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2022 EULAR Recommendations for ANCA-associated Vasculitis
EULAR has published the 2022 update on recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).
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Big Time Vasculitis (3.10.2023)
Dr. Jack Cush Reviews the News and Journal articles from the past week on RheumNow. This weeks highlights includes insights on scleroderma, myositis, vasculitis and answers the question - does aggressive biologic treatment of psoriasis prevent future psoriatic arthritis?
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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/cmwGEWHQEO
Eric Dein ericdeinmd ( 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/quOWjJjgB3
Eric Dein ericdeinmd ( View Tweet)
Dr. Robert Spiera on Recent IL-6i in PMR treatment:
SPARE and SEMAPHORE study - Tocilizumab
SAPHYR - Sarilumab (now FDA approved for PMR tx)
@RheumNow #RNL2023 https://t.co/gofe54wSjo
Robert B Chao, MD doctorRBC ( 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SAPHYR, presented at #ACR22, unpublished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/k3w2TQ3yEB
Eric Dein ericdeinmd ( View Tweet)
@anisha_dua reviews considerations for your differential for PMR at #RNL2023 @RheumNow https://t.co/3ZsczB1UKH
Dr. Rachel Tate uptoTate ( View Tweet)
I use US in my practice and since this data was presented last year, I’ve been evaluating subacromial/deltoid bursas my PMR patients. @anisha_dua reviews imaging at #RNL2023 @RheumNow https://t.co/1TYdXNmcx0
Dr. Rachel Tate uptoTate ( 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/4yszV9KMA9
Robert B Chao, MD doctorRBC ( View Tweet)
#RNL2023
@anisha_dua:
Temporary artery biopsy still preferred, rec over u/s, especially if not
Early imaging for GCA recommended
@RheumNow https://t.co/41fiQuj2x9
Eric Dein ericdeinmd ( View Tweet)
A reminder by @anisha_dua
➡️15% #PMR patients get #GCA
➡️ up to 50% GCA patients get PMR
#RNL2023
Dr Gurdeep Dulay gurdeep_dulay ( 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/HBHBGeFm6J
Eric Dein ericdeinmd ( View Tweet)
Highest pre-test probability for GCA is actually:
1) Limb claudication
2) Jaw claudication
#RNL2023 @RheumNow https://t.co/13tDXMhJKM
Robert B Chao, MD doctorRBC ( View Tweet)
@anisha_dua shares her take home points for PMR. Check out her great review below! #RNL2023 @rheumnow https://t.co/PAqXaXcXAb
Dr. Rachel Tate uptoTate ( View Tweet)
@anisha_dua Table on imaging in LVV
U/S: increase specificity for PMR, operator dependent
CTA: high detail, contrast + radiation
MRA: cost and limitations in CKD, metal
PET/CT: useful but not specific for vasculitis and very high cost
#RNL2023 @RheumNow https://t.co/aTdrlPfN9J
Eric Dein ericdeinmd ( View Tweet)
@RheumNow Live 2023 Starts Tomorrow!
Or does it start earlier?
Love that there is a pre-learn and pre-test to set the stage for #RNL2023
Excited for this talk by @anisha_dua on assessment for GCA/PMR
#RheumTwitter https://t.co/VcawlnaPFf
Eric Dein ericdeinmd ( View Tweet)
Retrospective insurance claims study of PMR & GCA pts. No cases PJP (pneumocystis) found in 547 Pt-Yrs F/U in 1168 GCA pts and 1 case found during 7,446 Pt-Yrs F/U in 15,575 PMR pts (incident 0.07 cases per 1,000 Pt-YRs). NO NEED FOR PJP prophylaxis! https://t.co/UFlKtm88Dj https://t.co/tFYusx0O4t
Links:
Dr. John Cush RheumNow ( View Tweet)
GCA patients with AORTITIS proven by CTA or FDG-PET/CT have higher rates of relapse. Among 82 GCA pts, 78% positive on both CTA & PET. Relapse was seen in 70% in the CTA+/PET+ group & 29% in the CTA-/PET+ (p = 0.019). https://t.co/2zU9ueWkEZ https://t.co/aFn2xH6KmI
Links:
Dr. John Cush RheumNow ( View Tweet)
GCA patients with AORTITIS proven by CTA or FDG-PET/CT have higher rates of relapse. Among 82 GCA pts, 78% positive on both CTA & PET. Relapse was seen in 70% in the CTA+/PET+ group & 29% in the CTA-/PET+ (p = 0.019). https://t.co/psA6hywouL https://t.co/WORiBd9Qli
Links:
Dr. John Cush RheumNow ( View Tweet)
BRIDGE-PMR a proof-of-concept trial studied 1 dose of IV RTX in 47 PMR pts - at 1 yr, 52% RTX were in GC-free remission (compared to 21% given PBO). Eight (33%) patients in the placebo group and six (26%) in the rituximab group had adverse events https://t.co/yv8ezFN5BJ https://t.co/7FOOPbEIf3
Links:
Dr. John Cush RheumNow ( View Tweet)
