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Best Imaging Techniques for non ANCA Vasculitis
Large vessel vasculitis (LVV) and CNS vasculitis are rare subsets of vasculitis. The challenges related to these diseases are well known to the rheumatologists who treat around the world.
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RheumNow Podcast – ACR 20 is Coming to Town (10.30.20)
Dr Jack Cush overviews the RheumNow commitment, upcoming bonus coverage of ACR20 and the good news and journal reports from the past week on RheumNow.com
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@RheumNow #acr20 abs0622 infection induced MPO anca vasc: most common triggers viruses(35.2%), mycobacterial (29.4%)& bacterial inf (29.4%). Onset 3 mo post inf. (70.5%) renal involvement, w/ biopsy-proven GN in 53%. 17.6%died. Rx steroids+abx, CYC in 47%.
Olga Petryna DrPetryna ( View Tweet)
Low pre🤰c3/c4 levels assoc'd w/ ⬆ risk of adverse obstetric outcomes in women w/ aPL w/or w/o APS. Pts w/ triple+ aPL and ⬇ c3/c4 predicts a worse prognosis. @RheumNow #ACR20 https://t.co/Cd2TQBfXSe
sheila RHEUMarampa ( View Tweet)
What happens long-term in Kawasaki disease now? Has IVIG availability fixed this?
Pop-based cohort, long follow-up.
Turns out cardiac event risk, whilst greatest early, continues >10y after - even in those w/o coronary aneurysms
@SickKidsNews @McMasterU #ACR20 ABST0937 @RheumNow https://t.co/1T6JmwhXNb
David Liew drdavidliew ( View Tweet)
Ground-breaking news... the end of #glucocorticoid use in #AAV?
very exciting to reduce GC toxicity! https://t.co/43eCofpOIX
KenWarringtonMD MdWarrington ( View Tweet)
Use of diagnostic imaging for #GCA is ⬆️
Use of temporal artery biopsy⬇️
data from #MayoClinicRheumatology @garveythomasma1
#acr20 #RheumTwitter https://t.co/kQTg5FTlVq
KenWarringtonMD MdWarrington ( View Tweet)
@drdavidliew @MGHrheumatology @RheumNow That is so interesting. Haptoglobin first described by Paolaggi et al in early 1980s as having potential to monitor PMR/GCA even when ESR normalised. See link here...
https://t.co/ERkhUwssox
Dr Sarah Mackie Sarah_L_Mackie ( View Tweet)
If TCZ blunts CRP a lot/ESR a fair bit, how can we pick GCA relapses in pts on TCZ?
Cool tech (mass spec w tandem mass tag multiplex) on GiACTA samples. Of 344 candidate proteins, guess what ranked highest?
Haptoglobin.
Let's validate!
@MGHrheumatology #ACR20 ABST0513 @RheumNow https://t.co/ErmqZuf2iu
David Liew drdavidliew ( View Tweet)
#ACR20 2F053. What is the future for GCA imaging? @RheumNow
Eric Dein ejdein1 ( View Tweet)
Excellent session on large vessel vasculitis imaging with @petercgrayson @anisha_dua #ACR20 @RheumNow https://t.co/up5ZcGDnPt
Richard Conway RichardPAConway ( View Tweet)
Still more interesting lessons from GiACTA, this time re: nature of GCA flares on TCZ:
- visual manifestation flares were rare
- ESR or CRP raised in 3/4 of flares (so not raised in 1/4)
Understanding these flares is crucial!
Unizony et al @MGHMedicine #ACR20 ABST0516 @RheumNow https://t.co/WVIitov7Ut
David Liew drdavidliew ( View Tweet)
Diagnosis in GCA is changing.
Some questions from these nice Olmsted County data:
- why are dx in women declining?
- in the past, without imaging, were we missing GCA diagnoses?
It's easy to forget how far we've come in GCA!
@MayoClinic @MdWarrington #ACR20 ABST0517 @RheumNow https://t.co/QsW8BSsf1a
David Liew drdavidliew ( View Tweet)
GCA phenotypic differences clearer again -
Large vessel involvement (on USS) in GCA are a/w:
- higher steroid burden
- first relapses occur later
- relapses harder to diagnose (symptoms less classical), but were a/w an IMT increase of about 25% (0.18mm)
#ACR20 ABST0518 @RheumNow https://t.co/87zVjAm9eU
David Liew drdavidliew ( View Tweet)
An emerging change in diagnostic (dx) modalities used in GCA? Although the leading dx modality remains a temporal a bx at 67% from 2010-2018, this is a decrease from 84% (1950-2009). Imaging is being used 19% of the time from 2010-2018 per data from Mayo Clinic. @RheumNow #ACR20 https://t.co/J97oVAGObj
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Dr Alba reports that in GCA angiotensin II system appears to be activated. Losartan reversed changes and reduced inflammatory markers. Possible role in GCA treatment? @rheumnow #ACR20 Abstr#510 https://t.co/IPp3lD1BUH
Richard Conway RichardPAConway ( View Tweet)
#ACR20 year in review by @JYazdanyMD latest data PEXIVAS and SEMIRA trials on corticosteroids - would you change your clinical practice to minimize even low dose Corticosteroids in RA and Vasculitis? @RheumNow
https://t.co/l7PTyANpjq
https://t.co/MRGbsjaGae
Bella Mehta bella_mehta ( View Tweet)
APS induced by CoViD-19: plenary session 1- another reason we need to break down the silos and involve rheumatologist more! Should we be using anticoagulation in these patients? #ACR20 @RheumNow @OSUWexMed
alexa meara lexmeara ( View Tweet)
Mavrilimumab (anti GM-CSF Receptor α Monoclonal Antibody) Reduces Time to Flare and Increases Sustained Remission in a Phase 2 Trial of Patients with Giant Cell Arteritis https://t.co/1kqWeBcEDq #gca #GmCSFinh Novel MOA , big unmet need
Peter Nash drpnash ( View Tweet)
Exciting to hear about 5 trials for #GCA
1. ABAGART (#Abatacept)
2. METOGIA (#tocilizumab vs MTX)
3. SELECT (#upadacitinib)
4. MAVRILIMUMAB (#gmcsf i)
5. TiTIAN (#secukinumab)
@VasculitisFound #vasculitis #vcrc https://t.co/DVvG5Ekfu9
KenWarringtonMD MdWarrington ( View Tweet)
