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Stable SLE - Should you Withdraw Immunosuppressant or Glucocorticoids?
An open-label, single-centre, randomized controlled trial tested whether immunosuppressant (IS) withdrawal is noninferior to glucocorticoid (GC) withdrawal in systemic lupus erythematosus (SLE) patients and found that IS withdrawal is noninferior to GC withdrawal in SLE patients in long-term
Glucocorticoids in SLE: how to start, how to follow, how to stop
Current guidelines recommend limiting the use of glucocorticoids by coining the new concept of “bridging therapy”, that is, use GCs when the disease is active and get rid of them as soon as you can. This way of thinking is conceptually attractive, however, the formula for translation to real life settings is not included.
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FDA has approved nipocalimab (Imaavytm), a FcRn for use in generalized myasthenia gravis (gMG). It is approved for using in gMG patents who are anti-AChR and anti-MuSK antibody positive adults and pediatric gMG patients aged 12 and older. https://t.co/fYCWuTZ6Uz https://t.co/aSfydBS9xh
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67 systemic sclerosis pts w/ mod-to-severe lower GI Sxs were Rx in phase 2, RDBPCT of placebo or fecal transplants at wks 0 and 2, with no signif change in GI sxs by week 12 (bloating or diarrhoea). https://t.co/vWq2c8d4Kn https://t.co/PpPsAQbj5M
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Triple positivity (anti-CarP Abs, RF, ACPA) assoc w/ increased Dz activity in RA. Single center, 138 RA pts. Triple pos. pts had signif more TJC (10 v 7.7), Pain (6.3 v 5.1), DAS28-CRP (4.7 vs. 4.0), ESR (33 v 23), ACPA (395 v 369), but lower RF (164 v 453). NO diff in Bone https://t.co/DexENW4W2T
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D-Lay MS trial: DBRPCT of Oral cholecalciferol 100 000 IU q2wks x 24 mos.signif reduced Dz activity in clinically isolated syndr(CIS) & early relapsing-remitting MS typical for MS. Dz activity seen in 60% w/ Vit D vs 74% w/ PBO (HR 0.66). Also time to Dz activity (432 vs 224d; https://t.co/GQsnnuWS9R
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Very low & very high vitamin D (25/OH) levels assoc w/ adverse pregnancy outcomes - miscarriage (P = 0.0045) & preterm delivery (P = 0.0007). APO were lowest w/ 25(OH)D levels of 40 to 59 ng/mL. Monitor vit D and Rx during SLE pregnancies https://t.co/Z9jEgETqId https://t.co/fJRqD3v7UF
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Circulating miR-126-3p is a mechanistic biomarker for knee osteoarthritis. Study of 145 pts w/ #OA undergoing knee or hip arthroplasty or arthroscopy. miR-126-3p highest in subchondral bone, fat pad &synovium, not cartilage. IV or IA miR-126-3p given to mouse model of kneeOA https://t.co/DzudhYAK8E
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Secondary Benefits to SGLT2 Inhibitor Use in SLE
An emulation trial of sodium–glucose cotransporter 2 inhibitors (SGLT2i) in systemic lupus erythematosus (SLE) patients yielded a significantly reduced risk of several cardiorenal complications among patients with SLE and type 2 https://t.co/aQK4Sc9tdU
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Contraception in SLE
Pregnancy in SLE receives significant attention in rheumatology due to increased risks. Historically, women with SLE were advised against pregnancy. As of 2004, the maternal mortality rate was 20 times higher than the general population. Although recent https://t.co/89df0TKtF5
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DANBIO registry study of 720 RA pts w/ a prior solid cancer (breast, colon. lung, endometrial, melanoma, bladder) in remission who received any biologic DMARD, TNFi or RTX found no incr risk of CA recurrence w/ any bDMARD, TNFi, RTX. Specifically, no incr in breast CA recurrence https://t.co/YJw8qXz1yM
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45 southern African American SLE pts compared to multiethnic cSLE, AA pts had signif higher Dz activity & greater damage accrual. Their mean SLICC score was 8.4, SLEDAI 13, but was 7.4 @6 mos & 4,7 @1 yr. They traveled an avg distance 75 miles to see Rheum https://t.co/R8WimzY0Az https://t.co/1lOJpjO2SY
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Rheumatologist Survey: What do you rely on to diagnose neuropsychiatric lupus (cerebritis)?
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2023 report from US NHANES study says #Gout affects 12.1 million in the USA. Gout prevalence incr from 3.6% in 2011/12 to 5.1% in 2017/2018. Recent increases do to doubling in Asian Americans from 3.3% to 6.6%. https://t.co/IBa3fOt83c https://t.co/06Ltm0FycI
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Procalcitonin > 0.9 ng/mL can be a critical marker for identifying bacterial infection in #SLE. Single center study of 116 juv. SLE pts dx bacterial infx in 17%. Procalcitonin was signif better than others: NLR, PLR, ESR, CRP, LC4R, ferritin (cut offs need to be defined) https://t.co/NAM8xopNW5
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"The most difficult thing is the decision to act, the rest is merely tenacity."
–Amelia Earhart https://t.co/ANVIvID8qj
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Complex Evolution of RA Management and Outcomes
FIRST is a Japanese longitudinal, real-world registry of rheumatoid arthritis (RA) management, and over the last 20 years has shown significantly improved outcomes, yet significant challenges and unmet needs remain. https://t.co/Vqe70WAijN
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Japan IORRA RA registry shows from 2011 to 2023, despite better Rx & control & less pred, Fractures went up in RA. From 2011 to 2023- DAS resmission 38 to 65%, bDMARD use 14 to 42%, GC use 38 to 22%, OP Rx 32 to 38%; But all FX incr 47 to 53/1000 Pys. https://t.co/cgz0Gkasai https://t.co/D2Uro7mEAT
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US guided lymph node Bx compared 25 controls, 14 ACPA (+) & 45 ACPA (-) RA pts. ACPA+ LN Bx showed upregulated adaptive imm. genes, but ACPA neg LN Bx showed higher innate imm genes - especially w/ higher neutrophil presence & incr CD15 + PMNs irrespective of ACPA status https://t.co/C42QMd2zap
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Immune Checkpoint Inhib causing Myasthenia Gravis w/ poor outcomes - 16 ICI Rx pts (9 Lung CA, 7 other tumors) Dx w/ MG; 11 w/ overlap myositis. Mean onset @ 49d. All Rx wp steroids, 6 immunosuppressives, 5 plasma exchange; only 2 complete resp. 6 deaths re: MG complications https://t.co/re73lh2Xfs
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