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For decades, glucocorticoids (GCs) have formed the backbone of polymyalgia rheumatica (PMR) management.
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The SELECT-GCA study, looking at upadacitinib in GCA, anchored the ACR 2024 opening plenary for a reason - it is highly notable and badly needed.
Dr. John Cush
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RIP to Glucocorticoids in GPA
For many years glucocorticoids were the mainstay of our treatment of granulomatosis with polyangiitis (GPA).
https://t.co/WqpO6ACqtu https://t.co/vb8qx3uHA0
Richard Conway
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Xia et al. Upadacitinib in refractory Behcets. Open label, 8 patients. Follow-up 4-14 months. Lower disease activity 2.5 vs 1.5. Lower pred, 11.9 vs 8.1. @RheumNow #ACR24 Abstr#2515 https://t.co/ZXsJkNRlTm https://t.co/S8LhpqZ8X3
David Liew
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Does vasculitis flare with checkpoint inhibitors?
@MDAndersonNews experience:
17 stable pts
4 pts flared - all able to be controlled
(i.e. 13 didn't flare)
Encouragement that stable vasculitis pts that need ICI should get them!
#ACR24 ABST1986 @RheumNow https://t.co/jO4w3HWBMd
Brian Jaros, MD
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Will be covering some TAK pearls and pitfalls from today’s session!
Renal dz stratified by location of vessel inflammation:
- TAK = proximal (off aorta)
- FMD = mid-section, beading
- PAN = distal arterial branches
@RheumNow #ACR24 https://t.co/zu6qJ6DXcF
Patricia Harkins
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Imaging in TAK Diagnosis
@KQuinnRheum @RheumNow
⭐ Take homes ⭐
👉location of renal artery stenosis (RAS) key to making Dx with proximal RAS in TAK
👉FDG PET -focal uptake in TAK vs diffuse in GCA
👉MRI good surrogate for disease activity where PET unavailable
#ACR24 https://t.co/UWxTAZScIt
David Liew
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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
Richard Conway
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The TAPIR study presented at #ACR24 may not be as attention grabbing as others like SELECT-GCA, but in my opinion it is arguablyone of the most important ANCA-vasculitis studies ever. I've shared some further thoughs in an article on @RheumNow https://t.co/mImAE8ezSQ
Richard Conway
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de Boysson et al. RCT anakinra in GCA. 30 patients. Week 52 relapse 53% in anakinra vs 46% in placebo. @RheumNow #ACR24 Abstr#1699 https://t.co/sqDWUlkXAX
Janet Pope
Tweet
Safer and less relapses in
#Takayasu’s #arteritis
In
#MTX + #MMF
Vs
#Cyclo ➡️ #azathioprine
@RheumNow #ACRBest @ACRheum abst#1696
WOW 😮 Amazing! https://t.co/y3BDjdAa6P
Janet Pope
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#Upadacitinib rises ‘ Up’ in all subgroups of #GCA Subset of overall #RCT of #rinvoq w more reduction of #steroids vs placebo+ slower #prednisone taper Consistent results best in UPA 15 mg >UPA 7.5mg/d > #placebo #ACR24 #ACRBest @RheumNow @ACRheum abst#1695 https://t.co/dA7RkNmWFd
Richard Conway
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Brenac et al. Orbital MRI to distinguish GCA AOIN/CRO from non-arteritic. @RheumNow #ACR24 Abstr#1641 https://t.co/qIwaX3qp02 https://t.co/5CIZ0aV98Z
Richard Conway
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Cowley et al. US pattern in Subclinical GCA in PMR vs GCA. Subclinical GCA has more isolated axillary artery involvement. Severity of US inflammation significantly higher in GCA than subclincal GCA @RheumNow #ACR24 Abstr#1629 https://t.co/6Iyx76YgkS https://t.co/DxzTEwE5J5
Mike Putman
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At "Envisioning a Steroid Free Future" talk
Angelo Gaffo at the mic: "Are there any situations you would do induction therapy for AAV without steroid?"
John Stone: [pause] "No." 😄
#ACR24 @RheumNow
Jiha Lee
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Reset the bar for remission (off steroids)!! Session #17S19
3% higher risk of organ damage for each 1mg of pred
Remission possible in rheum with lower dose GC regimen and faster taper #GCStewardship
#ACR24 @RheumNow @BethIWallace
Akhil Sood MD
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Reason for consult: aortitis- evaluate for systemic causes
Abstract 1638: Kmetova et al highlight the promising clinical utility of calprotectin as a marker for clinically isolated aortitis
@RheumNow #ACR24 https://t.co/2qPaAqWswG
Eric Dein
Tweet
John Stone
Steroid-free AAV
CYCLOPS: steroid tox like “wallpaper on room”
WGET (ETN for GCA) - taper off by 6 mos - neg trial but started tapers
RAVE - low doses 8-9 mg/d over 18 mos
LoVAS - low dose steroid equally eff
ADVOCATE - AVA one month taper, tox score
#ACR24 @RheumNow https://t.co/C7eLK5UNPM
Janet Pope
Tweet
#Blinded by results? 😊
#Ocular #involvement in #GPA
👇
Helped by #rituximab
👁️ #GPA
Difficult
Proptosis
Pseudotumour
Conjunctivitis
Scleritis
Vasculitis
Ocular muscles - diplopia
Small case series ‘author defined’ remission in
80% 👍 #RTX
#abst0726 @rheumnow #ACR24 https://t.co/GHptelOTyv
Mike Putman
Tweet
"We look forward to Carol Langfords upcoming leadership at ACR and its newfound focus on ANCA vasculitis as the most important disease" 😆😂
-Phil Seo
#ACR24 @RheumNow
