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Do biologics help taper steroids in Adult Still’s Disease?

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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Great and Not So Great (9.30.2022)

Jack Cush, MD

This week it's the great and not-so-great on gout, chondrocalcinosis, osteoporosis and misdiagnosis. We are good at many of those things - what's not so great? Let's review the news and journal reports from the past week on RheumNow.

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70% of #AOSD pts were females! Large HCA database study - incidence rate - 0.16 - 0.21 per 100,000 (similar to French studies). 24% required ICU level of care, 12% had PNA (fig) Mortality is higher than other cohorts - 3.2% #ACR22 @RheumNow abst#0829 https://t.co/fcFUnExYOE
Bella Mehta bella_mehta ( View Tweet)
#ACR22 Abstr#0826 2 years on since FDA approved #Tocilizumab in Adults Onset Still's Disease, real-world data from Japan affirmed its effectiveness and as a steroid-sparring agent @RheumNow https://t.co/jbmhEnGwXO
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
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

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Richard Conway RichardPAConway ( View Tweet)
New concept of sJIA to MAS as a continuum on the spectrum of disease severity. Molecular basis via impact of mTORC1 (mechanistic target of rapamycin complex 1) inhibition in Il1rn-/- mice. Looking forward to the full paper. Huang Z Abs004 https://t.co/3OtIp90PnG #ACR22 @RheumNow https://t.co/PPHQj8bYKu

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Dr. Antoni Chan synovialjoints ( View Tweet)
Germany based 74 pt #FMF prospective non-interventional, multicenter observational study on Canakinumab - RELIANCE Registry 63% in remission in 2 yrs serious adverse drug reactions - 1.56 per 100 patient years @RheumNow #ACR22 abst#0138

Bella Mehta bella_mehta ( View Tweet)

#ACR22 Abstr#0127. Cross-sectional study of 59 patients with #SAPHO and Chronic Nonbacterial Osteomyelitis showed that patients had high level of pain and fatigue and low function. Important to assess for these and could be a treatment target @RheumNow https://t.co/451KrlJWZF
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
mTORC1 may be driver of inflammation that connects the pathogenesis of sJIA and MAS as seen in mouse models. Further evaluation needs to be determined in humans, but interesting nonetheless. Abs 0004 #ACR22 @RheumNow https://t.co/RFokZqFQZp https://t.co/E7yxCPDGCd

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Dr. Rachel Tate uptoTate ( View Tweet)
#ACR22 Presents New Data on JIA Clinical Remission with Combo DMARDSs New research being presented at #ACR22, demonstrated that polyarticular juvenile idiopathic arthritis patients were more likely to achieve clinical remission with combo DMARDSs. https://t.co/qmfnEvDedA https://t.co/VhkYlZJG3s

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Dr. John Cush RheumNow ( View Tweet)
QD Clinic - 1st Line Anakinra New-onset systemic JIA - how will you treat? #ACR22 https://t.co/cxG6ZcBXUv https://t.co/YCXD4z9BQ7

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Dr. John Cush RheumNow ( View Tweet)
Will we see you there? #ACR2022 What are you most looking forward to on the agenda? https://t.co/KQGHJtwboe
Dr. John Cush RheumNow ( View Tweet)
Follow us for real time coverage #ACR2022 https://t.co/5CBdiKWdKM
Dr. John Cush RheumNow ( View Tweet)

How do Pts check Temps? Paired oral & temporal temps in 2031 Blacks & 2344 Whites: / whites showed no diff (36.97 vs 36.95°C), but signif diff in blacks (36.98 vs 37.05). Fever seen in 10.2-10.8% Whites, but 10.1% (temporal), 13.2% (oral) in Blacks https://t.co/D4XowfsYXD https://t.co/LmvEnAVGbr

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Dr. John Cush RheumNow ( View Tweet)

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/rcnTPkDTjq https://t.co/RbW1fPSjfU

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Dr. John Cush RheumNow ( View Tweet)
A Review of AOSD - Adult - Onset Still's Disease https://t.co/VvWX5t3WPY @Stills_Now https://t.co/uEoCjhViRP

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Dr. John Cush RheumNow ( View Tweet)

2 HIV+ pts with HLH (MAS) successfully Rx w/ JAKi - ruxolitinib. Both had high fevers, severe pancytopenia, hypofibrinogenemia, hypertriglyceridemia, & increased ferritin, BMBx Hemophagocytosis, splenomegaly. https://t.co/yGs7e4Ftgp https://t.co/cv9NX31bZr

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Dr. John Cush RheumNow ( View Tweet)
Record a Question or Comment... Rheums: Have a Rheumatology question or case for Jack Cush? Record it here and we'll feature it on an upcoming podcast. Tell us your name and where you practice rheumatology. https://t.co/rICbSJzPbk https://t.co/VIjlR6xlwQ

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Dr. John Cush RheumNow ( View Tweet)

IL-18 is a proinflammatory cytokine involved in innate &adaptive immune responses. IL-18 is a key mediator in autoinflammatory diseases, MAS, Still’s disease. Serum IL-18 levels may be useful in diagnosis and monitoring of disease activity https://t.co/P8ecLAtNx5 https://t.co/3mo1vcYKUr

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Dr. John Cush RheumNow ( View Tweet)
Joint Flares extend disease & show joint specific memory. Study of 95 JIA pts, 12.5 yrs F/U: 95% got to inactive dz, 81% flared 1+ times. 74% flares in prior joints, usual side 83%, contralateral 17%, 40% new Jt; more likely off meds https://t.co/20UEtZXUIW https://t.co/yDt7WXvkB0

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Dr. John Cush RheumNow ( View Tweet)
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