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Up-front Secukinumab in PsA?
We now have an absolute plethora of agents available for use in psoriatic arthritis (PsA). In contrast we have an almost complete lack of understanding of how best to optimise use of these agents – what is the right agent at the right time for the right patient. A study presented this week has given us some further information on the topic.
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JAKs and Other Drugs in PMR
This has been an interesting ACR meeting in terms of PMR updates. I would argue that we are still far too wedded to glucocorticoids only in the management of PMR. Yes, some patients will do fine with just glucocorticoids but we persist far too long with a glucocorticoid only strategy in others who clearly need an alternative as glucocorticoid adverse events multiply.
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Say Goodbye to Methotrexate in PMR?
For decades, glucocorticoids (GCs) have formed the backbone of polymyalgia rheumatica (PMR) management.
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All-caps abstract text throw-down by Michelle Petri re:fractures in SLE 😆
I keep saying this; our obsesssion with vitamin d is not commensurate w/reality
It's. The. Prednisone.
#ACR24 @RheumNow Abstr#2679 #ACRBest https://t.co/13luByNvYT
Links:
Mike Putman EBRheum ( View Tweet)
What are the predictors of fracture in #SLE?
🦴Prednisone! Even at low doses ≤5mg
🦴Stroke
🦴Caucasian race
🦴Female
🦴Low BMD
Try to avoid steroid use. If they are needed, IM triamcinolone or IVMP preferable to oral GC.
Ab2679 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
Increased risk of mortality related to negative effects of GC use persists long after stopping and never return to pre-GC levels. #GCStewardship
#ACR24 @RheumNow ABST#2673 https://t.co/5AwHDmvQGf
Jiha Lee JihaRheum ( View Tweet)
How long is a long acting #intra-articular #steroid #injection in #knee #osteoarthritis?
#IA steroids can be q3monthly
#RCT of IA #fluticasone #propionate
Was superior to #placebo
Seemed to last approx 24 weeks
➡️ sub analysis in moderate pain, BMI<30
#ACR24 @RheumNow #2106 https://t.co/QBFCqXd1Q8
Janet Pope Janetbirdope ( View Tweet)
Continuing or Stopping Low Dose Glucocorticoids in GPA
Dr. Mike Putman reports about plenary session abstract 0774 (the TAPIR study) about how and when patients can stop steroids in GPA. #ACR24
https://t.co/OWqN0jmkc1 https://t.co/foOaVRtGiV
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Dr. John Cush RheumNow ( View Tweet)
A#2652
NEWTON study 🇫🇷 Retrosp cohort
51% relapse. Median @8.7 mos, dose 9mg pred
Rf: limb art involv- HR 1.9
Pred taper speed not risk for relapse
Most relapse -> incr GCs
Toci 1/3 at dx, 50% stopped
-61% d/c due to remission, 39% SEs
-1/3 relapse after d/c
@RheumNow #ACR24 https://t.co/NP0wieDmvo
Eric Dein ericdeinmd ( View Tweet)
Peyrac et al. 211 GCA. Relapse in 52% at median 261 days (so 1st year). 83% on GCs at relapse, median dose 6.5mg pred. 36% relapse post-toc discontinuation, at median 133 days. 64% no relapse when toc stopped, at median 511 days @RheumNow #ACR24 Abstr#2652 https://t.co/NqtdDNGGoc https://t.co/mXD8x7O6Ww
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Richard Conway RichardPAConway ( View Tweet)
A#2648
PET for GCA
Delayed imaging at 180 min improve dx performance for pts on GCs
Optimal PET w/in 3 days of GC, most patients unable to do w/in that window
Delay has sensitivity 92% even on prednisone - may be good tool for pts unable to get early PET/CT
#ACR24 @RheumNow https://t.co/kxpNfRqkGN
Links:
Eric Dein ericdeinmd ( View Tweet)
Important study in SLE: out of 590 pts with pericarditis, 20% had recurrence w/in 1 year
Higher in early dx, younger pts, higher dx activity, & pred exposure
Is prednisone risk confounding by indication? Or causative?
#ACR24 @RheumNow @andreafava Abstr#2372 https://t.co/Seyi4F6weY
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Mike Putman EBRheum ( View Tweet)
Depressing finding re:glucocorticoid discontinuation in SLE
No improvement over decades in rate of GC discontinuation; if anything, we start more GC than ever
@AliDuarteMD help me out here; why haven't we made more progress?
#ACR24 @RheumNow Abstr#2421 https://t.co/uzZATKPWVC
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Mike Putman EBRheum ( View Tweet)
Abstract 2503: Clofutriben (HSD-1 inhibitor) minimizes adrenal suppression. Adding clofutriben to prednisolone boosts ACTH & cortisol levels with fewer patients with suppressed morning cortisol (≤5.0 mg/dL) (34% vs 14%).
@RheumNow #ACR24 #GCTox
Akhil Sood MD AkhilSoodMD ( View Tweet)
Class V #Lupus Nephritis usually takes longer to treat. Stay the course if no contraindications and taper steroids! - Dr A Askanase #ACR24 LN Guidelines @RheumNow https://t.co/4BBuAWi2da
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TheDaoIndex KDAO2011 ( View Tweet)
Instead of just JAKi, why don't we look at all our RA meds and MACE risk
FAERS data & reporting odds ratios here: all the caveats of voluntary reporting, so don't put too much weight, but...
prednisone. Don't forget pred is really not great for MACE!
#ACR24 ABST1981 @RheumNow https://t.co/L9SlPZF2Jd
David Liew drdavidliew ( View Tweet)
Systemic polyarteritis nodosa looks creepily/scarily beautiful on PET/CT. Look at that Christmas tree!
but sensitivity can be affected by pred, & isn't great even without (48%).
By itself, a good rule in test, but not a good rule out test.
#ACR24 ABST1962 @MayoClinic @RheumNow https://t.co/y28J6VKja4
David Liew drdavidliew ( View Tweet)
Further evidence for risk of #MACE with cumulative GC use in RA
In a national cohort of pts with RA: ⬆️cumulative GC exposure associated with ⬆️odds of MACE, regardless of baseline MACE risk
Ab1719 #ACR24 @RheumNow https://t.co/RmxokfBXYX
Mrinalini Dey DrMiniDey ( View Tweet)
STAR trial of GC w/d in RA LDA
SEMIRA of GC w/d controlled RA on Toci
Very slight disease activity increase, but higher flares
No symptomatic adrenal insufficiency, but data of abnormal ACTH stim
No good evidence of steroid w/d symptoms
Beth Wallace
@RheumNow #ACR24 https://t.co/j6UPWlVNIu
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Eric Dein ericdeinmd ( View Tweet)
Great table re:side effects of even low dose steroids in RA
Likely generalizes to other diseases ie PMR, SLE
P in prednisone stands for poison!
#ACR24 @RheumNow https://t.co/0opDEtzm9E
Mike Putman EBRheum ( View Tweet)
