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Diagnostic Yield of Cranial and Large Vessel Imaging in GCA
Combined cranial and large vessel ultrasound and PET/CT provided excellent accuracy for the diagnosis of giant cell arteritis (GCA).
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EULAR 2023 recommendation for imaging in large vessel vasculitis
Diagnosis of large vessel vasculitis can be challenging, and imaging modalities help with not only the diagnosis but sometimes in assessing flares in the disease. At EULAR 2023, recommendations for imaging modalities for large vessel vasculitis were discussed. These were evidence-based recommendations adapted for practicality in clinical use.
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New treatment for Takayasu’s arteritis?
Several studies were reported at EULAR2023 about Takayasu’s arteritis (vasculitis), a very rare large vessel vasculitis that occurs in young individuals.
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ANCA-associated vasculitis: beyond therapy with rituximab?
Following the success of Phase 3 randomised controlled trials of non-renal and renal vasculitis, therapy with rituximab has tremendously improved the outcomes of AAV patients. However, some patients are unable to taper their glucocorticoids during rituximab therapy while others appear to be refractory to therapy, particularly those with EGPA. Hence, what are other current or future approaches beyond rituximab?
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Small study 57 EGPA pts shows using MTX or AZA to be equipotent as 1st or 2nd line therapy in EGPA. MTX pts used more cumulative steroids (6 g vs 10.7 g @5 yrs) & more AE (66% vs 30%); AZA had fewer asthma/ENT relapses (23% vs 64%, p= 0.04) https://t.co/WZHudojrzk https://t.co/X6xITcQtCw
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Dr. John Cush RheumNow ( View Tweet)
RheumNow’s newly launched Poster Hall features sponsor-generated clinical trial posters designed to educate and inform. Posters addressing vasculitis, AxSpa and nrAxSpa, and PMR now available.
https://t.co/0dV23VPDQH https://t.co/HfKhji40vU
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Dr. John Cush RheumNow ( View Tweet)
Diagnostic Yield of Cranial and Large Vessel Imaging in GCA
Combined cranial and large vessel ultrasound and PET/CT provided excellent accuracy for the diagnosis of giant cell arteritis (GCA).
https://t.co/0gBXXLy1db https://t.co/zp12wZIkqL
Links:
Dr. John Cush RheumNow ( View Tweet)
EULAR 2023 recommendation for imaging in large vessel vasculitis
Diagnosis of large vessel vasculitis can be challenging, and imaging modalities help with not only the diagnosis but sometimes in assessing flares in the disease.
https://t.co/o8cpSOXNy4
@bella_mehta https://t.co/aCM3yzT32e
Links:
Dr. John Cush RheumNow ( View Tweet)
ANCA-associated vasculitis: beyond therapy with rituximab?
AAV is a group of multi-system autoimmune small vessel vasculitides which includes GPA, MPA and EGPA.
https://t.co/z8RgNYvBiO https://t.co/NI4z4kSAHQ
Links:
Dr. John Cush RheumNow ( View Tweet)
Late Breaker - EULAR 2023 update on imaging of large vessel vasculitis. Ultrasound is now recommended as first line imaging test in all patients with suspected GCA, and axillary arteries should be in the standard examination, Dejaco C et al, Abst#LB0009, #EULAR2023 @RheumNow https://t.co/ya41nJG6qK
Dr. Antoni Chan synovialjoints ( View Tweet)
2023 @eular_org recommendations for LVV imaging
interestingly, the key changes vs 2018 are about PET/CT:
- can consider PET/CT for cranial GCA diagnosis
- PET/CT (alt MRI) can be used for monitoring - more for when you lose ESR/CRP because of IL-6i
#EULAR2023 @RheumNow https://t.co/2DC37CM6gA
David Liew drdavidliew ( View Tweet)
2023 update @EULAR recommendations imaging in GCA
What's new:
1. US = first line imaging test
2. Axillary arteries should be included in standard examination
3. Alternative imaging FDG-PET or MRI
4. Takayasu: MRI preferred CT or FDG-PET alternatives
@Rheumnow #EULAR23 LB0008 https://t.co/rGPfOPX1gI
Aurelie Najm AurelieRheumo ( View Tweet)
#EULAR2023 Clinical Highlights. Vasculitis: OP0061 - new US imaging showing vessel inflammation differentiating patients with Behcet’s vs No-BD. OP0304: cohort study showed Benralizumab (IL5 RA) given for eosinophilic asthma also improved BVAS. RCT for EGPA is ongoing @RheumNow https://t.co/7uohfjGk49
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
#EULAR2023 #POS0222 Post-hoc Analyses of Phase 3 RCT in Rituximab-treated ANCA vasculitis patients only (65% of total) showed more patients met Remission rate & with lower GC Toxicity vs Pred Taper + RTX at 52 weeks, consistent with Trial Main Results @RheumNow https://t.co/BmiujbhQI9
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
The steroid dosing in SAPHYR (sarilumab in PMR):
Bottom two trajectories: sarilumab protocol & actual
Top two trajectories: placebo protocol & actual
Fascinating that with sarilumab, more PNL only really in play at PNL <3mg/d. Def takes the heat out
POS0715 #EULAR2023 @RheumNow https://t.co/aEC8cQaR7O
David Liew drdavidliew ( View Tweet)
What do we do with PMR patients with subclinical GCA seen on ultrasound?
Well, in these non-blinded cohorts the subclinical GCA pts got more pred.
Was it warranted? Hard to say. If we’re going to look for it, let’s try and figure out what it means
POS0712 #EULAR2023 @RheumNow https://t.co/KmCcE0Nsu9
David Liew drdavidliew ( View Tweet)
I mean, if proteomics is more your jive for GCA, we’ve got that too here at #EULAR2023. Definite potential for phenotyping a disease with diverse outcomes
POS0694 @RheumNow https://t.co/tSWpZlUPoE
David Liew drdavidliew ( View Tweet)
Very early days, but it’s cool to see transcriptomics in GCA ➡️ in situ spatial profiling ➡️ drug-gene interactions ➡️ new therapeutic targets identified.
Only time will tell if they will work, but very cool nevertheless.
POS0091 (Mayo, La Jolla, & INSERM) #EULAR2023 @RheumNow https://t.co/n7raIENVOT
David Liew drdavidliew ( View Tweet)
Do we use too much PNL in GCA (when not using TCZ)? Could we wean quicker?
Salvarini group n=22
26w PNL weaning protocol from GiACTA, but no TCZ
10/26 in relapse free remission at 1y
Much less PNL, still some steroid AEs
Way of the future for some?
POS0728 #EULAR2023 @RheumNow https://t.co/qeZHeCi9vq
David Liew drdavidliew ( View Tweet)
#EULAR2023 #OP0007 What are the recent trends of autoimmune disease (AID)? A database study (22m) in UK showed:
- 1 in 10 people had AID in the last 20yrs
- socioeconomic, seasonal & regional disparities cd influence pathogenesis
- CTD (SLE,pSS,SSc) tended to co-occur @RheumNow https://t.co/3DDPR2K5NC
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
