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Preview of EULAR 2019 Abstracts
EULAR 2019 begins today in Madrid and features over 2000 presentations. After an initial review of titles and abstracts, I’ve compiled a hit list of presentations of interest to me and hopefully other practicing rheumatologists.
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Management of Hemophagocytic Lymphohistiocytosis (HLH) in Adults
Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome induced by activated macrophages and cytotoxic T cells. HLH manifests recurrent fever, cytopenia, liver dysfunction, and a sepsis-like syndrome that may complicated by multiple organ failure.
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Proinflammatory Diets May Increase CRP and RA Onset
Despite the lack of good evidence, there has been great speculation about the role of diet in causing or alleviating inflammation. Now there's new research suggesting that proinflammatory diets can increase serum C-reactive protein levels and also the risk of rheumatoid arthritis onset.
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Might IL-17 Inhibition Be Effective in RA?
Interleukin 17 (IL-17) inhibitors are highly effective and FDA approved for use in psoriasis, psoriatic arthritis and ankylosing spondylitis. However, many of the initial trials were done in rheumatoid arthritis (RA) where it was projected to be effective, but was not. A recent metanalysis examines how effective IL-17 inhibition was in two RA populations: biologic-naïve or tumor necrosis factor inhibitor inadequate responders (TNF-IR).
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RheumNow Podcast – Rituximab Monitoring (5.31.19)
Dr. Jack Cush presents the news and best of rheumatology and medicine from the past week on RheumNow.com
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2019 EULAR Guidelines on Antiphospholipid Syndrome Management
A EULAR task force has reviewed the medical literature and developed evidence-based recommendations for the management of antiphospholipid syndrome (APS) in adults. They note that a high-risk antiphospholipid antibody (aPL) profile is associated with greater risk for thrombotic and obstetric APS.
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Predictors of Serious Infections with Rituximab
The risk of serious infectious events (SIE) with rituximab (RTX) is similar to that seen in other biologics (e.g., RA: 2% or 4.3/100PY), but with prolonged use the risk may change. Recent research says that low IgG levels, RTX induced neutropenia, prior SIE and comorbidities can significantly augment this risk.
A retrospective longitudinal single center study of 700 rheumatic and musculoskeletal diseases (RMDs) treated monitored serum immunoglobulins (at baseline and 4–6 months after each cycle), clinical outcomes and SIE over time.
Nintedanib May Benefit Systemic Sclerosis Related Interstitial Lung Disease
The NEJM reports a randomized placebo controlled trial of nintedanib, a tyrosine kinase inhibitor, in systemic sclerosis patients with interstitial lung disease (ILD) resulted in less pulmonary decline, but had no effect on other features of systemic sclerosis.
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Risk Score Predicts Thrombosis Recurrence in APS
A combination risk score helped predict recurrent thrombosis -- particularly arterial -- among patients with antiphospholipid syndrome (APS), an international study found.
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FDA Final Guidance on Interchangeability with Biosimilars
The FDA has published an industry guidance document to define interchangeability as regards to biosimilar use in the United States under section 351(k) of the Public Health Service Act (PHS Act) (42 U.S.C. 262(k)).
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Methotrexate Use Not Linked to Interstitial Lung Disease in RA
People with rheumatoid arthritis have a significant risk of developing interstitial lung disease (RA-ILD), yet there is often a question as to whether methotrexate (MTX) exposure can cause or worsen ILD. A controlled cohort study suggests that MTX use is not associated with an increased ris
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Calcineurin Inhibitors in Anti-Synthetase Dermatomyositis ILD
A pilot treatment study of patients with anti-aminoacyl-tRNA synthetase antibody–positive polymyositis/dermatomyositis-associated interstitial lung disease (anti-ARS-PM/DM-ILD) shows therapy with glucocorticoids and calcineurin inhibitors (CNI) to be highly effective.
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Biomarkers Predict Thrombosis in Lupus
A composite risk score that included three biomarkers predicted thrombotic events among patients with systemic lupus erythematosus (SLE), a cross-sectional study found.
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Pilot Study Targets Insulin Resistence in Fibromyalgia
An unusual pilot study has shown that insulin resistence (IR), assessed by Hgb-A1c levels, was more prevalent in fibromyalgia (FM) patients compared to non-diabetic controls and that when FM patients were given metformin, half had complete resolution of their pain.
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Monocyte Patrolling Contributes to Lupus Glomerulonephritis
Systemic lupus erythematosus (SLE) is an autoimmune disease with a propensity to develop glomerulonephritis (47-70%) or end-stage kidney disease despite therapy.
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Targeting GM-CSF Works in Rheumatoid Arthritis
Namilumab, a monoclonal antibody that targets the granulocyte-macrophage colony-stimulating factor (GM-CSF) ligand, showed promise as a treatment for rheumatoid arthritis (RA) in a phase II study.
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EULAR 2019 Update to Lupus Management
The goal of SLE treatment is remission or low disease activity and flare prevention. Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight. Glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent). Appropriate initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can be tailored to the clinical scenarios and may allow for tapering or discontinuation of GC.
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Better Tests Ahead in Lupus
The advent of "big data" and "-omics" technologies offers hope that clinicians will soon have better diagnostics for systemic lupus erythematosus, rheumatologists here were told.
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Update on Vaccines in Autoimmune Patients
Although both the disease and the treatment for it in rheumatology patients may work at cross-purposes with immunizations, only a very few vaccines are absolutely contraindicated in this population, an infectious disease specialist told rheumatologists here.
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RheumNow Podcast – A Tofa Two-fer (4.12.19)
Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com
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