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Giant Cell Arteritis Growing More Lethal
MedPage Today
Mortality rates among patients with giant cell arteritis (GCA) in Canada's Ontario province rose by 15% from 2000 to 2018, a new study found, even as the general population saw declines in overall mortality.
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Sanchez-Martin et al. Tocilizumab in newly diagnosed vs refractory GCA. 471 patients. Appears of relatively similar efficacy in both groups. Surprising that the difference is not greater given refractory GCA inherently more complex @RheumNow #EULAR2022 POS0817 https://t.co/HEWzYCz9YD
Richard Conway RichardPAConway ( View Tweet)
HAS-GCA study @alwinuk @profbdasgupta Southend pretest probability score and Halo score useful in diagnosis and prognosis in GCA. Halo score may be useful for monitoring. @RheumNow #EULAR2022 POS0818 https://t.co/sxYjnQQFA8
Richard Conway RichardPAConway ( View Tweet)
Unizony et al. Case series of tocilizumab + 8 weeks steroid in GCA. 30 patients, 50% new 50% relapsing. 77% in sustained remission at week 52! No vision loss. Exciting, needs an RCT @RheumNow #EULAR2022 OP0185 https://t.co/ohBYIWYxBC https://t.co/fsn4x17Hwv
Links:
Richard Conway RichardPAConway ( View Tweet)
What does avacopan mean for sustained remission in AAV?
New post-hoc from ADVOCATE - keeping in mind the avacopan was instead of steroids. Impressive numbers, so increasingly the questions will be about strategy and cost?
#EULAR2022 @RheumNow https://t.co/B4y8jZiHf5
David Liew drdavidliew ( View Tweet)
Mortality after PMR:
looking at 35y follow-up of a cohort in Norway,
apparent higher mortality for women (vs men, general population) decades after.
Is this real? Treatment related?
My wild guess: sarcopenia kills.
Thoughts @Sarah_L_Mackie & tagged?
OP0181 #EULAR2022 @RheumNow https://t.co/k7p9jNfW5s
David Liew drdavidliew ( View Tweet)
Sometimes hear “GCA associated with PMR is extracranial”
Interesting point:
of the 20% of PMR patients with USS-evident subclinical GCA
- one-quarter had isolated cranial disease
GCA phenotypes not so clear cut
(Proviso: it’s subclinical disease)
OP0184 #EULAR2022 @RheumNow https://t.co/storHFL8aW
David Liew drdavidliew ( View Tweet)
Sanchez-Bilbao et al. TCZ for large vessel GCA. Has been a concern due to limited LVV/imaging in RCTs 196 patients. Seems to work well. 20% sustained remission month 6, 60% month 12. Clinically significant reduction steroid doses as shown in figure. @RheumNow #EULAR2022 POS0802 https://t.co/Z0HEVal6RI
Richard Conway RichardPAConway ( View Tweet)
ANCA vasculitis guidelines make sense. Less use of cyclophosphamide was already the case, rituximab can be for induction & maintenance, I am reluctant though in severe disease to stop maintenance Rx at 1 or 2 yrs and go longer as at least 1/3 will relapse beyond 2 yrs. @RheumNow https://t.co/3xRHWya2Uq
Janet Pope Janetbirdope ( View Tweet)
#EULAR2022 Updated ANCA Vasculitis Recommendations
⭐️Incorporates PEXIVAS and ADVOCATE findings
⭐️EGPA guidelines
⭐️PJP PPx recommendations
https://t.co/CnMnxTlB1D
@Rheumnow
Eric Dein ericdeinmd ( View Tweet)
Continue with PJP prophylaxis during the 6 months of induction Rx and until B cells repleted and if prednisone > = 20 mg/day #EULAR2022 AAV reccs @rheumnow
TheDaoIndex KDAO2011 ( View Tweet)
Norwich regimen of steroids for GCA @cmukhtyar et al. Bespoke regime starting at 1mg/kg tapered over 100 weeks. Drug-free relapse free survival 82% at 100 weeks, 69% 150 weeks. @RheumNow #EULAR2022 POS0793 https://t.co/b5smCqCkgg
Richard Conway RichardPAConway ( View Tweet)
More from the VITAL study Dr Costenbader @karen_kc123 et al. 5 year supplementation followed 2 year follow up. Vit D 2000iu ⬇️incident autoimmune disease 21%. RA, PMR, psoriasis trend towards reduction. No effect omega-3 @RheumNow #EULAR2022 OP0038 https://t.co/kbKqDhtN9z https://t.co/HcFXbweEPm
Links:
Richard Conway RichardPAConway ( View Tweet)
PMR bursas are filled with macrophage subtypes esp CD68+, expressing IL-6 & GM-CSF.
PMR is now far from just a vibe - real science, real targets for therapy.
Not every day that PMR basic science makes it on stage, lovely from @VasculitisUMCG @jiemy_william
#EULAR2022 @RheumNow https://t.co/zem3JEosQL
David Liew drdavidliew ( View Tweet)
Jiemy et al. Phenotyping monocytes/macrophages in PMR. Synovial/bursal macrophages have pro-inflammatory phenotype with prominent IL-6 and GM-CSF response. Rationale for tocilizumab/mavrilimumab @RheumNow #EULAR2022 OP0015 https://t.co/53GJkL4BcP
Links:
Richard Conway RichardPAConway ( View Tweet)
Zhao et al. Infection risk is ⬆️ in incident AAV. aHR 3.8 for first infection and 3.8 for infectious mortality. 3.2 fold increase in number infections. @RheumNow #EULAR2022 OP0093 https://t.co/LSe4vJqZym https://t.co/tNqI2m30SD
Links:
Richard Conway RichardPAConway ( View Tweet)
More #EULAR2022 Updated Reccs for #AAV
👉use clinical assessments & not just ANCA or CD19+ B-cell testing to inform decision for change in Rx.
👉measure Ig levels w/RTX prior to each course of RTX (to eval for immunodeficiency)
👉use PJP prophylaxis in high risk pts @rheumnow https://t.co/kYPQnLvcCK
TheDaoIndex KDAO2011 ( View Tweet)
Overarching principles #EULAR2022 AAV Updated reccs are patient centered:
1. Best care w/shared decision making
2. Access to education on AAV
3. Screen pts for Rx side effects/comorbidities
4. Need a multidisciplinary approach w/vasculitis expertise @rheumnow https://t.co/OgE4l4np12
TheDaoIndex KDAO2011 ( View Tweet)
Can SGLT2 Inhibitors Be Protective in Lupus and Vasculitis?
SGLT2 inhibitors are all the buzz in the renal world with reports of a renal protective and mortality lowering effects
https://t.co/b7YupKPJr7
#MedEd https://t.co/AYPeX360Gv
Links:
Dr. John Cush RheumNow ( View Tweet)
Can SGLT2 Inhibitors Be Protective in Lupus and Vasculitis?
SGLT2 inhibitors are all the buzz in the renal world with reports of a renal protective and mortality lowering effects
https://t.co/9mzE06K9uO
#MedEd https://t.co/dVgOtCSHFU
Links:
Dr. John Cush RheumNow ( View Tweet)
