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Mortality in Low Dose Prednisone

Eric Dein, MD

Upon release of the new ACR 2020 Pharmacologic Treatment Recommendations for the Management of Rheumatoid Arthritis, many practitioners were surprised that the new guidelines recommended against glucocorticoid initiation at disease onset.

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The tantalising prospect of glucocorticoid-free treatments for systemic vasculitis

Richard Conway, MBBChBAO, PhD

Glucocorticoids are a highly effective treatment in systemic vasculitis but are also a significant cause of long-term harm in the form of treatment related adverse events.

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What’s new in knee osteoarthritis that matters?

Janet Pope, MD, MPH, FRCPC

Are intra-articular steroid injections effective in symptomatic knee OA? Do they accelerate cartilage loss? Does weight less actually help? Do we have DMARDs for knee OA? Insights from 2020 ACR Convergence.

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RheumNow Podcast – ACR 2020 Epilogue (11.20.20)

Jack Cush, MD

Dr. Jack Cush reviews a few more ACR 2020 abstracts and presents a new plan to learn or take in ACR20 content.

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Ten-Year Analysis of Low-Dose Glucocorticoids in early RA

Meral K. El Ramahi, MD, FACP, FACR

Abstract #1998 by C. Roubille et al from Montpellier, France is a 10-year prospective analysis that looked at the risk of severe outcomes related to very low-dose glucocorticoid in early rheumatoid arthritis from the ESPOIR cohort.

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Check out our latest article from Richard Conway ( @RichardPAConway) #ACR20 The tantalising prospect of glucocorticoid-free treatments for systemic vasculitis https://t.co/VG1ah3Nq5c https://t.co/js3l527VHg

Links:

Dr. John Cush RheumNow ( View Tweet)
#BestACR20Tweets RT @RichardPAConway :Dr Cid presents phase 2 trial of anti-GM-CSF agent mavrilimumab in combination with steroids in GCA. 70 patients. Sustained remission at week 26 in 83.2% of mavrilimumab vs 49.9% of placebo p=0.0038. @DrPujaMehta1 #ACR20 Abstr#L06 https://t.co/ynWbguXXzR
Dr. John Cush RheumNow ( View Tweet)
#BestACRTweets20 RT @RHEUMarampa : IgG4-RD tx: GCs are mainstay tx starting at 30-40mg/d tapered gradually but 30% of pts will have recurrences Potential therapeutic targets to ⬇GC toxicity ✏B cell/plasmablasts (promising) ✏T cells (anecdotal) #ACR20 https://t.co/htu849kng3

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Dr. John Cush RheumNow ( View Tweet)

"The tantalising prospect of glucocorticoid-free treatments for systemic vasculitis" by Dr. Richard Conway ( @RichardPAConway) https://t.co/VG1ah3Nq5c https://t.co/jORhfQn3EC

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Dr. John Cush RheumNow ( View Tweet)
Mortality in Low Dose Prednisone by Dr. Eric Dein ( @ejdein1). #ACR20 https://t.co/y6dL9V6iDC https://t.co/e7119ymgiq

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Dr. John Cush RheumNow ( View Tweet)
Read our news article "Ten-Year Analysis of Low-Dose Glucocorticoids in early RA" by Meral K. El Ramahi ( @MeralElRamahiMD) #ACR20. https://t.co/S9rOHc0864 https://t.co/6X4owP6pF0

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Dr. John Cush RheumNow ( View Tweet)
Quick Read! Mortality in Low Dose Prednisone by Dr. Eric Dein ( @ejdein1). #ACR20 https://t.co/y6dL9V6iDC https://t.co/ZFpxoTH07p

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Dr. John Cush RheumNow ( View Tweet)
Dr P Seo notes based on PEXIVAS study while PLEX does not seem to help with AAV, it showed you can drop steroid dose sooner: start pred 1 mg/kg/d but drop down after 1 week to 0.5 mg/kg/d #ACRReview #ACR20 @rheumnow

k dao KDAO2011 ( View Tweet)

Low-dose steroids in RA: what's the harm, right? (You probably know where I'm going with this) ESPOIR 10y data: total events, and severe infections worse with dose and time (cumulative 8.4g ≡ 5mg/d) No doubt some residual confounding, but real risk! #ACR20 ABST1998 @RheumNow https://t.co/BAQmOR1ped
David Liew drdavidliew ( View Tweet)
What would you use next? sero+ RA new keratitis requiring prednisone and now also 20 SJC. New rheumatoid nodules. Pt has been on triple csDMARDs + Leflunomide, then 2 JAKi and 2 TNFi also with MTX each time. All Rx works for 6 months then relapse. @RheumNow @CRASCRRheum https://t.co/9cTS1tNE42
Janet Pope Janetbirdope ( View Tweet)
Summary of #ACR20 part B: - The future is bright with many trainees producing great research per Dr. Diane Karen - Belimumab (phase III) reduced proteinuria, improved renal for, and helped w/ tapering of GC in pts w/ lupus nephritis but more infect in GC group @RheumNow

Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)

2020 #ACR20 RA guidelines were against steroid usage in RA. ESPOIR French cohort: 10 years of very low dose GC show increase events (death/CVD/fracture/severe ifn) even on low doses. HR increases every year. Cum GC dose-effect esp ifn, CVD. @RheumNow #ACRBest https://t.co/7b7chCPRxm
Eric Dein ejdein1 ( View Tweet)
When you give IA steroids for knee OA how long do you tell pts it will work for @RheumNow #ACR20 @CRASCRRheum abstr#1650

Janet Pope Janetbirdope ( View Tweet)

Intra-articulations steroids for the knee OA- finding benefits again! IA steroids were good then villified in press with accelerated cartilage loss. Pendulum swings back in abstr#1649 where quadriceps & gait improve post injection @RheumNow #ACR20 @CRASCRRheum #ACRbest https://t.co/0bRsiEKsW4
Janet Pope Janetbirdope ( View Tweet)
Study of Chinese pts on long-term GCs by Dr CC Mok: DEN >> ALN in ⬆spinal BMD & suppressing bone turnover markers after 1yr tx. No sig. diff in AEs among grps. Limits: Open-label,small ss,short tx dur'n, not powered for fractures @RheumNow #ACR20 abs1442 https://t.co/m8mT0hMPN8
sheila RHEUMarampa ( View Tweet)
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