The ACR and the Vasculitis Foundation have published their evidence-based recommendations and expert guidance for the management of GCA and Takayasu arteritis. These recommendations address a variety of clinical questions and scenarios including diagnostic testing, imaging, treatments, and surgical interventions. Recommendations for GCA and TAK include support for the use of glucocorticoid-sparing immunosuppressive agents and the use of imaging to identify large vessel involvement. Recommendations for TAK include the use of glucocorticoids as initial therapy.
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Chung et al have published the 2021 treatment guielines for the management of antineutrophil cytoplasmic antibody–associated vasculitis, including granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis. These guidelines are put forth by the ACR and the Vasculitis Foundation as benchmark guidance to assist health care professionals in managing AAV.
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Dr. Jack Cush reviews this week’s news and journal reports featured on RheumNow.com.
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Dr. Jack Cush reviews and highlights his favorite abstracts and presentations from last week's virtual EULAR 2021 meeting.
ICYMI: One of our top June videos
WATCH: Is blindness with Tocilizumab in GCA a worry?
Dr. David Liew ( @drdavidliew ) weighs in. #EULAR2021
https://t.co/eFrmbkW9Gy https://t.co/4tY3hEDj2j
ICYMI:
Drugs capable of inducing drug-associated ANCA vasculitis - mirabegron (Myrbetriq), sofosbuvir (Sovaldi, antiviral), nintedanib (Ofev), hydralazine, propylthiouracil, thiamazole, minocycline, carbimazole, allopurinol, influenza vax.... https://t.co/KhK2w0IGAx
ICYMI:
EULAR guidelines rec starting prednisone dose in #PMR to be between 12.5-25mg/d. A cross sectional study of 138 pts (63M, 75F, age 73.4 yes) saw the mean starting dose to be 19.2±7.7 mg. https://t.co/Yf3yqRRMCK
ICYMI
While myeloperoxidase (MPO) Abs are seen in idiopathic pulmonary fibrosis (IPF), only 7–23% develop vasculitis. Study of 58 pts w/ IPF & MPO Abs - UIP most frequent ILD pattern, 13 had rheumatic dz; MPO Abs did not change survival of UIP/IPF pts https://t.co/RXXIPUBMBT https://t.co/sJpbzIbBJt
While myeloperoxidase (MPO) Abs are seen in idiopathic pulmonary fibrosis (IPF), only 7–23% develop vasculitis. Study of 58 pts w/ IPF & MPO Abs - UIP most frequent ILD pattern, 13 had rheumatic dz; MPO Abs did not change survival of UIP/IPF pts https://t.co/RXXIPUBMBT https://t.co/v3KhEaefZD
Drugs capable of inducing drug-associated ANCA vasculitis - mirabegron (Myrbetriq), sofosbuvir (Sovaldi, antiviral), nintedanib (Ofev), hydralazine, propylthiouracil, thiamazole, minocycline, carbimazole, allopurinol, influenza vax.... https://t.co/KhK2w10hs5
ACR/Vasculitis Foundation 2021 Guidelines for ANCA–Associated Vasculitis
Chung et al have published the 2021 treatment guidelines for the management of antineutrophil cytoplasmic antibody–AAV, including GPA, MPA, and EGPA.
https://t.co/234OQ7klRd https://t.co/33sWq1U55T
Plasmapheresis Indications : TTP, HUS, Cryoglobulinemia, Hyperviscosity, Myasthenia gravis, Goodpastures, Catastrophic APL Syn, Chr inflamm demyelinating polyneuropathy, Removal of drugs/toxins, Alveolar hemorrhage, ANCA vasculitis (questionable)
https://t.co/uph9Eprlvc https://t.co/FPLOgzZpfB
Textbooks say fever is common in lupus ("36%–86%") BUT IT IS NOT! Lupus is cause of FUO in 5%; Fever is seen in a minority of SLE onsets; Fever occurs w/ SLE complications - vasculitis, pneumonitis/serositis/alveolar hem, CNS, & INFECTION!
https://t.co/KvZeo6Q1WY
WATCH: Is blindness with Tocilizumab in GCA a worry?
Dr. David Liew ( @drdavidliew) weighs in. #EULAR2021
https://t.co/eFrmbkW9Gy https://t.co/imMaEIczb8
Blindness with Tocilizumab in GCA: Is it a Worry?
https://t.co/PJYap294jm https://t.co/q1izGlH68j
Danish population study shows that all cause mortality in GCA is increased 49%,(RR 1.49; CI1.36-1.64) after 1 year but less so at 10 years (RR 1.03: 1.00-1.05). Deaths usually due to infectious, endocrine, cardiovascular, GI diseases https://t.co/p36zDskf6y
French Vasculitis registry studied 354 GPA patients- 25% had hypereosinophilia (HE) ≥ 500; mostly male (73%) w/ most skin dz (49%) peripheral neuropathy (32%) & higher BVAS (21 vs 18, p= 0.01): severe HE had more baseline renal dysfunction https://t.co/G4s3CEavL9
David Liew
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Rituximab in PMR. Intriguing
proof of concept (SB?) RCT
(1:1, total n=47 (recent dx 38/relapsing 9))
17w rapid PNL taper
ritux 1g x1
21w:
steroid-free remission: 48% v 21%
PNL ≤5mg/d: 100% v 54%
effect mainly from recent dx pts
We do need options!
POS0343 #EULAR2021 @RheumNow https://t.co/g6xJekY92O
Richard Conway
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Dr Schapp on nasal Staph Aureus eradication in ANCA vasculitis. Neither the presence or eradication of Staph Aureus appeared to influence the vasculitis @RheumNow #EULAR2021 Abstr#POS0249 https://t.co/bxtaznejNk
Richard Conway
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Dr Marsman presents positive RCT of Rituximab in PMR. GC-free remission 48% vs 21% (p=0.049) GC<=5mg 100% vs 47% (p=0.005) @RheumNow #EULAR2021 Abstr#POS0343 https://t.co/tjkKTS6DMN


