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IgG4 disease- the WInS withdrawal study results
IgG4-related disease describes a group of fibroinflammatory diseases whose features may include autoimmune pancreatitis, swelling of or within an organ system, salivary gland disease, swollen lymph nodes, skin manifestations, and symptoms consistent with allergies or asthma. While remission induction treatment with glucocorticoids has proven effective, the high relapse tendency is an ongoing challenge for clinicians.
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Here at Last: Treatment Options for VEXAS
We have known about the VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome for nearly 3 years, but there has been relatively little to say about how to treat it. To date there have been over twice as many publications about VEXAS (263 publications) as there have been patients described with respect to treatment strategies (116 patients). One of the late breaking abstracts may finally have rectified this imbalance.
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Are Rheumatologists doing Enough for Cervical Cancer?
Should rheumatologists be counseling patients on cervical cancer prevention and screening?
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"Protein kinases: drug targets for immunological disorders". Great full-read review from J Shea et al. Reviews Hx, biology, clinical use and safetey of Kinase targeted therapy. https://t.co/qBc0ng1Z9h https://t.co/Qm8PFpNxQF
Dr. John Cush RheumNow ( View Tweet)
NEJM Clinical Images: Scleromyxedema (cutaneous mucinosis w/ a paraproteinemia).53-yoM w/ itchy rash, Raynauds, dysphagia, burning dysesthesia hands; Waxy papules across forehead & hands w/ skin thickening & finger contractures. Skin Bx & SPEP done https://t.co/vkpYGNd3Uw https://t.co/T5gVPRBrhh
Links:
Dr. John Cush RheumNow ( View Tweet)
Are Rheumatologists doing Enough for Cervical Cancer?
Should rheums be counseling patients on cervical cancer prevention and screening? The data from Abstract #1479 at #ACR23 suggests this should be an important conversation with our lupus patients.
https://t.co/VFobM0T3u7 https://t.co/L45N3tsTdN
Dr. John Cush RheumNow ( View Tweet)
Substudy of the ADVOCATE trial looked at 214 ANCA assoc vasculitis pts treated with #RTX; avacopan Rx showed improved recovery of renal function, faster reduction in albuminuria and lower glucocorticoid toxicity compared to a prednisone taper. https://t.co/91PtvQfoIr https://t.co/ZjYCVP5lqG
Dr. John Cush RheumNow ( View Tweet)
Chikungunya - takeaway points
🪔Acute arthritis in large joints , polyarthritis and tenosynovitis in hands
🪔 Associated with travel history to Africa/Asia/Asia Pacific
🪔<5% develop chronic arthritis
#ACR23
#ACRambassador https://t.co/yzZDpy70i3
Tanmayee Bichile, MD ( View Tweet)
As per #ACR23 ABST0433, what % of RA patients on US Medicare are on a DMARD within 1y of diagnosis?
I'm not talking your choice of b/tsDMARD.
I'm talking any cs/b/tsDMARD of any sort.
Hear from @JihaRheum to skip to the answer:
https://t.co/lI2M20JWKC
Truly stunning. @RheumNow
David Liew drdavidliew ( View Tweet)
INSIST trial: MMF vs Tac in SS-ILD
N=25 pts
👉No significant diff between MMF & TAC in mean change in FVC at 24 weeks [2.52%, 95% CI (-10.3 to 5.18)p=0.500]
👉No SAEs noted in both grps
Larger studies w/ longer ffup needed.
#ACR23 ABST2595 @RheumNow https://t.co/cqpnxyMDmv
sheila ( View Tweet)
Dr. @Janetbirdope has the best quotes ever ‘ if its ain’t broke, don’t fix it, just leave it alone’ 🤷🏻♀️
IGg4 is very interesting , could just be reacting / secondary to an underlying phenomenon?
https://t.co/hueCJuYI32
@RheumNow
#ACR23, Daily recap.
Nouf Al hemmadi ( View Tweet)
Is MSOT the New Ultrasound?
Dr. Aurelie Najm reports on oral abstract 0750 presented at #ACR23
https://t.co/okbGHTR0i3 https://t.co/9zkHPiFl74
Dr. John Cush RheumNow ( View Tweet)
A randomised clinical trial show improvements in clinical outcomes CDAI, VAS for both the ITIS diet and the Med diet. Baseline differences in the microbiome between responders and non-responders were seen. Sala Climent M, Abst#2124 #ACR23 @RheumNow https://t.co/tiyNcV7cmD https://t.co/EEP4zrwjXs
Dr. Antoni Chan ( View Tweet)
Fecal transplant for treatment of GI complications of systemic sclerosis?
No change in those who received transplant...
Overall procedure safe
@RheumNow #ACR23 Abs#2597 https://t.co/TEdeGHuzpi
Robert B Chao, MD ( View Tweet)
What's the long-term mainentance game plan in IgG4-RD?
WInS IgG4-RD study
China, n=146
IgG4-RD stable disease >12mo
Withdrawing both IM+GC completely has much higher relapse rates vs at least keeping some IM
IgG4-RD needs some steroid-sparing Rx ongoing
#ACR23 L16 @RheumNow https://t.co/1JJpQmFTF5
David Liew drdavidliew ( View Tweet)
L18 @ #ACR23
⭐️Clinical Implications in Primary Sjögren's Syndrome (pSS) by Molecular classification of Salivary Glands (SGs)
➡️ transcriptomic profiling of SGs in Chinese cohort
👉 396 pSS, 87 non-pSS, & 44 early-pSS
➡️ 3 distinct sub-types:
⭐️Pacui-immune/C1… https://t.co/3ZdrghCB6F https://t.co/hZ9S3hvCzv
Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Withdrawing immunosuppression and steroids in IgG4-RD
Maintaining immunosuppression with or without steroids associated with low relapse rate
52% of pts who withdrew steroids +immunosuppression relapsed
@RheumNow #ACR23 Abs#L16 https://t.co/xJyDiCkMVD
Robert B Chao, MD ( View Tweet)
Inflammation in interstitial fibrosis & tubular atrophy (i-IFTA) is assoc w/ GFR loss accdg to this study by Dr SMalvica et al.
✳️In pts w/ mod-to-severe IFTA, the degree of i-IFTA was assoc'd with higher risk of GFR loss
#ACR23 ABST2552 @RheumNow https://t.co/7iA0nzbmgM
sheila ( View Tweet)
Beware of the « HOT stuff 🌶️ bias »
In his very didactic catalogue of bias, Timothy McAlindon particularly warns us against the hot stuff, or the tendency to be less rigorous in the scientific approach when a topic is fashionable
@RheumNow #ACR23 https://t.co/rS8lItDrGS
Aurelie Najm ( View Tweet)
#ACR23 Abstr#2580 Could high-intensity resistance training improve outcomes in myositis? RCT showed 16 wks of training was tolerable, improved quality of life & functional capacity, without increasing disease activity/damage @RheumNow https://t.co/O1nP2x9C1L
Md Yuzaiful Md Yusof ( View Tweet)
