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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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Long-Term Survival of Idiopathic Inflammatory Myopathies
A single center cohort study analyzed the outcome and survival of idiopathic inflammatory myositis (IIM) patients and showed good 5 and 10 year survival but showed significant declined 15-25 years post-diagnosis.
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Geo-epidemiology of Autoantibodies in Rheumatoid Arthritis
A multinational study of rheumatoid arthritis (RA) patients shows a variety of post-translationally modified anti-modified protein antibodies (AMPA). While AMPA differed in different ethnic populations, their levels correlated with total serum IgG.
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Annually acetaminophen is responsible for 112 000 US poison center calls, 59000 emergency department visits, and 38000 hospitalizations. Of more concern, it is the leading cause of acute liver failure in the US and other high-income countries https://t.co/5AtQAD1dKu https://t.co/ntZ8dD1srz
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Does Methotrexate Work in Alopecia Universalis?
Alopecia areata totalis (AT) and universalis (AU) are the most severe and difficult to treat forms of alopecia areata (AA).
https://t.co/Lvd7P6r85w https://t.co/hX3rz5fBKT
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NEJM Case: 44 yoF w/ 1wk hx of pustular rash, 1st on face, then legs. Also has ankle pain & odynophagia. PMHx oral ulcers. Exam: Aphthous ulcers & all labs were negative (ANA, ANCA, HIV, RPR, etc). Skin Bx= small-vessel vasculitis. What Dx? https://t.co/4Zw4xXxaAL https://t.co/GM3Yq70tWq
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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
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Renal Involvement is Pivotal in ANCA-Associated Vasculitis
Researchers have identified four different trajectories of kidney function over time in AAV patients, with implications for personalized treatment, as well as future research.
https://t.co/JfIWmpkNiS https://t.co/72jRAVxj13
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Systemic sclerosis current therapy:
- early dcSSc: MMF, CTX, RTX, TCZ
- rapidly progressive dcSSc - ?Stem cell transpl?
- SSc-ILD: MMF>CTX, possibly nintedanib, perfinidone
- Raynauds w/ digital ulcers: CA channel block, PDE5 inhib, iloprost, Bosentan https://t.co/z4OzFklrcl https://t.co/bM01inV2QY
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Long-Term Benefit of Rituximab in Systemic Sclerosis
A small cohort trial of rituximab (RTX) in 29 systemic sclerosis patients showed significantly improved skin sclerosis and lung function after a follow-up of 96 weeks.
https://t.co/qrtv9eK1Oz https://t.co/GdOyaCIPUA
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Serum beta-2 microglobulin (B2M) in 100 #SLE pts - strong correlations betw B2M & 24 hr urinary protein, BUN, creatinine, disease activity, & damage score (p < 0.001), & negatively correlated with GFR, C3, C4 (p < 0.001). B2M predicted lupus LN https://t.co/wXCs0WlIYv https://t.co/vZPWtnqIta
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Metanalysis of 3 RCTs & 19 observational studies, showed hematopoietic stem cell transplantation . (HSCT) significantly improved skin thickness and lung function. While HSCT had more deaths than IV CTX, HSCT had higher 2 yr survival rate https://t.co/FMWFfmYPod https://t.co/SFjlj1yV0x
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Metanalysis shows Takayasu's arteritis pts are at higher risk of adverse pregnancy outcomes. (27 studies, 825 pregs) showed more miscarriage (16%), hypertension (37%) and pre-eclampsia (14%) in TA patients (p < 0.01) https://t.co/stVx5jvPsj https://t.co/LaftdsHmSz
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Does Methotrexate Work in Alopecia Universalis?
Alopecia areata totalis (AT) and universalis (AU) are the most severe and difficult to treat forms of alopecia areata (AA).
https://t.co/x8EjMekMBJ https://t.co/ntejSJcG5M
Links:
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CDC says EVERYONE should be tested for Hepatitis B al least once, w/ 3 lab - HBsAg, & Abs to hepatitis B surface Ag (anti-HBs), hep B core Ag (anti-HBc). At increased risk for HBV - persons in jail, +Hx of STDs, multiple sex partners or Hx of hepatitis C https://t.co/DRzAuhVJSJ https://t.co/9ma0I61xeD
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Population study from Japan shows that Aging is an independent contributor for seronegative RA in patients who are female, have a nonsmoking history, and a BMI < 25. https://t.co/WWRGczmc4K https://t.co/ZHRIHlxDIK
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1215 pts w/ refractory SJS/TEN (not responding to pulse steroids x 3d) compared subsequent plasmapheresis- vs IVIG treated patietns and shows similar mortality rates(18.3% vs 19.5%), but apheresis had more stays (45 vs 32 d) & cost ($34k vs $23k) https://t.co/QTnbPzf6Jd https://t.co/EgI2ueIhdz
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Registration is still open! Join us at RheumNow Live on 3/18 and 3/19. We have a great agenda lined up including a panel on Rheumatoid Arthritis: Revolutionary Advances in Therapy.
https://t.co/duAfKSDi1O https://t.co/JkbHa6b2Fg
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NEJM Case: 44 yoF w/ 1wk hx of pustular rash, 1st on face, then legs. Also has ankle pain & odynophagia. PMHx oral ulcers. Exam: Aphthous ulcers & all labs were negative (ANA, ANCA, HIV, RPR, etc). Skin Bx= small-vessel vasculitis. What Dx? https://t.co/gxjXRaRKzq https://t.co/OYmC4om6hi
Links:
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Study of 21 Downs syndrome pts shows DS to be an autoimmunity-prone state, with a steady-state cytokinopathy, and evidence of hyperactivated CD4 T cells and ongoing activated B cells (CD11c+) - all contribute to a breach in immune tolerance. https://t.co/UUEByfBrqk https://t.co/ekq8AHYlxQ
Dr. John Cush RheumNow ( View Tweet)