapse rates vs at least keeping some IM IgG4-RD needs some steroid-sparing Rx ongoing #ACR23 L16 @RheumNow https://t.co/1JJpQmFTF5
David Liew drdavidliew ( View Tweet)
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