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Steroids in RA: Friend or foe (or both)?

d Julian Segan, MBBS, BMedSc, FRACP

While have come so far from the days of our patients living on massive doses of steroids, we still have many patients who use steroids for our diseases, with increasing data for toxicity, even in low dose. As someone much smarter than me described them, steroids are our best frenemy.

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Is #Tofacitinib an option in #PMR poly myalgia rheumatica? RCT of Tofa 5 mg bid vs prednisone 15 mg/d and tapering. Equal results. Needs a phase 3 trial but could be an option if needing to avoid prednisone ex osteoporosis, DM, etc. abst#1107 #ACR22 @RheumNow https://t.co/OgcgslwaB5
Janet Pope Janetbirdope ( View Tweet)
ACR Best

ACR Best Abstracts - Day 2

d Jack Cush, MD

Day two at ACR 2022 was full of great sessions on imaging, vasculitis, lupus, vasculitis, spondyloarthritis, COVID, pregnancy, microbiome, economics and more.

Here are the RheumNow faculty selections for #ACRbest abstracts today:

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Kaneko et al. Tocilizumab leads to significantly lower steroid doses in Adult onset Stills Disease @RheumNow #ACR22 Abstr#0826 https://t.co/jc1S6sdfkm https://t.co/z0cHB4wYu6

Links:

Richard Conway RichardPAConway ( View Tweet)
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Do biologics help taper steroids in Adult Still’s Disease?

d Bella Mehta, MBBS, MS

A Japanese large scale claims data study was able to collect 5-year data to study the treatment patterns in Still’s. In May 2019, intravenous tocilizumab was approved in Japan for Still’s disease. The study was designed to see patterns of steroid exposure before and after the approval of this therapy.

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Very cool initiative @Robsonjo4 1. I love patient reported outcomes (PROs) 2. I think we under-appreciate how much steroids affect our patients quality of life Looking forward to seeing this live! #ACR22 #Vasculitis22 @RheumNow https://t.co/1akO1k7VgU
Mike Putman EBRheum ( View Tweet)
Yr in review #ACR22 @RheumNow 🌟GLORIA 2 yr data: 👉Pred 5mg OD vs PBO >65y/o RA ✅⬇️ disease activity (DAS28 -0.38) ✅⬇️ joint damage (sharp/van der heijde -1.7) ❌ 24% ⬆️ a/e “Weigh success in benefit and failure in harm 2 individualise use of low dose pred in RA >65y/o”

Patricia Harkins DrTrishHarkins ( View Tweet)

Dr. C Langford #YearinReview: RDBPCT on benefits/harms prednisolone 5 mg/day for 2 years added to SOC in 65yo+ with active RA. Results: improvement in DAS28 (0.37) but AEs occurred in 24% (infection, low bone density)—NNT 9. Study does not apply to younger pts. #ACR22 @rheumnow https://t.co/p2C6IfSje1
TheDaoIndex KDAO2011 ( View Tweet)
Year in Review #ACR22 GLORIA Low steroid usage: lower DAS28, reduced joint damage BUT 24% increased adverse effects ⁦@RheumNow⁩ https://t.co/vYTAhoQEqr
Eric Dein ericdeinmd ( View Tweet)
Older woman

Polymyalgia rheumatica: more than just steroids at ACR22

d David Liew, FRACP

After decades of having little else proven apart from glucocorticosteroids with which to treat polymyalgia rheumatica (PMR), evidence for steroid-sparing options has grown in recent years, and this crescendo is set to continue at ACR Convergence 2022 in Philadelphia, PA.

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Short-term intra-articular steroids are effective (unclear- long term benefits) - no increase risk for knee replacement with repeat steroid injx #osteoarthritis @rheumnow #acr22 #acrreview https://t.co/MJHXWePF70
TheDaoIndex KDAO2011 ( View Tweet)
Medicare will cover #DXA testing for these diagnoses ⁦@RheumNow⁩ #acr22 #acrreview https://t.co/keZg0fxyz9
TheDaoIndex KDAO2011 ( View Tweet)
Target,T2T,bullseye

SLE T2T - Lupus Low Disease Activity State Predicts Outcomes

d Jack Cush, MD

Treat-to-target management of SLE has been shown to protect against organ damage and to improve quality of life. Now a prospective study shows that T2T with a goal of lupus low disease activity state and remission has been shown to improve mortality risk.

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Think about checking Ig levels prior to Rituximab administration. Low IgM was most common after RTX in RA. The following are risk factors for hypogammaglobulinemia: 🧪 Older age 🧪 Use of steroids 🧪 Repeated doses of RTX 🧪 Low Ig at baseline https://t.co/oOjqnmFdYt
Catherine Sims, MD DrCassySims ( View Tweet)
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Infection: a Leading Cause of Death in Lupus

d Jack Cush, MD

 Analysis of a national database of hospital discharges from Spain shows that infections accounted for 25% of lupus deaths, making infection the most common cause of death in SLE.

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Anakinra in Pericarditis: A Systematic Review (comprehensive, full read) -Options include steroids, colchicine, NSAIDs, pleuropericardial window, IL-1 inhibitors. ANAKINRA - 11 studies, 259 pts, all showing significant rapid resolution. https://t.co/mEkaa7Yjt1 https://t.co/BaMYHiG5Pb

Links:

Dr. John Cush RheumNow ( View Tweet)
Difficult to treat RA (D2T-RA) study of 48 D2T-145 non-D2T-RA pts. D2T-RA was predicted by Not starting MTX w/in 3 mos (17% vs 33% non-D2T-RA;p= 0.011) &being on steroids > 6 mos (71% vs 34%, p< 0.001). https://t.co/Ugbr7z7mia https://t.co/TCU7wSfMrS

Links:

Dr. John Cush RheumNow ( View Tweet)
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Second Efforts in Treating RA Partial Responders

d Jack Cush, MD

The results of a treat-to-target (T2T) combination therapy trial in patients with early rheumatoid arthritis (RA) show that if patients fail to respond initially, then a second, more intensified regimen can turn initial nonresponders into responders.

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Intravenous Immune Globulin in Dermatomyositis

d Jack Cush, MD

Few drugs have been studied well in the treatment of dermatomyositis (DM) and only recently has intravenous immune globulin (IVIG) been granted FDA approval for the treatment of DM, based on this pivotal trial.

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Heavy Metal Rheumatology (9.23.2022)

d Jack Cush, MD

Below are this week’s highlights from RheumNow, as discussed by Dr. Jack Cush. Thanks to all of you for your kind comments and great reviews of our weekly podcast. Please let us know how we can improve by emailing me or recording your suggestion using the "Ask Cush Anything" link on our website.

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