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PMR classification criteria by @anisha_dua @RheumNow #RNL2023
Bursal and biceps tenosynovitis gets one point in PMR classification criteria. https://t.co/Lj1X9mkgBz
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Beautiful summary of GPA management by Dr.Carol Langford #RNL2023 @RheumNow https://t.co/FCwKN9tovX
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
PMR lab studies by @anisha_dua @RheumNow #RNL2023
Majority of patients will have elevated inflammatory markers.
Rapid clinical response to low dose of steroid. https://t.co/AgdIJ5YbOu
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Some points to consider in relapsing PMR , by @anisha_dua @RheumNow #RNL2023
Elevated ESR and CRP rule out GCA.
Relapses are common with steroid tapering, especially below 5mg. https://t.co/D17mdly7z5
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Dr.Robert Spiera approach to GCA #RNL2023 @RheumNow https://t.co/ublzYwBbIF
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Steroid sparing agents in GCA , what worked? By Dr.Robert Spiera #RNL2023 @RheumNow https://t.co/7Q9UYRSAhR
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
PMR by @anisha_dua @RheumNow #RNL2023 https://t.co/mHIBqqRUWh
Nouf Al hemmadi NoufAhmedAlham2 ( 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/O3U29jmsHv
Eric Dein ericdeinmd ( View Tweet)
Carol Langford #RNL2023
Use of CYC + RTX:
Not routine upfront, but may be needed for escalating disease
Limited data to support initial usage
Higher risk of hypogammaglobulinemia, infection, and death
@RheumNow https://t.co/SHwV8o4xX1
Eric Dein ericdeinmd ( View Tweet)
Dr. Langford #RNL2023
When to use CYC over RTX for severe GPA induction?
- Severe disease with RTX intolerance
- Worsening disease despite RTX
- RGPN Cr > 4.0, mechanical ventilation? (these were excluded from RAVE trial)
@RheumNow https://t.co/twVJ81pgUK
Eric Dein ericdeinmd ( View Tweet)
Dr. Carol Langford on GPA treatment
Duration of remission maintenance therapy?
- at least 2 years, after 2 years, maintenance appropriate in many cases
- consider RTX, and other cDMARDs (MTX, MMF, AZA)
@RheumNow #RNL2023 https://t.co/VmswcnzN5v
Robert B Chao, MD doctorRBC ( 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/u7lqCGGeNs
Eric Dein ericdeinmd ( View Tweet)
Beyond immunosuppression, Dr. Carol Langford reviews non-med management of GPA upper airway disease. Things to consider for patients and will change the way I practice. @rheumnow #RNL2023 https://t.co/4SlYx1r5ZK
Dr. Rachel Tate uptoTate ( 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/0DL1WUP177
Robert B Chao, MD doctorRBC ( View Tweet)
Dr. Langford's take home for GPA. Remember to consider disease severity (will determine tx,) maintenance tx, and non-medical management including vaccination options for pts. #RNL2023 @RheumNow https://t.co/HWdv3Fv9zK
Dr. Rachel Tate uptoTate ( View Tweet)
Limitations of IL6 and some unanswered questions in GCA ? By Dr.Robert Spiera #RNL2023 @RheumNow https://t.co/3tJpRhmFAJ
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Sirilumab ( SAPHYR trial) in PMR, By Dr.Robert Spiera #RNL2023 @RheumNow
It also improved patient reported outcomes. Great news👌 https://t.co/NDxhIwvACq
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
#RNL2023
AGATA trial showed benefit of Abatecept in GCA - 48 to 31% disease free survival
Robert Spiera
@RheumNow https://t.co/pPzbdTTvEi
Eric Dein ericdeinmd ( 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/OedVG03yN3
Eric Dein ericdeinmd ( 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/sHx2ceVmAi
Eric Dein ericdeinmd ( View Tweet)
