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Prophylaxis Against PJP in SLE: I'll Pass
I think we're all somewhat familiar with PJP prophylaxis. This is the thing we do to stop the scary, opportunistic infection that affects people who are immunocompromised. I'm going to start by actually steelmanning the case for doing PJP prophylaxis before I explain why I think you probably shouldn't be doing too much of it.
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Complex Evolution of RA Management and Outcomes
FIRST is a Japanese longitudinal, real-world registry of rheumatoid arthritis (RA) management, and over the last 20 years has shown significantly improved outcomes, yet significant challenges and unmet needs remain.
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Post-treatment Lyme Syndrome
EurekAlert!
Symptoms that persist long after Lyme disease is treated are not uncommon — a 2022 study found that 14% of patients who were diagnosed and treated early with antibiotic therapy would still develop Post Treatment Lyme Disease (PTLD). Yet doctors puzzle over the condition’s causes and how to help their patients through symptoms ranging from severe fatigue and cognitive challenges to body pain and arthritis.
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Metanalysis of ANCA-associated vasculitis with interstitial lung disease (8 studies, 654 pts shows the following significan mortality risk factors: age (HR 1.06), ever smoker (HR 1.61), UIP pattern (HR 2.07), acute exacerbation (HR 2.73) & microscopic polyangiitis (HR 4.03). https://t.co/z4zfDq9Wf9
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Arterial or venous thrombotic events (AVTEs) are common w/ new forms of monogenic vasculitis (DADA2 & VEXAS), resulting from pathogenetic mechanisms of endothelial dysfunction, immune complex deposition and pro-inflammatory cytokines. Reviewed here. https://t.co/Nw9wNYssg3 https://t.co/1PoPWPWNec
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Study of 42 pts w/ long standing RA-LD undergoing Lung Transplant (LTx) betw 2004 -2020. Median survival was 5.3 yrs (1-yr survival 88%) - same survival as LTx in other CTD & non-CTD ILD LTx. Mortality was 43%, higher w/ UIP. RA/CTD is not a contraindication to LTx. https://t.co/JcTug1wsTZ
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Prophylaxis Against PJP in SLE: I'll Pass with @EBRheum
https://t.co/tUGwziEYCg https://t.co/VqTa9jG8oj
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single-centre study of 469 consecutive RA pts - 15 had VTE (3%). Strongest risk factor of VTE was the history of previous VTE (OR 44.7), recent hospitalisation (OR 6.82), diabetes (OR 11.23), and JAKi (OR 5.54) (Other studies show inflammation incr VTE risk) https://t.co/pBJDhXOgut
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67 systemic sclerosis pts w/ mod-to-severe lower GI Sxs were Rx in phase 2, RDBPCT of placebo or fecal transplants at wks 0 and 2, with no signif change in GI sxs by week 12 (bloating or diarrhoea). https://t.co/vWq2c8d4Kn https://t.co/PpPsAQbj5M
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Procalcitonin > 0.9 ng/mL can be a critical marker for identifying bacterial infection in #SLE. Single center study of 116 juv. SLE pts dx bacterial infx in 17%. Procalcitonin was signif better than others: NLR, PLR, ESR, CRP, LC4R, ferritin (cut offs need to be defined) https://t.co/NAM8xopNW5
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Post-treatment Lyme Syndrome
Symptoms that persist long after Lyme disease is treated are not uncommon — a 2022 study found that 14% of patients who were diagnosed and treated early with antibiotic therapy would still develop Post Treatment Lyme Disease (PTLD). https://t.co/mmwGCnARY8
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Castleman disease (CD) is a rare, non-clonal lymphoproliferative disorder w/ systemic sxs & maybe linked w/ herpesvirus 8, POEMS or TAFRO syndrome. Mimickers include lymphoma, sarcoma, IgG4-RD, Infections (EBV, HHV8, HIV, CMV, TB), Autoimmune Dz (RA, SLE, Stills) https://t.co/29M0jePXHd
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Piperacillin effectively treats Lyme disease at 100-times lower dose than doxycycline https://t.co/vbu78RbRys https://t.co/AqSkm7XtbB https://t.co/olTi8OWsQ6
Links:
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Castleman disease (CD) is a rare, non-clonal lymphoproliferative disorder w/ systemic sxs & maybe linked w/ herpesvirus 8, POEMS or TAFRO syndrome. Mimickers include lymphoma, sarcoma, IgG4-RD, Infections (EBV, HHV8, HIV, CMV, TB), Autoimmune Dz (RA, SLE, Stills) https://t.co/70sROoHusy
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Piperacillin effectively treats Lyme disease at 100-times lower dose than doxycycline https://t.co/NQXG7FRtwh https://t.co/YcIYJqorKX https://t.co/e7UCG0z4wL
Links:
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Diabetes Prevention with Hydroxychloroquine in Sjogren’s
A Taiwanese insurance claims analysis looked at HCQ use in primary Sjögren syndrome (pSS) and showed that HCQ exposure significantly reduces the risk of new onset diabetes in pSS. Conversely, higher doses of https://t.co/WQD0RNfm5Z
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CDC's Committee on Immunization (ACIP) met and recommended:
1. Expand strains for meningococcal vax
2. Lower age for RSV vax > 50y
3. Rec. chikungunya vax for certain travelers
- Flu & Covid Vax to be up next mtg 6/25 https://t.co/jInnR5JSxS https://t.co/PXg0HDLgnL https://t.co/Vro5mbjG9R
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Distinguishing Septic and Gouty Arthritis
A single center, retrospective review of patients undergoing knee joint fluid aspirations for presumed crystalline arthritis (CA) showed that synovial WBC may provide a useful diagnostic marker for SA with an optimal threshold of 50,000 https://t.co/ye69mRooSh
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Is High Dose Aspirin Needed in Kawasaki Disease (KD)?
Does aspirin add any advantage to intravenous immunoglobulin (IVIG) alone in children with KD? A randomized clinical trial IVIG alone was not inferior to IVIG plus aspirin, suggesting that high-dose aspirin during initial https://t.co/uuCgDmgNif
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Should Lupus Nephritis Receive PJP Prophylaxis?
A current review article suggests that the need for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in patients with systemic lupus erythematosus (SLE) and lupus nephritis will need to be individualized based on therapies and https://t.co/QGHxk3O8q4
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