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Stopping therapy in GCA
They say the easiest bit about GCA, like PMR, is the first week after you start steroids. Those fond memories belie the challenge of ongoing treatment in GCA. In a steroid-only world, there is only misery. Steroid-sparing therapies have changed this completely.
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Upadacitinib: revisiting safety data in RA and GCA
For the last several years, conversations about JAK inhibitors have often started and ended with safety. The shadow cast by ORAL Surveillance has made clinicians more cautious and regulators more restrictive.
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The Great Debate – Who Really Won?
My favorite session at ACR Convergence is often the “Great Debate.” The debate this year also evaluated one of my favorite topics – ultrasound in giant cell arteritis (GCA). More specifically, it asked the question of whether biopsy or ultrasound should be the preferred modality for diagnosing GCA.
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#2659 In a large real-world target trial (>1.3M with T2D), SGLT2 inhibitors, esp dapagliflozin & empagliflozin, were assoc with lower risks of RA, lupus, vasculitis & other autoimmune rheumatic diseases vs DPP-4 inhibitors. Possible immune benefits of SGLT2i? @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Lung Disease in ANCA-associated Vasculitis
Dr. Mike Putman discusses abstract 0721, "Pulmonary Manifestations of Granulomatosis with Polyangiitis and Microscopic Polyangiitis", presented at #ACR25.
https://t.co/A5uKT4jG1I https://t.co/7E4k7QdiNK
Links:
Dr. John Cush RheumNow ( View Tweet)
EGPA relapse in MANDARA including OLE
Majority of relapses are asthma / sinonasal in nature
Of non-airway:
- arthralgia/myalgia
- sensory peripheral neuropathy
@RheumNow #ACR25 Abst1769 https://t.co/cPjjzl4RWS
Links:
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Cutaneous vasculitis: who is most likely to have systemic disease?
430 pt w skin vasculitis examined in case-control
Associated with risk for systemic vasculitis/CTD:
- GI sx
- ulcerating/necrotic lesions
- constitutional sx
- hematuria
@RheumNow #ACR25 Abst 2525 https://t.co/lRjLKRYxDW
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Interesting study evaluating the "CALLY" index (serum albumin × lymphocyte count / CRP / 10,000) for predicing mortality in AAV
I typically dislike these because (1) they are often cumbersome to calculate & (2) they often perform poorly
This one piqued my interest; pretty https://t.co/ziroQOH5Cq
Mike Putman EBRheum ( View Tweet)
Late Breaker: Observational study of MEPO in EGPA
375 pts receiving MEPO had less ARF/CKD than 727 pts receiving standard of care
Smallish event #'s & lots of p values... also, what about the vasculitis?!?
#ACR25 @RheumNow AbstLB16 https://t.co/XwqNthfwPF
Links:
Mike Putman EBRheum ( View Tweet)
PLEX continues to be OUT for DAH in AAV
Retrospective review of ~1.4k AAV-DAH pt
375 who received PLEX compared to those who did not
PLEX tx patients:
- higher odds of death
- higher sepsis
- increased LOS
- increased hospitalization cost
@RheumNow #ACR25 Abst 2517
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
MAINRITSEG: RTX vs. AZA for maintenance in EGPA
RTX not superior in primary remission outcome
RTX favored in secondary outcome of remission with pred <4mg daily
Limitation: only ~50% pt with FFS 1+
@RheumNow #ACR25 Abst 1765 https://t.co/dh5ZWCT12T
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Great debate on GCA ultrasound vs biopsy. Wolfgang Schmidt making the case for GCA US with the rise of its use in guidelines @RheumNow #ACR25 https://t.co/ORxzzG8xnF
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
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 https://t.co/LYRk0rHlzx
Dr. John Cush RheumNow ( View Tweet)
#1725 Functional NOTCH4 variants contribute to vasculopathy & fibrosis in SSc, particularly in African-American patients
NOTCH4 hyperactivation disrupts angiogenesis & drives EndoMT; inhibition (including with FDA-approved Nirogacestat) restores vascular repair @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
PET and histologic discordance in aortitis
Of 5 aortitis patients who had PET/CT prior to aortic surgery with path, only 1 showed concordance (neg PET, neg biopsy)
4/5 patients had inflammatory biopsy with neg PET
Small # but PET is not perfect!
@RheumNow #ACR25 Abst 1620
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
PMR patients need healthcare professionals who know a bit about their disease.
Survey of US HCPs, amongst responders:
- 68% were not aware/unsure about PMR
- of those who were aware, knowledge was… not great (see below)
PMR needs everyone’s respect
#ACR25 ABST1617 @RheumNow https://t.co/SpyEnAW8lI
David Liew drdavidliew ( View Tweet)
ANCA status does not inform IL-5 agent response in EGPA patients
Terrier et al. analyzed the OLE of MANDARA and compared ANCA+ and ANCA- subgroups:
- similar rates of remission
- similar rates of GC withdrawal
- comparable relapse rates
@RheumNow #ACR25 Abst 1594
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
#ACR25 Abstr#1608 10! 10! Across the board. 2-yr data from RCT + Open Label showed frequency of both airway and non-airway features of #EGPA improved with Benralizumab/Mepolizumab. Provides assurance to use more in real-world @RheumNow https://t.co/i78xXojGja
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
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)
Case series of 5 patients with binutuzumab (CD20) in AAV
Short story short; it worked. Of course it worked. Obviously it worked. Everyone knew it would work.
Why aren't we doing more TRIALS with new/better B cell inhibitors in AAV?
#ACR25 @RheumNow Abstr#1601 https://t.co/H6Zz3Tf3xo
Mike Putman EBRheum ( View Tweet)
