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2022 EULAR Recommendations for ANCA-associated Vasculitis
EULAR has published the 2022 update on recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).
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How does HCQ work
@Lupusreference in #RNL2023
HCQ works by inhibition of Toll-like receptor (TLR) with affects on IFN
HCQ works as base to increase lysosomal pH and affect cellular function
@RheumNow https://t.co/RTEUF0cS0u
Eric Dein ericdeinmd ( View Tweet)
Smoking and SLE
Smoking increases SLE activity
Smoking decreases HCQ efficacy
Skin response on HCQ down 50% in smokers 🚬
@Lupusreference #RNL2023 @RheumNow
Eric Dein ericdeinmd ( View Tweet)
✅ Check my TAKE-HOME MESSAGES about #hydroxychloroquine & #Lupus for RheumNow Live 2023 #RNL2023
@RheumNow ⬇️ https://t.co/E2xdv3ODG6
Laurent ARNAUD Lupusreference ( View Tweet)
SRI Responders more likely able to reduce prednisone and far
Serological improvement
SF-36
Fatigue
by Richard Furie #RNL2023 @RheumNow https://t.co/ilsyOXw7nA
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
#RNL2023 Year in Review
COMPLETE-PsA: DMARDs for PsA!
LEF+MTX better than MTX alone, 78 total patients
PASDAS at week 16: 59% for MTX+LEF vs 34% MTX+PBO
More treatment discontinuations (10 vs 3) in combo group due to GI intolerance
@RheumNow https://t.co/3Al8PQmNli
Eric Dein ericdeinmd ( View Tweet)
Should we be measuring HCQ levels?
- note HCQ doses should be reconsidered in pts with CKD stage >2 w/ 4 fold higher odds of HCQ levels
- adjust dose for pts with renal impairment
@RheumNow #RNL2023 https://t.co/JvaRJKJRPv
Robert B Chao, MD doctorRBC ( View Tweet)
#RNL2023 Year in Review
BE COMPLETE: P3 trial Bimekizumab for PsA in TNF inadequate responses at 16 weeks
160 mg BKZ SQ q4w vs PBO
ACR50 43%, PBO 7%
PASI 1000: BKZ 58.5% vs PBO 4.5%
Safety: oral candidiasis: 2.6% BKZ vs PBO 0%
@RheumNow https://t.co/bW00Wg6Cnf
Eric Dein ericdeinmd ( View Tweet)
Talk to me about candidiasis. BKZ showed increased safety signals for candida infections. I fear infxns may be under reported (after approval and in use) if patients see other physicians for treatment vs their rheumatologist/derm. Thoughts on this signal? #RNL2023 @rheumnow https://t.co/UPA5oP9G49
Dr. Rachel Tate uptoTate ( View Tweet)
Could MTX every other week dosing be an option in patients with stable disease..?
#RNL2023 https://t.co/EZRdQnuXjy
Dr Gurdeep Dulay gurdeep_dulay ( View Tweet)
Year in Review by Dr. Cush and Dr. Kavanaugh
Combo biologic therapy?
Phase II study from GI colleagues for UC
Guselkumab + golimumab
- no additional safety concerns
- improved clinical response
- extrapolate to rheumatology use?
#RNL2023 @RheumNow https://t.co/DirAovm1AX
Robert B Chao, MD doctorRBC ( View Tweet)
✅ RheumNow Live 2023
#RNL2023 @RheumNow
Which adverse events ⬇️ can be expected by patients & their rheumatologists when using #hydroxychloroquine for #Lupus? https://t.co/9zP8aJ4cGq
Laurent ARNAUD Lupusreference ( View Tweet)
#ClinicalPearl #Methotrexate weekly May reduce side effects in rapidly dividing cells vs using it daily or every few days. GI, oral, bone marrow side effects should be less if once a week. Joel Kremer @RheumNow #RNL2023 https://t.co/i0LZoQuK0w
Janet Pope Janetbirdope ( View Tweet)
Do you stop MTX on patients on bDMARD?
MTX decrease anti-drug antibodies on patients on infliximab - increases drug duration.
Similar seen with new combination usage with pelogloticase
Joel Kremer MD
#RhuemNow @RheumNow https://t.co/8UrGZaFStA
Eric Dein ericdeinmd ( View Tweet)
How do you wean MTX?
Consider every other week dosing as options - supported by 2 randomized studies from 1995 and 1999
Option to lower weekly dosing in patients that want to take less often
Joel Kremer #RNL2023 @RheumNow https://t.co/3GMdn3lLhy
Eric Dein ericdeinmd ( View Tweet)
Do and don’t around MTX , Dr.Kremer approach to MTX #RNL2023 @RheumNow https://t.co/dXLQ0epsp4
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Jaks are every where in Psoriatic disease domains, By Eric Ruderman #RNL2023 @RheumNow
Good news, especially with Updacitinib recently and Crohn’s disease ( full package). https://t.co/nlBWJhzpLp
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
DMARDs/TNF for PMR:
MTX- initial benefit, but no 5 year steroid sparing effect
Infliximab - no benefit
Lef - some benefit in case series
Robert Spiera #RNL2023 @RheumNow https://t.co/cmwGEWHQEO
Eric Dein ericdeinmd ( View Tweet)
JAKinib safety takeaways
- avoid in older population > 65 yo, malignancy, CV risk, VTE risk
- appropriate in younger pts without VTE/CVD risk factors
#RNL2023 @RheumNow https://t.co/5i1bRqqr7g
Robert B Chao, MD doctorRBC ( View Tweet)
#RNL2023 @RheumNow
Dr. Stanley Cohen: possible adverse effects of JAKi
-Herpes zoster, other infections
-Malignancy
-Occasional cytopenias
-LFTs (with DMARDs)
-Incr Cr or CPK
-Acne
-Incr lipids
-GI perf
-VTE
Which do you counsel with your patients? https://t.co/AZDKShOPbU
Eric Dein ericdeinmd ( View Tweet)
