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New Biomarkers and Therapeutics Show Potential in Still's Disease
Adult-onset Still’s disease (AOSD) is a rare complex, sporadic, systemic autoinflammatory disease similar to systemic juvenile idiopathic arthritis (sJIA) characterized by sustained fever, salmon-colored rash, and arthritis.
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Prof Schett provides #ACR23 a wonderful, easy to digest, review of how CAR-T works. @RheumNow https://t.co/y5HZVAvvhy
Dr. Rachel Tate ( View Tweet)
In case you missed it! Watch our ACR Monday Recap of the meeting with me, @RheumNow @EBRheum and @ericdeinmd. #ACR23 @uptoTate https://t.co/GpMdev0Yk7
TheDaoIndex KDAO2011 ( View Tweet)
@lastwalsh @KyleWalkerM @RheumNow Second question: do you ever give a PEXIVAS-standard style steroid taper?
I'm 100% in agreement that we should favor PEXIVAS over observational data in most cases
In practice it seems like some patients need a bit more immunosuppression, though
Curious to hear your thoughts!
Mike Putman EBRheum ( View Tweet)
Abst #1584 TMP-SMX⬇️PJP ⬇️SIE,⬇️outpt infx in GPA on RTX. 919 patients: 31% had TMP-SMX, 40% on pred >20 mg/day followed median 496 days. SIE (aHR 0.5, 95%CI 0.3-0.8), outpt infx (aHR 0.7, 95%CI 0.5-0.9), & PJP. Thirteen PJP (all not on TMP-SMX). #ACRbest #ACR23 @rheumnow
TheDaoIndex KDAO2011 ( View Tweet)
Trimethoprim sulfamethoxazole (TMP-SMX) negatively associated with serious infections. Rates for adverse events possibly attributable to TMP-SMX per 100 person-years were 29.6 during and 13.4 post exposure. Mendel A, Abst#1584 #ACR23 #ACRBest @RheumNow https://t.co/hHY2bZXrkS https://t.co/2YMoCi1zrx
Dr. Antoni Chan ( View Tweet)
Ultrasound (and specifically intima-media thickness) might not just be for diagnosis in GCA - it might be a GCA disease activity measure for monitoring:
- improves over time
- increases with flares
Valentin Schaefer #ACR23 ABST1649 @RheumNow https://t.co/QWdIVGrHbn
David Liew drdavidliew ( View Tweet)
Ross et al. Ultrasound assessed Optic nerve sheath measurement in GCA. Previously shown increased in GCA. Here decreases with treatment shown in 9 patients Abstr#1650 #ACR23 @RheumNow https://t.co/fcrS4tT6U0 https://t.co/ylnPKzdUe0
Richard Conway ( View Tweet)
FDG-PET uptake at baseline in GCA predicts future risk of future thoracic aneurysm
In print here: https://t.co/2SQm18y6zP
Could this help stratify aneurysmal screening?
#ACR23 ABST1647 @RheumNow https://t.co/p1Dhkm2WTX
David Liew drdavidliew ( View Tweet)
PET/CT real-world performance in GCA diagnosis, Sydney @tonysammel:
comparable to other modalities
can optimize for sen or spec based on managing equivocal results
?some steroid confounding
but definitely one of 3 complementary imaging options for GCA
#ACR23 ABST1646 @RheumNow https://t.co/FvdLMvpqEU
David Liew drdavidliew ( View Tweet)
#ACR23 Abstr#1634 Promising therapy for two #Sjogren groups: 1 (high ESSDAI & ESSPRI) & 2 (low ESSDAI, high ESSPRI). Phase 2 RCT of Iscalimab (anti-CD40ab) showed more ISC-treated pts met the primary endpoint (ESSDAI and ESSPRI changes at WK24) vs PBO. Going to Phase 3 @RheumNow https://t.co/3bN3IS1zCO
Md Yuzaiful Md Yusof ( View Tweet)
Dr. AMendel et al:TMP-SMX prophylaxis assoc w⬇️serious infexns in RTX treated GPA pts; BL (aHR 0.5;95%CI 0.3-0.8) & time-varying exposure (aHR 0.5; 95%CI 0.3-0.9)
A good thing to consider but weigh benefits/harms w/TMP-SMX prophy. More studies req'd?
#ACR23 ABST1584 @RheumNow https://t.co/dfsfpcQu2A
sheila ( View Tweet)
TMP-SMX in AAV with RTX. 919 patients. Only given to 31% (40% on steroid>20mg), what!? TMP-SMX aHR 0.5 for serious infection, aHR 0.7 for minor infection. PJP 13 vs 0. Abstr#1584 #ACR23 @RheumNow https://t.co/4YQELIC82F https://t.co/U5l5KzSkB5
Richard Conway ( View Tweet)
TMP-SMX PPx in GPA
A#1584 @RheumNow #ACR23
919 pt analyzed
TMP-SMX ass w/ decr serious ifn (HR 0.5), less outpt ifns (0.9)
Rates for AEs attrib to TMP-SMX per 100 py: 29.6, wo TMP-SMX: 13.4
13 PJP, all in non-TMP-SMX pts
Should we use Bactrim to prevent ifn beside PJP? GC effects
Eric Dein ( View Tweet)
#ACR23 Abstr#1584 Data N=919 pts with GPA vasculitis treated with rituximab showed Septrin prophylaxis (+/- 28days of RTX) reduced serious & any infection. PJP=1.4% not on septrin. Question remains re: how long for in those receiving repeat cycles & steroid confounding @RheumNow https://t.co/81f8hbMids
Md Yuzaiful Md Yusof ( View Tweet)
#ACR23 Abs #1032 identified six major themes of diverse patient experiences. Studying patient experiences is critical for understanding mechanisms of health disparity, targeting interventions and, ultimately, improving quality of care. https://t.co/Fd2m4yzlHp @rheumnow https://t.co/EhIIF9cquQ
Dr. Rachel Tate ( View Tweet)
OA and Microbiome!
Ab#1581 @RheumNow #ACR23
Microbiome transplantation of mouse models - benefit if before or soon after OA induction (meniscal destabilization)
⭐️OA is inflammatory dis of innate immune sys, not "wear-and-tear" and gut biome may be a 🔑 https://t.co/eA8unUBnpC
Eric Dein ( View Tweet)
How does Dr. Robert Spiera manage GCA?
1) Tx with steroids alone, taper by 6 months
2) Do not chase ESR/CRP
3) Pay attention to steroid complications
4) Low threshold to use IL-6i
Similar plan for PMR
Taper steroids by month 4
@RheumNow #ACR23 https://t.co/KSwyfjobFY
Robert B Chao, MD ( View Tweet)
Still uncomfortable with IL-6i in GCA or PMR especially given the pt population and potential AE?
Be on the look out for NEW biologics!
Mavrilimumab
Secukinumab
and MORE!
@RheumNow #ACR23 https://t.co/gdcDIcvffa
Robert B Chao, MD ( View Tweet)
More vitamin D during pregnancy is better, right?
Hopkins Lupus cohort, vit D levels & adverse pregnancy outcomes
Actually, there's a sweet spot
(too high just as unfavourable as too low)
Maybe popping vit D pills isn't always limitless
@jhrheumatology #ACR23 ABST1364 @RheumNow https://t.co/TVPCqP3dq9
David Liew drdavidliew ( View Tweet)