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How Age of Onset Affects Giant Cell Arteritis

MedPage Today

Giant cell arteritis (GCA) has a different phenotype when diagnosed late in life compared with earlier onset, a large Italian cohort study indicated.

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ANCA, vasculitis, test

International Consensus on ANCA-Associated Vasculitis with Glomerulonephritis

Jack Cush, MD

Nephrology Dialysis Transplantation has published an overview of the management of anti-neutrophil cytoplasmic antibody associated vasculitis with glomerulonephritis based on several international guidelines, including those frorm the ACR 2021, EULAR 2022 and KDIGO 2021 (Kidney Disease: Improving

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Allergic Drug-Induced Arthritis (5.19.2023)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.  This week we delve into some odd associations, repeat drug warnings and the consequences of antirheumatic therapies.

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Evidence-Based Guidelines for EGPA

Jack Cush, MD

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, affecting between 10 and 14 cases per million globally. This adult disorder has a mean age at diagnosis of nearly 50 years and affects both sexes equally, presenting with pulmonary symptoms (asthma), eosinophilia and granulomatous or vasculitic involvement of several organs. A multidisciplinary, multinational European group has developed evidence-based, guidelines for the diagnosis and management of EGPA, intended to include recent advances.

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Autoimmune disease diagnoses slowly on the rise, despite reduced smoking - but that’s now 10% of the population, & many patients have more than one. Most are lifelong. Surely this needs more investment?? CPRD data from the UK #EULAR2023 OP0007 @RheumNow https://t.co/7NGF5YaE9z https://t.co/m6SaibqmEq

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David Liew drdavidliew ( View Tweet)
Watch: GPA Treatment Choices https://t.co/9v6C5nOLqu https://t.co/1E347ulsvR

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Dr. John Cush RheumNow ( View Tweet)
"Ideally, you should get your TA biopsies within 2 weeks, but that's not always possible. Don't delay tx." @anisha_dua reminds us that bx can still be positive up to 8 weeks after steroid initiation. Just be aware of lesional changes with time. #RNL2023 https://t.co/uYBNrGzdQm https://t.co/Rvs0ewHzwb

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Dr. John Cush RheumNow ( View Tweet)
Dr. Anisha Dua on Imaging in PMR: - US of shoulders to eval for bursitis can increase specificity - MRI better for pelvic girdle, but expensive - Consider PET if lack of response to steroids, r/o malignancy #RNL2023 @RheumNow https://t.co/tjhGlJPDWZ https://t.co/9h1FwfM0CP

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Dr. John Cush RheumNow ( View Tweet)
Avacopan in GPA - non-inferior to prednisone for induction remission - received FDA approval for treatment of severe active GPA in combo with standard therapy and steroids - should be used in newly diagnosed active or relapsing disease @rheumnow #RNL2023 https://t.co/My6M5MGBl1 https://t.co/0aPFUeE55Q

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Dr. John Cush RheumNow ( View Tweet)
How to long for maintenance of GPA? Continue for 24 months, then consider: Relapse history? Organ damage? Toxicity? Patient wishes? Compliance? Family planning? Dr. Langford @RheumNow #RNL2023 https://t.co/tFn2p5DfJV https://t.co/Uu4Fmans40

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Dr. John Cush RheumNow ( View Tweet)
Carol Langford #RNL2023 @RheumNow Rx options for GPA showed by targeted to patient's disease characteristics of severe vs non-severe disease CYC not for non-severe due to toxicity MTX, MMF not for severe disease https://t.co/jw3wq2k7gb https://t.co/y3ck6KuCDj

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Dr. John Cush RheumNow ( View Tweet)
"Highest pre-test probability for GCA is actually: 1) Limb claudication 2) Jaw claudication #RNL2023 @RheumNow https://t.co/Ed52fIcVaI" https://t.co/dA1FlCEU3i

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Dr. John Cush RheumNow ( View Tweet)
GCA biopsy: When and How Early is best, rec'd in first 2 weeks. Findings can be present at 8 weeks but be less prominent @anisha_dua rec's unilateral imaging in most pts, especially w scalp tenderness on one side >1 cm length #RNL2023 @RheumNow https://t.co/Pn25Qt0WL4 https://t.co/5qROaTbD2w

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Dr. John Cush RheumNow ( View Tweet)
Dr. Spiera's approach to PMR treatment - prefers methylprednisolone - rapid taper over 16 weeks - consider GC sparing therapy (MTX, IL-6i) @Rheumnow #RNL2023 https://t.co/LR9e0aXkeN https://t.co/qXUBkz5vfe

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Dr. John Cush RheumNow ( View Tweet)
SAPHYR, presented at #ACR22, unpublished Robert Spiera at #RNL2023 Phase 3 study for refractory PMR Sustained remission of disease, less steroids usage, steroid toxicity, and improved PROs @RheumNow https://t.co/oQJV7gUV3W https://t.co/S1LRBT55Qn

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Dr. John Cush RheumNow ( View Tweet)
IL-6 for PMR SPARE and SEMAPORE (Toci), SAPHYR (Sari) 2/2023: FDA approves sarilumab for PMR for inadequate response to corticosteroids or unable to taper off Robert Spiera @RheumNow #RNL2023 https://t.co/VtzW01Ez7D https://t.co/P6oUQvmDXH

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Dr. John Cush RheumNow ( View Tweet)
Evidence-Based Guidelines for EGPA Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, affecting between 10 and 14 cases per million globally. https://t.co/VixECcPv4R https://t.co/XgEHRgDiPj

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Dr. John Cush RheumNow ( View Tweet)
DMARDs/TNF for PMR: MTX- initial benefit, but no 5 year steroid sparing effect Infliximab - no benefit Lef - some benefit in case series Robert Spiera #RNL2023 @RheumNow https://t.co/d7BpmxFfct https://t.co/jLJDPuMtD3

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Dr. John Cush RheumNow ( View Tweet)
Is there role for MTX in GCA Favorable results in a meta-analysis with NNT 11 to prevent 1 cranial relapse BUT: limitations of meta-analysis, short follow-up, dose response not evaluated Robert Spiera at #RNL2023 @RheumNow https://t.co/lucAWypvr7 https://t.co/W604xXesaI

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Dr. John Cush RheumNow ( View Tweet)
#RNL2023 Rob Spiera: I often use aspirin a day, especially if cranial complications and no contra-indications" No prospective studies, 2 large retrospective studies suggesting benefit @RheumNow https://t.co/V8C43LN5wl https://t.co/2focIzWhPP

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Dr. John Cush RheumNow ( View Tweet)
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