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NEW ANCA Associated Vasculitis Guidelines - discussed at #ACR19
1. Rituxan > cytoxan
2. Reduced steroid regimen!
3. Rec against PLEX
4. Rec FOR scheduled RTX over ANCA+B cell guided
5. MTX for limited dx
Well done everyone - very reasonable and evidence based!
@RheumNow https://t.co/oX6qEJDQON
Mike Putman EBRheum ( View Tweet)
NEW Draft Guidelines for EGPA presented at #ACR19 @RheumNow
1. TTE and FFS to guide tx
2. GC plus cytoxan or rituxan for active/severe dx
3. Imuran/MMF/MTX for maintenance after severe dx
4. Mepo for non-severe over csDMARDs
Larger role for RTX than expected, overall reasonable https://t.co/MEb10n5Mzd
Mike Putman EBRheum ( View Tweet)
Video from @gensler_MD on AS and nr-axSpA studies presented at #ACR19 @rheumnow https://t.co/fcn9zCxouU via @YouTube
Philip Robinson philipcrobinson ( View Tweet)
Pregnancy outcome in the DESIR cohort (SpA cohort) #ACR19 @RheumNow https://t.co/PcwR6rrMRw
Philip Robinson philipcrobinson ( View Tweet)
The bit I particularly like out of this: you get *at least* another 10% from going back for more slices from your temporal artery biopsy. Please, sir, may I have some more (slices)?
Reggio Emilia #ACR19 ABST2648 @RheumNow
David Liew drdavidliew ( View Tweet)
The more we know, the more we learn we struggle to predict GCA flares.
Model based on three large GCA cohorts (total n=778) could pick some factors (headaches, limb claudication, aortitis, CRP) but couldn't discriminate well. Other variables important?
#ACR19 ABST2650 @RheumNow
David Liew drdavidliew ( View Tweet)
In case we needed more reassurance: ANCA positivity on IF without a MPO or PR3 rarely leads to ANCA-associated vasculitis.
Maybe if the pathology report had that info attached, it would help reassure our generalist colleagues?
@ShaareZedekMed #ACR19 ABST2642 @RheumNow
David Liew drdavidliew ( View Tweet)
MGUS is really common in the general population. Therefore, it’s going to be really common in our rheumatic patient population
#acr19 https://t.co/9HIWvDm20n
Dr Irwin Lim _connectedcare ( View Tweet)
Here’s the risk stratification for MGUS
#ACR19 @rheumnow 5T064 https://t.co/fKeJu8n5DI
Dr Irwin Lim _connectedcare ( View Tweet)
Do you routinely consider ACPA status in your choice of Biologic MOA?
Olga Petryna DrPetryna ( View Tweet)
#ACR19 @rheumnow L20 head-to-head IXE vs ADA PSA 52wk trial: IXE shows significantly ⬆️ response than ADA for simultaneous ACR50 + PASI100 through Wk 52.TEAEs in 73.9% IXE &68.6% ADA pts. sAEs in 4.2% IXE&12.4% ADA pts, and d/c 2/2 AEs in 4.2% IXE & 7.4% ADApts; no deaths https://t.co/WeGdmu0vh6
Olga Petryna DrPetryna ( View Tweet)
#ACR19 RITAZAREM RCT rituxan vs imuran, AAV maintenance
RTX superior to imuran w/HR 0.36 and relapse rate at 24 months (13% vs 38% imuran, NNT=4). Hypogam risk only 4% higher vs imuran (NNH~25) and non-severe infections similar
Supports guideline recs from this AM!
@RheumNow https://t.co/m9FkJ7d7I9
Mike Putman EBRheum ( View Tweet)
#ACR19 @RheumNow
FINCH1 results for filgotinib in RA w/MTX inadequate response
Good efficacy over PLBO for ACR50 at 24 wks (NNT~4), somewhat less impressive than UPA against TNF (NNT~20, not superior)
Lower rates of HSV! Also, like UPA there is (as yet) no VTE signal https://t.co/1HjFgfXvlX
Mike Putman EBRheum ( View Tweet)
J Stone IgG4-RD pearl: If elevated at baseline the serum IgG4 is a good biomarker for IgG4-RD.
If very high, IgG4, can be a marker for recurrent disease. Hypocomplementemia implies renal involvement. #ACR2018 @RheumNow
Maeve Gamble MaeveGamble ( View Tweet)
Ixekizumab is a high-affinity monoclonal antibody against interleukin-17A.
In patients with psoriatic arthritis, ixekizumab was better than adalimumab in treating skin disease (PASI 100).
Similar improvements in joint disease (ACR20/50/70).
Dr. Josef Smolen #ACR19 @RheumNow https://t.co/BriY8o10Hq
Jonathan Hausmann MD hausmannMD ( View Tweet)
In patients with Sjogren's, Ianalumab, a dual-mode of action biologic combining BAFF receptor inhibition with B cell depletion, showed significant response in ESSDAI, a disease activity index, but did not seem to improve most PROs such as fatigue #ACR19 @RheumNow https://t.co/l5UFwOjt2C
Jonathan Hausmann MD hausmannMD ( View Tweet)
Abstr# 2440: Strong association between psoriatic arthritis and osteoporosis (45%) and osteopenia (13%). A good reminder to screen these patients to avoid complications of these additional comorbidities. #ACR19 @RheumNow https://t.co/0RvJtYCYJl
Dr. Paul Sufka psufka ( View Tweet)
Abstr# 2137: Patient with metastatic melanoma who develop PD-1 inhibitor related inflammatory arthritis have significantly improved survival.
Although checkpoint inibitors are associated with autoimmune side effects, often suggests a better cancer prognosis. #ACR19 @RheumNow https://t.co/geTUO2yLJX
Dr. Paul Sufka psufka ( View Tweet)
It was such a pleasure to interview ACR Master Dr. John Reveille! He spoke about how the field has changed, what he looks forward to at #ACR19, and he even gave us a preview of his Hench lecture!
@rheumnow @UTHealth
https://t.co/JwIOWmBA4x via
@YouTube
Kanika Monga, MD DrKanikaMonga ( View Tweet)
SLE has high work disability. Interestingly work disability was not high in some organ systems such as renal but mild GN or CRF may not be symptomatic. Fibromyalgia, low education, low SED and older age increase work disability ACR219 @RheumNow abstr 1578 https://t.co/DdHgluRPIV
Janet Pope Janetbirdope ( View Tweet)