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Glucocorticoids-free zone in SLE?
For over 70 years, glucocorticoids, (GC) have been a part of standard therapy in SLE. They are classically used to not only induce remission or treat an acute flare, but also as maintenance therapy. They are a valuable 'friend' if used wisely, and can become a 'foe' if used excessively.
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ACR Convergence Preview (11.10.2023)
Dr. Jack Cush reviews this past week's news on RheumNow.com and suggests a learning plan for those wanting to consume the upcoming ACR Convergence 2023 meeting.
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Incidence, Microbiological Studies, and Factors Associated With Prosthetic Joint Infection After Total Knee Arthroplasty
A study of nearly 80,000 US veterans who underwent primary knee joint arthroplasty (TKA) showed the incidence of prosthetic joint infection (PJI) was highest in the first 3 months and remained elevated through 12 months compared with 12 months or more after surgery.
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Late Should Not Be Less (11.3.2023)
Dr. Jack Cush reviews the news, journal reports and regulatory approvals from the past week on RheumNow.com.
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20 years real-world data on disease burden, patient experience & unmet needs in Refractory #RheumatoidArthritis
▶️Higher glucocorticoid & opioid use
▶️Greater comorbidity & symptom burden
▶️More rheumatology visits
#ACR23
👉🏽https://t.co/CAUorjQbvN
by @KristinWipfler @Dr_K et al https://t.co/vx1aOZizfE
Dr Ai Lyn Tan DrAiLynTan ( View Tweet)
#ACR23
Scleroderma renal Crisis (SRC)
May precede skin involvement also.
RISK FACTORS
• Early diffuse skin disease
- 2-3 years from SSc onset, median 8 months
• Anti-RNA polymerase III (60%)
• Use of corticosteroids
- >15 mg/d or low doses for longer time https://t.co/RSIxEXLdX7
Aditya Burje AdityaBurje ( View Tweet)
Are we tapering steroids too rapidly? Real world experience: steroid tapering in severe #AAV based on #PEXIVAS protocol noted higher rates of dz progression, relapse, ESRD, death. Risk greatest when creatinine > 300umol/L and w/RTX induction #Plenary1 #ACR23 Abst#0725 #ACrBest https://t.co/Rtv7vkzUUD
TheDaoIndex KDAO2011 ( View Tweet)
Reduced-dose GC regimen in severe GPA or MPS (creatinine >300 umol/L, RTX as induction) associated with increased risk of death, ESKD, progression before remission requiring treatment modification or relapse, Nagle S Abst#0725 #ACR23 #ACRBest @RheumNow https://t.co/ZVZYRnSy3n
Dr. Antoni Chan ( View Tweet)
#ACR23 Abstr#0782 Triple therapy in #lupus nephritis. Propensity match data AURORA vs ALMS showed pts treated with voclosporin+MMF+low dose GC vs MMF+High dose GC achieved earlier reduction in UPCR & fewer AEs. Cdnt control for everything e.g. HCQ but assuring @RheumNow #ACRBest https://t.co/dmriAyQPr0
Md Yuzaiful Md Yusof ( View Tweet)
Differences in #glucocorticoid dosing. In #lupus #nephritis less steroids are the same as high dose steroids. Placebo arms of pooled data from #LN #RCTs. Less is equal! #ACRbest #ACR2023 @RheumNow @ACRheum abst0781 High dose steroids tended to have lower MMF doses https://t.co/XwTlsy4xKE
Janet Pope ( View Tweet)
Sarilumab for relapsing of PMR. Any thing to to taper off prednisone quickly.
#ACR23 , year in review.
Lost of good studies and smart discussions @RheumNow at Make rheum for PMR month. https://t.co/VyRP8ls3OC
Nouf Al hemmadi ( View Tweet)
Important plenary re:reduced vs standard GC for AAV... IRL
PEXIVAS & recent guidelines supported low dose taper
Real world data w/severe dx? Increased risk of death & ESKD for REDUCED pts
Need full data but yikes...
@RheumNow #ACR23 #ACRBest https://t.co/3S23O9d1ok
Mike Putman EBRheum ( View Tweet)
Abst#0725 #ACR23 @RheumNow
PEXIVAS Real life data!
GPA & MPA pts - Retrosp observ study
⭐️Reduced-dose GC regimen ass w/ INCREASED risk of death, ESKD, progression
Greatest risk: pt w Cr levels >300 umol/L, RTX induction Rx
⚠️Caution w/ reduced GC, RTX, severe kidney dis
#ACRBest https://t.co/7qI5c1ZiqO
Eric Dein ( View Tweet)
Interesting study on PEXIVAS reduced steroid use from today's plenary session!
Reduced steroid dose in GPA/MPA pts associated w/
INCREASED risk of death, ESKD, progression of dz
Even greater risk in pts with higher Cr lvls or RTX induction use
@RheumNow #ACR23 Abs#0725 #ACRbest https://t.co/frsOrANKhf
Robert B Chao, MD ( View Tweet)
Real world data on low dose PEXIVAS steroid by Nagle et al. Increased risk of progression/relapse/death/ESKD in those with severe GPA/MPA HR 1.72. More marked in those with creat>300 or with RTX induction Abstr#0725 #ACR23 @RheumNow https://t.co/vTXVZfjbXx https://t.co/4FuMjxOuyB
Richard Conway ( View Tweet)
#ACR23 Real-world multicentre study showed steroid-sparing effect of Belimumab in #SLE. At 2 years, proportion of patients on =>10mg/d decreased from 52% to 3%. 18% and 13% achieved LLDAS and DORIS remission. Support its use esp. in those relying on glucocorticoids @RheumNow https://t.co/ad5XH3pmYc
Md Yuzaiful Md Yusof ( View Tweet)
YR in Review: Dr. Seo
🚩GLORIA Trial
RA pts > 65yo: prednisolone 5 mg/d x 2 yrs vs PBO + std care
➡️decr dz activity (DAS ⬇️0.37) but 24% incr ADE
🚩Extension:
➡️Tapered off pred over 3m and..
⭐️NO ADRENAL INSUFF
But, small incr in dz activity (DAS ⬆️0.23)
#ACR23 @RheumNow https://t.co/YQbS6C8ZT5
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Revisiting question in #painful #knee #osteoarthritis Which #steroid to inject - esp with #triamcinolone #hexacetonide shortages which is superior to #acetonide. New extended release #fluticasome #propionate > #placebo ? Is how about vs IA steroids LB04 @RheumNow @ACRheum #ACR23 https://t.co/qJazwihSe0
Janet Pope ( View Tweet)
PEXIVAS results: the reduced-dose GC regimen associated w/ ^ death, ESRD, and uncontrolled dz risk in severe GPA/MPA pts. Even greater risk in pts w/ creatinine levels > 300 μmol/L & in those tx w/ RTX induction. #ACR23 Plenary 0725 https://t.co/mBMrEaGj5k @rheumnow https://t.co/flAfYEKSXJ
Dr. Rachel Tate ( View Tweet)
Steroid (GC) use is increasing - Claims data from (US, Taiwan, Denmark; n=54,630,437; 2009-2018), GC use increased from 6.4 to 7.7% USA, 16.6 to 18.7% Taiwan, & 1.7 to 2.9% Denmark. Most Rx by PCP to healthy adults; 20-25% Rx for URI. https://t.co/GkQR0hcys1 https://t.co/5fpBv2Kyo8
Dr. John Cush RheumNow ( View Tweet)
