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Infection or Disease Flare: What Tools Can Help Differentiate?
Differentiation between a flare of disease and infection in patients with autoinflammatory (AI) conditions, where fever is the hallmark, can be extremely difficult. Few studies have evaluated potential differentiators; and having such tools would meet a huge unmet need.
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ACR21 Best Abstracts - Day 2
The RheumNow faculty reporters have been scouring and reporting on the best abstracts from the ACR. Here is a sampling of their choice abstract presentations reported during ACR 2020 Day 2 (#ACRbest).
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Knowledge Bowl at #ACR21
⭐️In a suspected PAN case, you order a peripheral smear to look for this potential etiology,
➡️Hairy cells
@RheumNow
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Knowledge Bowl at #ACR21
⭐️Increased susceptibility to a certain most common adult vasculitis is conferred by this HLA allele
➡️HLA DRB10404
@RheumNow
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR21 Knowledge Bowl Final Question: Vasculitis Mimics: @RheumNow https://t.co/laD3oO8Uq9
Eric Dein ericdeinmd ( View Tweet)
Knowledge Bowl at #ACR21
⭐️This HLA allele can be seen in a certain vasculitis where panuveitis is a possibility and has a venulitis predilection
➡️HLA B51
@RheumNow
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
One of the most provocative & interesting abstracts the GCA space at #ACR21 -so many sides to consider- I will be discussing at @RheumNow Panel w @drdavidliew WEDS AM @AdamJBrownMD @CCalabreseDO @CleClinicMD #vasculitis @EBRheum @anisha_dua https://t.co/STR9gNPdsO
Leonard Calabrese LCalabreseDO ( View Tweet)
TCZ in GCA: one disadvantage is that you can't use CRP+/- ESR for flares
Mavrilimumab in GCA:
- CRP/ESR consistently go up with symptomatic flares
- CRP/ESR up less (cf. placebo), in the absence of Sx flares
More signal, less noise.
phase 2 post-hoc #ACR21 ABST1401 @RheumNow https://t.co/c0lMJMcQv0
David Liew drdavidliew ( View Tweet)
Baricitinib for *relapsing* GCA (Th1+Th17)
w abbreviated steroid wean (15-22w)
Despite being tougher to treat:
100% off steroids at 24w
93% off steroids at 52w
no ischemic Sx
promising as another GCA Rx option!
(post-cessation 4pts flared)
@MayoClinic #ACR21 ABST1396 @RheumNow https://t.co/dqFnHQYogk
David Liew drdavidliew ( View Tweet)
"GCA is not a single, monolithic disease"
- Christian Dejaco, rightfully asking why we don't stratify treatment/trials in GCA
#ACR21 PMR/GCA Study Group @RheumNow @Sarah_L_Mackie @profbdasgupta @EBRheum @RichardPAConway @SattuiSEMD @drceowen
David Liew drdavidliew ( View Tweet)
#ACR21 Rheum Pearls and Secrets
Not all (or most) ulcers is Behcet's! Here's a great approach to use in clinic. Jason Kolfenbach: "Sometimes, taking off the mask is worth it"
@Rheumnow https://t.co/OEBgf1eFhd
Eric Dein ericdeinmd ( View Tweet)
Watch: What's Cool and Hot in Vasculitis with Dr. Janet Pope (@Janetbirdope ) #ACR21
https://t.co/ZKT9QJVhYl https://t.co/Kwd5PQGts7
Links:
Dr. John Cush RheumNow ( View Tweet)
Image of Takayasu's retinopathy (compared to normal) presented by John Stone #ACR21 . I'm no eye doctor, but this cannot be good. @RheumNow https://t.co/rjoQZ8TGDz
Richard Conway RichardPAConway ( View Tweet)
#ACR21 #Rheumatology #Pearl: In #Takayasu's, listen for bruits on the back- could be originating from pulmonary artery or descending aorta.
@RheumNow https://t.co/0wGdR3Rqy2
Mrinalini Dey DrMiniDey ( View Tweet)
Pearl: Erythema nodosum isn't typically located on the posterior calf and does not ulcerate; if it does👉consider #vasculitis
@RheumNow #ACR21 #RheumTwitter https://t.co/hlsaQLj7cN
sheila RHEUMarampa ( View Tweet)
VITAL RCT of Omega-3 and Vit D in preventing autoimmune diseases in 25,871 individuals. They both work! Reducing incident autoimmune disease by 25-30%. This is game-changing! Abstr#0957 #ACR21 @RheumNow #ACRBest https://t.co/BaeZDTTnQf
Richard Conway RichardPAConway ( View Tweet)
Novel treatment options for Giant Cell Arteritis
At this #ACR21, encouraging data will be presented on two such potential options for GCA.
https://t.co/gyVXHDRXrj
@RichardPAConway https://t.co/V2Fg8kCjWy
Links:
Dr. John Cush RheumNow ( View Tweet)
Results from @rheum_covid on #COVID19 outcomes in patients with #vasculitis #Abs0952 #ACR21
👉🏼~1000 pts
👉🏼Severe outcomes esp in #GCA and #AAV
👉🏼Older age, comorbidities, disease activity, high-dose steroids assoc with worse outcomes
@RheumNow
https://t.co/e2UlgDpyjw https://t.co/skoTKVYbEL
Mrinalini Dey DrMiniDey ( View Tweet)
@zach_wallace_md on RTX vs CYC remission induction in AAV. Multivariable and propensity score matching. No difference in ESRD or mortality. Real world confirmation of RAVE. Abstr#954 #ACR21 @RheumNow https://t.co/oSauqV8JnD
Richard Conway RichardPAConway ( View Tweet)
Does AAV induction choice (CYC v RTX) affect long-term outcomes (that might be missed in clinical trials)?
Boston data done two ways: multivar analysis & trial emulation using PS
CYC and RTX-based induction both perform equally well over many years👍
#ACR21 ABST0954 @RheumNow https://t.co/8BZRgKiQNB
David Liew drdavidliew ( View Tweet)
