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Renal Involvement is Pivotal in ANCA-Associated Vasculitis
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MedPage Today
Bearing in mind that renal impairment is among the worst complications of ANCA-associated vasculitis (AAV), researchers have identified four different trajectories of kidney function over time in AAV patients, with implications for personalized treatment, as well as future research.
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NSAIDs in Pregnancy (3.3.2023)
Dr. Jack Cush reviews the lastest journal articles, news, and FDA announcements from the past week on RheumNow. This week, the importance of IFNa, Subclinical PsA and NSAID safety during Pregnancy.
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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/kyUNgcsIPD https://t.co/KA1otftKTc
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Study of 197 AAV pts in RAVE trial (RTX vs CTX; followed by AZA) showed most serious infections (82%) occurred in 6 mos (68% Resp infx) & assoc w/ lower#s CD19+ cells. TMP/SMX prophylaxis against P. jirovecii decreased SIE rates https://t.co/oz530OkGs8 https://t.co/YFW7PD6wrW
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Massachusetts Medical Society workforce survey (600 MDs) shows that >half have cut back patient time, 55% admitted to burnout (more in women), & 1 in 4 physicians plan to leave medicine in the next two years. https://t.co/VUd101BrEi https://t.co/Hc6UyGMW1E
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Periodontal Mucosal Breaks Trigger RA Disease Activity
Periodontal disease (PD) is more common in RA, especially those with anti-citrullinated protein antibodies (ACPAs). RA activity has been linked to the severity of PD and mucosal inflammation.
https://t.co/Yx7fPMrB7v https://t.co/pH0XGPqGhJ
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Drs Schett & Mackensen reported a case of refractory inflammatory myositis successfully treated with CD19 CAR T cells. 41yoM w/ +Jo-1, myositis, ILD, Raynauds, periorb edema, not responding to steroids, RTX, IVIG, tacrolimus, CTX https://t.co/DlKs3DGWNu https://t.co/M7qrcfcE2y
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Study of 78 pt suspected of #GCA undergoing Temp. artery Bx and US. Nearly half (35) Dx w/ GCA. Both had similar sensitivities(69% and 63%, respectively), but specificity higher w/ biopsy (100% vs 79%). Compression sign had best diagnostic performance https://t.co/wzVqrHvfqM https://t.co/HRmfb6g7aF
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Is it Lupus?
https://t.co/dsHQvyuCtC https://t.co/JBYGAWQJ7X
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Phase 3 Trials of Baricitinib Disappoint in SL
Despite the encouraging phase II trial results of baricitinib in SLE patients, two parallel phase III trials have failed to redemonstrate the efficacy of baricitinib in active SLE.
https://t.co/SwU7ujZnsP https://t.co/IgpCTtyDNA
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While anifrolumab targets IFN alfa in SLE, its unclear how much IFNa is needed for Rx response. A study of 40 pts shows Rx naive SLE has signif higher serum IFN activity; this is assoc w/ fever, leukopenia, ALE rash and oral ulcers & more organ damage https://t.co/nhqg0ky7RT https://t.co/kBuqvJYFYE
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"My eye is swollen": an underrecognized mimic of IgG4-related disease
Artem Minalyan, MD, presenting his poster at RWCS 2023.
https://t.co/N2VShY5OHY https://t.co/fQYbFH6Mnb
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Treat-to-Target Guidelines for GCA and PMR
The Annals of Rheumatic Disease has published updated multinational, T2T recommendations for the treatment of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR).
https://t.co/zb0PXsW5mw https://t.co/PdFd9A794O
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FDA has approved sarilumab (Kevzara) for the treatment of polymyalgia rheumatica (PMR) in adult patients who have had an inadequate response to corticosteroids or who cannot tolerate corticosteroid taper. Approval is based on Phase 3 SAPHYR study https://t.co/7GHG2uG9yQ https://t.co/MZ7RYGdDfG
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Triad of Trouble: A case of joint, skin and GI woes
Sara Faghihi Kashani, MD, presents her poster at RWCS 2023
https://t.co/xwT2jV1gJv https://t.co/g63tRHsoQY
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Sarilumab is FDA Approved for PMR
The FDA approved sarilumab for PMR, stipulating it is indicated in those patients who have had an inadequate response to corticosteroids or who cannot tolerate corticosteroid taper.
https://t.co/VjzloCbpBv https://t.co/9dVb6sVbph
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"My eye is swollen": an underrecognized mimic of IgG4-related disease
Artem Minalyan, MD, presenting his poster at RWCS 2023.
https://t.co/1j3FMazdyk https://t.co/K7VoQHhhGz
Links:
Dr. John Cush RheumNow ( View Tweet)
Without head-to-head trials, do we look to metanalyses? 13 trials of TNF inhibitors in JIA pts - Results at 12-14 weeks. While it ADA looks possibly better, that would be an over-interpretation and misuse of trial data that isnt truly comparable https://t.co/k6QcPZZj67 https://t.co/SwwND1VFfT
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51 Juvenile SLE (j-SLE) studied for neuropsychiatric Dz (j-NPSLE)- 39% presented with jNPSLE. While no clear biomarker/imaging of j-NPSLE identified, they found CSF neopterin (& IFN-α) levels signif higher w/ active j-NPSLE & CNS involvement (p=0.0008) https://t.co/QM8yJGrBJu https://t.co/4hj1eE2JIC
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Study of 87 pts with isolated Nail Psoriasis noted that 11% went on to have #PsA (concurrently or within 3 years). NP findings were mainly onycholysis in79% and nail pitting in 70% https://t.co/2NynITxe6B https://t.co/qs4uYySjxp
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