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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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Marco A Alba, MD, PhD
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@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.
Adam Kilian MD
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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
Emily Littlejohn
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We need to start utilizing and normalizing anti phosphatidylserine/prothrombin antibody ordering in clinical practice #ACR20 https://t.co/LeeHnuX9x0
E. Sloan
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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
David Liew
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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
Olga Petryna
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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%.
sheila
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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
David Liew
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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
KenWarringtonMD
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Ground-breaking news... the end of #glucocorticoid use in #AAV?
very exciting to reduce GC toxicity! https://t.co/43eCofpOIX
KenWarringtonMD
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Use of diagnostic imaging for #GCA is ⬆️
Use of temporal artery biopsy⬇️
data from #MayoClinicRheumatology @garveythomasma1
#acr20 #RheumTwitter https://t.co/kQTg5FTlVq
Dr Sarah Mackie
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@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
David Liew
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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
Eric Dein
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#ACR20 2F053. What is the future for GCA imaging? @RheumNow
Richard Conway
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Excellent session on large vessel vasculitis imaging with @petercgrayson @anisha_dua #ACR20 @RheumNow https://t.co/up5ZcGDnPt
David Liew
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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
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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
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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
Meral K. El Ramahi, MD
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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
Richard Conway
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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
