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Mimics of ANCA-associated vasculitis: How can we tell?
With increased disease awareness and more regular, accessible testing for anti-neutrophil cytoplasmic antibodies (ANCA), ANCA-associated vasculitis (AAV) has become an increasingly recognized clinical entity in rheumatologic practice.
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Colchicine Ineffective in Long COVID
Management of long COVID has been perplexing with symptoms having functional and possibly inflammatory origins. Colchicine has been studied in long COVID and failed to improve functional capacity, respiratory function, or inflammatory markers.
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Pregnancy Management in Inflammatory Bowel Disease: A Global Consensus
Consensus guidance on the management of pregnancy in patients with inflammatory bowel disease (IBD) was simultaneously published in six international journals, including The American Journal of Gastroenterology.
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56 pts w/tracheobronchial stenosis in GPA, highly frustrating disease manifestation
Not surprising to see severe dx & prior intralesional tx assoc with incidence (ie necessity) of tracheal dilation
Leflunomide protective? Have others seen this?
#ACR @RheumNow Abstr#1596 https://t.co/djJXnAkxnv
Mike Putman EBRheum ( View Tweet)
In pooled analysis of 9 PsA trials, 6.9% of secukinumab-treated patients had fungal infections, mostly mild/moderate. Candida rates were low (1.86–2.18/100 PY) and didn’t increase over time. 89.7% resolved fully; only 0.8% led to discontinuation. Abstract 1459 @RheumNow #ACR25 https://t.co/kltMZVEDf9
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
England et al. Predictors of progression RA-ILD - UIP pattern (HR 1.46), current (HR 1.98) and former (HR 1.60) smoking, age (HR 1.03). @RheumNow #ACR25 Abstr#1308 https://t.co/IvQo8Istta
Richard Conway RichardPAConway ( View Tweet)
Infection data from SELECT-GCA:
Glucocorticoids seem to drive overall infectious risk
UPA use associated with higher zoster - vaccinate!!
@RheumNow #ACR25 Abst# 0895 https://t.co/ueVbFPxG0Q
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Post Hoc analysis from SELECT-GCA
Increased rate of herpes zoster for 26wk steroid-UPA 15mg (7.3% vs 4.2% 52wk steroid-plbo) but lower rate of SERIOUS infections (7.9% vs 12.7% 52wk steroid-plbo)
Zoster risk is real; steroids are the bigger problem
@Rheumnow #ACR25 Abstr#0895 https://t.co/IKzO2J4hLH
Links:
Mike Putman EBRheum ( View Tweet)
Concerns using dupilumab in EGPA due to secondary eosinophilia
What about when combined with IL-5 therapy?
16 pt on dupi + IL5 agent
- if dupi alone caused eosinophilia -> quelled by IL-5
- no eosinophilia when dupi added to IL-5
- effective but slow
@RheumNow #ACR25 Abst 1605
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Ultra-low dose (ULD) RTX in AAV maintenance
200mg q6 mo vs. 500mg q6 mo interim analysis
No major difference in infection risk or hypogammaglobulinemia thus far but both doses appeared similarly efficacious
#ACR25 @rheumnow Abst 1609 https://t.co/ZGYNVGY3dr
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
In this MTX+PNL vs TCZ+PNL in GCA study, we saw 5 pts on MTX+PNL get PJP, very surprising.
@EBRheum asked what I knew/hoped he’d ask: why did this happen?
PJP is v rare in GCA
(https://t.co/oPN0dpvG8Q) & with MTX in other diseases.
Worth interrogation!
#ACR25 ABST0891 @RheumNow https://t.co/rsbScryIFR
Links:
David Liew drdavidliew ( View Tweet)
CMV is a worry with high-dose steroids, especially in certain settings.
The risk is far from universal, though: in this Korean cohort treated with high dose pred, almost no-one without risk factors got it.
Meds are rarely the only infection risk factor
#ACR25 ABST203 @RheumNow https://t.co/zLYhLVKgYL
Links:
David Liew drdavidliew ( View Tweet)
A retrospective study from Spain assessed the relationship bet HPV infxn & biologic tx in SLE pts
🔅 Prevalence of HPV 9.9%
🔅 No significant assocs bet HPV infxn, biologic tx, SLE-related dse variables & HPV RF progression
Still, emphasize HPV screening
#ACR25 @RheumNow Abs0659 https://t.co/1YusM1nYPr
sheila RHEUMarampa ( View Tweet)
Why do pts with #Still’s #AOSD
Get hospitalized?
#Sepsis
1827 unweighted & 9135 Weighted #US #hospitalizations
Worse in
men
Black
Medicaid
But is it truly #infection or Still’s flare or both?
Abst#0163
ACR25 @RheumNow @rheumacr
#ACRBest as largest N ever! https://t.co/fLMNyQQNNj
Janet Pope Janetbirdope ( View Tweet)
Lindberg et al. Nationwide case-control study in Sweden. Big increase in risk of DVT/PE in AAV, most marked early after diagnosis @RheumNow #ACR25 Abstr#718 https://t.co/FpDcbX15hm
Richard Conway RichardPAConway ( View Tweet)
Abstract 0806
Compared to belimumab, Anifrolumab associated with:
↑ infection risk b (HR 1.40, 95% CI 1.05–1.88)
↑ herpes zoster (HR 3.94) & COVID-19 (HR 1.66)
No diff in mortality or hospital use
📈 3-yr infection: 38.3% vs 21.3%
@RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Singla et al. In secukinumab phase 3 trials, fungal (inc candida) infections uncommon. 5.51 for sec vs 3.39 for PBO per 100PY. @RheumNow #ACR25 Abstr#585 https://t.co/g78zUsxD5a
Richard Conway RichardPAConway ( View Tweet)
A cohort study of 1 548 538 mother-child pairs with antenatal exposure to steroids (ACS) found a significantly increased risk of res v nonrespiratory infections in preterm & full-term children up to 21 years. (incidence rate, 65 vs 40 & 30 vs 18 per 1000 person-Yrs, https://t.co/Vh4TNYMXgo
Dr. John Cush RheumNow ( View Tweet)
MSK Manifestations in Pediatric IBD
Arthritis and musculoskeletal (MSK) symptoms may accompany pediatric-onset inflammatory bowel diseases (pIBD) as an extra-articular intestinal manifestation, but may vary in presentation and clinical course.
https://t.co/VoU3itr0EM https://t.co/ar19JdrsHH
Dr. John Cush RheumNow ( View Tweet)
Taiwan study of HBV or HCV reactivation w/ bDMARD use in PsO & PsA - among 5527 treatment episodes (3197 ts/bDMARDs) found a 10% risk of reactivation of HBVr (10.6%) & HCV (9.9%), highest w/ TNFi. Reactivation assoc w/ TNFi, HBsAg+, HBeAg+, immunosuppressant use without antiviral https://t.co/AwpmRpfJUT
Dr. John Cush RheumNow ( View Tweet)
