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Allergic Drug-Induced Arthritis (5.19.2023)
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
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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Prevalence and Mortality of IgG4-related disease in the USA
A current review of the epidemiology of IgG4-related disease (IgG4-RD) in the USA shows a low prevalence with possibly increasing numbers, owing to increasing awareness of this unique immune-mediated condition.
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"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
Links:
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
Links:
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
Links:
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
Links:
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
Links:
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
Links:
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
Links:
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
Links:
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
Links:
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
Links:
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
Links:
Dr. John Cush RheumNow ( View Tweet)
Tuesday Night Rheumatology: POD 3: Vasculitis: Evolution and Advances
This webinar will feature highlights from these lectures followed by live audience Q & A:
-New Therapies for PMR & GCA
-Assessment of GCA and PMR
-GPA Treatment Choices
https://t.co/PRj6QQnxIS https://t.co/Y4aCyTrg0Z
Links:
Dr. John Cush RheumNow ( View Tweet)
Tuesday Night Rheumatology: POD 3: Vasculitis: Evolution and Advances
This webinar will feature highlights from these lectures followed by live audience Q & A:
-New Therapies for PMR & GCA
-Assessment of GCA and PMR
-GPA Treatment Choices
https://t.co/MQBAEmUvuC https://t.co/qh2By6a3Kf
Links:
Dr. John Cush RheumNow ( View Tweet)
PJP Prophylaxis Needed with Steroids and RTX
The 2023 EULAR Vasculitis guidelines recommends primary prophylaxis with antibiotics, especially in rheumatic disease patients receiving RTX.
https://t.co/eq42bK7MB1 https://t.co/Wk1hOpXanv
Links:
Dr. John Cush RheumNow ( View Tweet)
