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RIP to Glucocorticoids in GPA
For many years glucocorticoids were the mainstay of our treatment of granulomatosis with polyangiitis (GPA). The paradigm shifted with cyclophosphamide and then again with rituximab, and we used less steroids, but we still used lots. Avacopan teased the demise of steroids, but in the trial they, and now we, still use them. Glucocorticoids are our old trusty friend, our comfort blanket. But no more! Good riddance to the medication with the highest long-term adverse event burden that we use. Long-term glucocorticoids in GPA should now be a rarity. The reason for such exuberance is the TAPIR study presented by Dr. Peter Merkel at Saturday’s opening plenary session.
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Can multidisciplinary clinics improve quality of care for PsA?
Abstract 0596: Multidisciplinary care in PsA associated with ↓ time to first biologic, ↑ dermatology & nurse visits, and better CV risk assessment. #ACR24 @RheumNow https://t.co/2OnUR6te63
Akhil Sood MD AkhilSoodMD ( View Tweet)
Harkins @DrTrishHarkins et al. Serum disease activity markers in PMR. ROC analysis for active vs remission - fibrinogen (1.000), ESR (0.986), Haptoglobin (0.976), CRP (0.986), ALP (0.854). @RheumNow #ACR24 Abstr#0741 https://t.co/f8cX68Ov9Y https://t.co/zp5c7aQwxr
Links:
Richard Conway RichardPAConway ( View Tweet)
Older adults with RA receive less DMARDs, the standard of care. Dr. Bruno Fautrel shows TOC tolerance in older adults is comparable to younger patients. Let's treat the patient, not their age! #ACR24 @RheumNow ABST#0516 https://t.co/054RWGh3a7
Jiha Lee JihaRheum ( View Tweet)
Happening now:
16S18 Into the Weeds: Cannabis in Rheum
@EleniTiniakou @BharatKumarMD
Do you discuss marijuana with your patients?
@RheumNow #ACR24
Eric Dein ericdeinmd ( View Tweet)
Abstr#0647
Toronto Lupus Clinic finds pericarditis in 20% of #SLE inception cohort, often with skin, heme, MSK, & renal involvement. Linked to younger age, White race, +SSB, & lower ACR/EULAR scores
- Tx: GC, HCQ, AZA
@RheumNow #ACR24
Akhil Sood MD AkhilSoodMD ( View Tweet)
Abstract #0614
What is the impact of Lupus on my quality of life?
Consider using Lupus Impact Tracker (https://t.co/fJQe2uHicM)
- high dose GC, comorbidities, and not actively working associated with worse impact on QoL
- HCQ shows benefit
@RheumNow #ACR24
Akhil Sood MD AkhilSoodMD ( View Tweet)
Harnessing power of AI in Rheumatology. Strengths and weaknesses of AI will need to be assessed. Amanda Nelson shares the limitation of AI @RheumNow #ACR24 https://t.co/G8FNVco7Qp
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Lots of ‘CARTS’, not enough ‘work horses’!
There are now ~40 CAR-T protocols in #lupus incl many presentations at #ACR24
-most are uncontrolled
-selection of pts is key.
We need a pathway forward for reg approval & guidelines for studies!
@RheumNow @ACRheum 18abst #OOO4 https://t.co/Mckwvn3Ffn
Janet Pope Janetbirdope ( View Tweet)
#Frailty leads to poor outcomes and occurs earlier in RA patients. Different tools measure frailty as a phenotype vs. deficit accumulation.
Discover the role of frailty in ED from #LancetRheum Ageing Series by Drs. Sarah Lieber and @KWyshamMD !
#ACR24 @RheumNow ABST#1334 https://t.co/25XQBDQMCo
Jiha Lee JihaRheum ( View Tweet)
Mycophenolate isn't great for vaccine immunogenicity, but withholding MMF for one week after both doses of recombinant zoster vaccine boosts Ab titres ++ in this Brazilian RCT.
A week off post-vaccine: definitely worth considering in stable disease
#ACR24 ABST0247 @RheumNow https://t.co/lajS5DzRbD
David Liew drdavidliew ( View Tweet)
Planned to post so much more from #ACR24; my favorite slides from today will have to suffice.
From the #BCRC Dr Monica Guma’s - diet and microbiome.
Dr @NamrataRheum -a reminder that we are all aging.
Dr Connie Weyand’s -metabolic checkpoints in RA T cells and macrophage. https://t.co/MtsheVsUEQ
Links:
Kristen Young kristenyoung ( View Tweet)
SELECT trial noted reduction in CV death, MI and stroke in obese pts without diabetes (other benefits: reduction in waist circumference, BP, lipids) @rheumnow # ACR24 https://t.co/GPK4Vg5bOt
Links:
TheDaoIndex KDAO2011 ( View Tweet)
GLP1ra is now part of GDMT, including pts without diabetes. The role of rheums in prescribing these remain to be seen. - Dr Weber #ACR24 @rheumnow @ACRheum https://t.co/U9XEhGBXBN
Links:
TheDaoIndex KDAO2011 ( View Tweet)
#0509
📊 RA DMARD Trends in US (2001-2021)
🧑🤝🧑 407,728 DMARD starts in 229,365 patients
📉 csDMARD use fell (79.7% → 54.7%)
‼️Methotrexate dropped 29% → 15%
📈 bDMARDs (20.3% →33.1%),tsDMARDs (0.1% → 12.2%) both ⬆️⬆️
💊Biosimilar uptake low
#ACR24 @RheumNow @jeffsparks https://t.co/JepaWj7azY
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
Dr. Catherine Bakewell @CatherineB27 shares the preliminary ACR guidelines on ultrasound imaging in psoriatic arthritis covering 4 domains, detailed PICOs covering the early phase, diagnosis, assessment covering the domains of PsA @RheumNow #ACR24 https://t.co/DoHE1rsSGf
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
"If you want an argument, put two rheumatologists in a room and ask them about steroid tapers. Add a third and you'll have a fight"
-P. Merkel at UPA plenary session
#ACR24 @RheumNow
Mike Putman EBRheum ( View Tweet)
How to Master ACR Meetings
https://t.co/ATbOYbatOy https://t.co/j1oRBbhWY2
Dr. John Cush RheumNow ( View Tweet)
Want to lose weight naturally? Eat your veggies and protein first, and the carbs last— this reduces the post-prandial glucose, insulin and raises GLP-1 - Dr Aronne #ACR24 @RheumNow https://t.co/cRVRzRTljT
TheDaoIndex KDAO2011 ( View Tweet)
Dactylitis management in PsA:
Acute: pain and swelling
Chronic: painless swelling
Broad ddx
No role for LEF or SSZ
#ReviewCourse #ACR24 @RheumNow https://t.co/KZXv1UvhXn
Links:
Adela Castro AdelaCastro222 ( View Tweet)
