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Evolution of GCA Treatments - More to Come
The field of Rheumatology is an ever-nascent field with an incredible expansion in our therapeutic armamentarium over the past half century. An example of such advancement is easily appreciated when reflecting on the innovative treatment approach to Giant Cell Arteri
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High #bloodpressure, jaw claudication and temporal artery abnormalities on palpation associated with increased risk of serious ischaemic events in #GCA, incl visual loss and #CVA. #MSK symptoms including PMR are protective.
Abs#1944 #ACR20 @RheumNow
https://t.co/sTeql8py9r
Mrinalini Dey DrMiniDey ( View Tweet)
SLR of frequency of visual ischaemia (VI) in relapse & follow-up of GCA
-VI >4weeks after GCA diagnosis is uncommon
-VI occurs in up to 3% patients with at least one relapse
-VI reported 3.5x more in RCTs vs retrospective studies
Abs#1929 #ACR20 @RheumNow
https://t.co/OztFRZ9VHc
Mrinalini Dey DrMiniDey ( View Tweet)
This is a great pearl from John Stone. Rapid bedside detection of nasal septal perforation in GPA. Shine light in on nostril, if you see it like this in the other then septum is perforated #ACR20 @rheumnow https://t.co/aecwAWqxOz
Richard Conway RichardPAConway ( View Tweet)
#Ulcer on lateral portion of mid-#tongue
➡️Giant Cell Arteritis #GCA
➡️#Granulomatosis with polyangiitis #GPA #Wegeners
#Rheumatology pearl by Dr Stone #ACR20
#GiantCellArteritis #vasculitis https://t.co/gTBQVescg9
Dr Ai Lyn Tan DrAiLynTan ( View Tweet)
Looking forward to learning lots of #rheumatology "pearls and myths" in this session by Prof. John Stone
#ACR20 @RheumNow https://t.co/p6vKd8DZLI
Mrinalini Dey DrMiniDey ( View Tweet)
COVID-19 changes everything, but our vasculitis patients particularly have had some really difficult decisions to make.
@VasculitisFound @michaelgeorgemd @maferradastrong @petercgrayson @RADoctor @DrPeterMerkel et al
#ACR20 ABST1416 @RheumNow https://t.co/lWXtgSqDqy
David Liew drdavidliew ( View Tweet)
We're getting better at treating vasculitis over time.
In-hospital mortality in pts primarily admitted with vasculitis is got much closer to all-comers 1998-2014 (US NIS). Hopefully with more new meds, we've closed the gap even more since!
@UABRheum #ACR20 ABST1423 @RheumNow https://t.co/kNq8HCjqQ0
David Liew drdavidliew ( View Tweet)
Dr. Jas Singh has shown theres been a decline In-Hospital Mortality in Vasculitis patients over 17 yrs (1998-2014) (using NIS data) #ACR20 Abst#1423 @jasvindermd https://t.co/rMJX5lRrLY https://t.co/aE2rJrMdDh
Dr. John Cush RheumNow ( View Tweet)
National Inpatient Sample claims: ANCA Assoc vasculitis pts hospitalized with acute MI (AMI) had a no increase in mortality rate (5.3% vs. 4.7%) during 2016-2017, suggesting potentially better control w/ new meds (RTX), less steroids #ACR20 Abstr#1424 https://t.co/TYELUAjm9d
Dr. John Cush RheumNow ( View Tweet)
Great poster-abstract 1260- chicken or egg- what comes first cognitive issues for patients with SLE then the Depression/anxiety or the opposite—-mental health is so important to address!! @RheumNow #ACR20 https://t.co/3ippKQN7Ap
alexa meara lexmeara ( View Tweet)
4S013: Rheum Secrets and Pearls - Dr. Stone gives high yield vasculitis pearls. Always characterize by vessels size, get down to fat for adequate skin bx. #ACR20 @RheumNow https://t.co/WTzb9LsO6q
Eric Dein ejdein1 ( View Tweet)
Time-trends analysis of in-hospital mortality in #vasculitis in the US shows it to have significantly declined in this population from 1998 to 2014.
Abs#1423 #ACR20 @RheumNow
https://t.co/TTI4DJiCRk
Mrinalini Dey DrMiniDey ( View Tweet)
Patients diagnosed w/ #ANCA #vasculitis aged >75yrs have lower risk of relapse than pts 65-75yrs. Pts >75yrs less likely to be treated w/ immunosuppression & steroids but do benefit from this treatment when it is required.
Abs#1417 #ACR20 @RheumNow
https://t.co/stTAcioiQG
Mrinalini Dey DrMiniDey ( View Tweet)
Feasibility of 18F-fluorodeoxyglucose Positron Emission Tomography to Monitor the Effect of Tocilizumab on Vascular Inflammation in Giant Cell Arteritis: A Prospective Observational Cohort Study https://t.co/Z91MhXJ5HK #gca #tocilizumab #pet what about the radiation?
Peter Nash drpnash ( View Tweet)
@drdavidliew @VasculitisUMCG @RheumNow Dear David, thanks for your interest in our abstract #ACR20. This is based on some intriguing findings found in our previous observational study https://t.co/HKm53j2xou Still a work in progress but the potential adjunctive anti-inflammatory effect of ARBs seems attractive.
Marco A Alba, MD, PhD MA_ALBA_vascul ( View Tweet)
Pearls from @anisha_dua for differentiating atherosclerosis vs. vasculitis inflammation on imaging:
1. Look at the Axillary arteries - they tend to be less likely affected by atherosclerosis
2. Vasculitic lesions tend to be concentric & longer/continuous
#ACR20 #RheumTwitter
Adam Kilian MD KilianMD ( View Tweet)
We need to start utilizing and normalizing anti phosphatidylserine/prothrombin antibody ordering in clinical practice #ACR20 https://t.co/LeeHnuX9x0
Emily Littlejohn ELittlejohnDO ( View Tweet)
Nice succinct review of recent DOAC studies in #APS by Dr. Ortel. Recommends avoiding DOACs in triple positive pts #antiphospholipid #ACR20 https://t.co/Hc6ye3mvTg
E. Sloan esloanmd ( View Tweet)
Should ARBs be adjunct Rx in GCA?
Plausible target:
- previous pharmacoepi
- ATII expressed in GCA inflamm lesions
- ATII induced pro-inflamm in PBMC/co-cultured VSMC
- steroids modulate ATII expression in GCA TA ex vivo
Maybe worth testing?
Cid et al #ACR20 ABST0510 @RheumNow https://t.co/mNNzZVYe7g
David Liew drdavidliew ( View Tweet)
