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Update on low-dose glucocorticoids in SLE

Md Yuzaiful Md Yusof, MRCP(UK), PhD

Glucocorticoids (GC) have been the mainstay of treatment in SLE for nearly three quarters of a century. GC induce a range of anti-inflammatory effects, quickly relieve some symptoms and lower mortality in some life-threatening flares. However, they also have multiple side effects that limit the duration of treatment, as well as the dose used. Accordingly, the 2023 EULAR recommendations for SLE set a target dose of ≤5mg/day. Is low dose GC an achievable target?

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Upside/Downside of Steroids in Lupus Nephritis

Jack Cush, MD

A systematic review of randomized clinical trials of patients with biopsy-proven lupus nephritis (LN) demonstrates both the benefits and harms to early glucocorticoid (GC) regimens on lupus outcomes. 

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"Don't You Know Who I am?" (5.17.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past 2 weeks. This week's question: can we prevent gout, ILD or psoriasis?

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Antacids can Diminish Bone Density

EurekAlert!

Proton pump inhibitors (PPIs), a specific class of antacid drugs, are among the most widely used medications of all. They are frequently prescribed to many groups of patients, including those with rheumatism.

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Pharmacologic Efficacy in Still's Disease

Jack Cush, MD

A systematic review of the effectiveness and safety of pharmacological treatments for adult-onset Still’s disease (AOSD) supports the use of either IL-1 or IL-6 inhibitors.

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Predicting Infection in Lupus Nephritis

Jack Cush, MD

Machine learning (ML) models were applied to 3 cohorts of lupus nephritis (LN) patients and established algorithms to predict co-infection in LN. 

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PMR patients get too much steroid. Data across 27 million people in England, n=39,438 with PMR. The blue are getting more pred than guidelines. Like everything in rheum: we need to be giving less pred, not more. Lumping PMR in with GCA won’t help. #EULAR2024 POS0411 @RheumNow https://t.co/bsi3lrAafm

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David Liew drdavidliew ( View Tweet)
Steroids are often started before pts see a rheumatologist This associates with long-term low-dose steroid use Need better collaboration between referrers and rheum to reduce this avoidable steroid burden POS0137 @RheumNow #EULAR2024

Mrinalini Dey DrMiniDey ( View Tweet)

« Glucocorticoids are such old drugs and we still use them so much » says Josef Smolen Summary slide from « 75th anniversary of GCd, what have we learnt? » @RheumNow #EULAR2024 https://t.co/XSRt44zupw

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Aurelie Najm AurelieRheumo ( View Tweet)
EULAR guidelines for screening for TB in rheumatic disease patients #EULAR2024 https://t.co/jaixl8lGkY

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Jilaine Bolek Berquist BolekBerqui ( View Tweet)
POS0277: proof of concept: Prophlx with canakinumab x 1 dose rather than steroids/colch/NSAIDS when starting pegloticase with MTX in pts with active, refractory gout: 11 pts: #gout flares 0 (compared 54% in MIRROR-C), infusion rxn 0, no safety signal @rheumnow https://t.co/4qFnQTOuq0

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TheDaoIndex KDAO2011 ( View Tweet)
The fracture risk with glucocorticoids is dose dependent. Lems W #EULAR2024 @RheumNow https://t.co/TGjKu1vfXx

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Dr. Antoni Chan synovialjoints ( View Tweet)
I was allocated to bring down the warning, & I did apologise up front to both the EMA and Janet #EULAR2024. It's a tough gig regulating impactful medicines with risk-benefit, especially when our world is full of other medicines with risk-benefit trade-offs (like prednisolone). 2/ https://t.co/6YPhYHbhg8

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David Liew drdavidliew ( View Tweet)
#EULAR2024 OP0124 EULAR recommended target oral Pred =<5mg/d. Should the threshold of LLDAS be changed to LLDAS5? Multicentre study showed the protection gained from mortality, irreversible organ damage accrual and flare was no different btw the two targets @RheumNow #EULARBEST https://t.co/GbP25tTmX8

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
#EULAR2024 OP0180 Can we safely taper GC in #lupus patients who are in remission? Single study in Italy showed in pts with SLEDAI=0 + pred =<5mg/d + stable IS/HCQ, GC discontinuation after proper tapering appeared safe and was associated with a low risk of flare @RheumNow https://t.co/8IIgPuZUrF

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Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
OP0165- incidence & risk factors of D2T RA in an early RA cohort Factors assoc with D2T RA: 🩸 Seropositivity 🦴 Erosions 📈 Disease activity 📊 D2T pts have higher steroid doses & more commonly develop iatrogenic-related #comorbidities, e.g. osteoporosis #EULAR24 @RheumNow

Mrinalini Dey DrMiniDey ( View Tweet)

Can you ⬇️ #Glucocorticoids or #immunesuppressive in #SLE & change am’t of damage From Asia Pacific #lupus collab (Biologics not included) Compared 7.5 mg #prednisone or less Or DMARD 1/2 flared after LLDAS ⬇️dose didn’t prevent damage #EULAR2024 @eular_org @RheumNow https://t.co/QmjEz87Cvw

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Janet Pope Janetbirdope ( View Tweet)

GC treatment duration for <90 and 90 to 360 days is associated with a higher risk of cumulative SI compared to nonexposed, especially the first year but also up to two years since first visit in RA patients. Maximum RR for <90 days is observed at 8 months since first visit (RR:… https://t.co/ecK2ylqrRk https://t.co/IQ5QQjExYQ

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Dr. Antoni Chan synovialjoints ( View Tweet)
🌎 Global disparities in steroid prescribing in #SLE 💊 HCQ assoc with decreased steroid use 📈 Other contributing factors may be prevalence, severity & phenotype of disease, plus access to DMARDs & biologics 📍SLE poster tour 15:30 TODAY #EULAR2024 Abs #POS0013 @RheumNow https://t.co/7pL8kpeqOs

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Mrinalini Dey DrMiniDey ( View Tweet)
Medicare & Optum claims data study of 2851 #RA pts w/ breast cancer (BC). In 3 mos before BC 27028% received bDMARDs. W/in 1st 3 yrs post-BC Dx 24-26% were receiving bDMARDs. 70% of RA pts on steroids without change w/ time https://t.co/51NcXv0xyc https://t.co/461NZiFvDO

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Dr. John Cush RheumNow ( View Tweet)
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