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RheumNow Podcast – COVID-19 Responds to Steroids (7.24.20)

Jack Cush, MD

Dr. Jack Cush reviews the News and Journal Reports from the past week on RheumNow.com.

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ACR Outlines Best Practices for Kids With MIS-C

RheumNow

Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 infection has both similarities and differences with Kawasaki disease, and requires distinct clinical management, according to draft guidance from the American College of Rheumatology (ACR).

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Serum calprotectin: a better biomarker in ANCA-associated vasculitis?

David Liew, FRACP

Flares in ANCA-associated vasculitis are difficult to predict, but serum calprotectin may help predict relapse and renal failure, according to data presented at the EULAR 2020 virtual meeting this week.

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First Look at COVID-19 Global Rheumatology Alliance Registry

Jack Cush, MD

Gianfresco et al have published the first peer-reviewed analysis of COVID-19 infected, rheumatic disease patients entered into the Rheumatology Global Alliance registry; showing that a) rheumatic disease patient can be infected with COVID-19, b) that DMARD and biologic use has no apparent effect on outcomes and c) steroid increase and TNF inhibitor decrease the odds of hospitalization.

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RheumNow Podcast - Rheumatic Patients with COVID (5.29.20)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.

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TNR Grand Rounds - Cytokine Storm Syndromes

Jack Cush, MD

This week's Tuesday Nite Rheumatology featured Dr Randy Cron from the University of Alabama - Birmingham as he spoke and took questions on the immunology, immunopathogenesis and treatment of Cytokine Storm Syndrome, especially as they relate to COVID-19 and rheumatic disease patients. The program was moderated by Dr. Jack Cush.

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RheumNow Podcast - COVID Kids and Men (5.15.20)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.

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Registry of COVID CNS complications reports 125 pts; 77 (62%) w/ Cerbrovascular event (57 ischemic CVA), 9 intracerebral hemorrhage, 1 CNS vasculitis. 39 w/ AMS, 9 encephalopathy & 7 encephalitis. 10 new-onset psychosis, 6 dementia, 4 affective Dz https://t.co/mXyTHIFBIE

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Dr. John Cush RheumNow ( View Tweet)

Skin is often involved w/ ANCA+ vasculitis - 1184 AAV pt study shows skin involvement in 34% GPA; 28% MPA & 47% EGPA. Common are petechiae/purpura pruritus, urticaria, and maculopapular rash. AAV w/ skin Sxs have more systemic dz (GN, alveolar hemorrhage) https://t.co/egPdW2IEnu

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Dr. John Cush RheumNow ( View Tweet)

Avacopan is as effective as steroids in ANCA Assoc Vasculitis – 330 pt RCT AAV Rx w/ RTX or CTX but randomized to p… https://t.co/mxm5NAjZtL

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Dr. John Cush RheumNow ( View Tweet)

PRES - Posterior reversible encephalopathy syndrome. Review of US hosp records finds 3125 cases. Rheum Dz associations include ANCA+ vasculitis (OR 9.3), PsA (4.6), Scleroderma (6.6), SLE nephritis (7.5), SLE (2.4); also renal failure, pre-/eclampsia https://t.co/uLQxU3RNuD

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Dr. John Cush RheumNow ( View Tweet)

#EULAR2020 #op0143 a nationwide study concludes GCA pts at higher risk for sarcoma (HR 2.14), kidney cancer (1.6), hematological malignancies (HL2.42&non-HL1.66). Overall cancer HR 1.29. Time to diagnosis shorter in GCA (~48mo) vs controls (~58mo) @RheumNow https://t.co/obAlZw2gei
Olga Petryna DrPetryna ( View Tweet)
Here's the data for GCA (even though labelled PMR) using the same methods, both looking at first 1y. Here's what gets me - it's obviously worse, but not that much worse... everyone's looking for steroid-sparing agents in GCA, but PMR's left behind? OP0275 #EULAR2020 @RheumNow https://t.co/YWkNBVitGa
David Liew drdavidliew ( View Tweet)
Whom with GCA should receive tocilizumab? What happens when it is stopped? Optimal dose for maintenance weekly or Q2 weekly? GiACTA gives only some answers. Need RWE #EULAR2020 @eular_org @RheumNow @CRASCRRheum @earlyarthritis #vasculitis https://t.co/aNvR14vfEV

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Janet Pope Janetbirdope ( View Tweet)

What dose/frequency of rituximab do you use in maintenance ANCA #vasculitis? @RheumNow @eular_org @CRASCRRheum @earlyarthritis #EULAR2020

Janet Pope Janetbirdope ( View Tweet)

Avacopan is as effective as steroids in ANCA Assoc Vasculitis – 330 pt RCT AAV Rx w/ RTX or CTX but randomized to prednisone or avacopan (C5aR antagonist). Avacopan=prednisone remission rates same (72% vs 70%) wk 26 & wk 52 (66% vs 55%). #EULAR2020 #OP0011 https://t.co/WIXJCYkxSb

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Dr. John Cush RheumNow ( View Tweet)

MAINRITSAN3 RCT, RTX v PLBO in AAV 28mo relapse free survival ⬇️ RTX (96% vs 74%, NNT~4), majr (100% vs 87%, NNT~8) 1. Selected grp (all pts from MAINRITSAN2) 2. All pts had GC q3mos - IRL benefit could be bigger? Strong data for RTX >2yrs in AAV PDF: https://t.co/Mbrq7bFHk0 https://t.co/auKJ3QPKr0

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Mike Putman EBRheum ( View Tweet)
Enticing stuff. Avacopan wins on 52w remission, steroid toxicity/use, renal fx, with minimal toxicity. Looks good to be a steroid replacement in AAV, with real benefit for patients. Exciting but cost will dictate if we get to use it (see: apremilast) OP0011 #EULAR2020 @RheumNow https://t.co/WTFk21D0KY
David Liew drdavidliew ( View Tweet)
Big one from plenary, new option in ANCA-associated vasculitis: avacopan (anti-C5a) vs prednisolone in patients receiving CYC/RTX: non-inf at 26w, superior at 52w in the phase III ADVOCATE trial with reduction in steroid toxicity Merkel, Jayne et al OP0011 #EULAR2020 @RheumNow

David Liew drdavidliew ( View Tweet)

Serum calprotectin as a biomarker in ANCA-associated vasculitis is enticing, and not just during induction: during maintenance following remission, it might predict relapse and renal decline independently of disease characteristics MAINRITSAN data OP0031 #EULAR2020 @RheumNow https://t.co/ItI0BPGrUX
David Liew drdavidliew ( View Tweet)
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