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Best of 2023: New ACR RA-ILD Treatment Guidelines – What Were They Smoking!?

Rheumatoid arthritis related interstitial lung disease (RA-ILD) is common, with symptomatic RA-ILD affecting approximately 8% of RA patients. There is a very limited evidence base supporting treatment and therefore the recent release of ACR guidelines is to be welcomed. However, the published guidelines appear discordant with the best available evidence base. 

Advancing PMR

Even though polymyalgia rheumatica is not perceived by many physicians as a severe diagnosis, its diagnosis and management actually propose significant challenges. I'd like to talk about those challenges, and what directions our path forward can include to advance our understanding and improve the treatment of patients who have PMR.

JAKi for PMR: Safe, or a Concern for Older Adults?

JAK inhibitors obviously have dominated a lot of the discussion in our therapeutic landscape over the last couple of years. What about their use in polymyalgia rheumatica? Let's consider.

Impact of glucocorticoids: more than just toxicity

As the sole effective treatment for polymyalgia rheumatica since their development in the 1950’s until recently, the impact of glucocorticoids and PMR outcomes are undeniably intertwined. So much so that when the OMERACT PMR working group first set out to develop a PMR core outcome set, they quickly realised that many of the outcomes important to patients were related to their glucocorticoid use.

Unpopular opinion: spinach can be bad for you

PMR might be one of the most rewarding diagnoses to make in real practice: the patient comes to you in severe debilitating pain, and you prescribe steroids, giving them their lives back! As much as this impressive response makes your intervention appear almost magical, there is the often-forgotten story about the implications of such a diagnosis and treatment on patients' daily lives. 

Frailty in PMR: Why do I need to care?

It is important to clarify that frailty is not a synonym of age (chronological age). Although there are only a few studies studying the impact of frailty in PMR, frailty is a relevant issue due to several important factors.

IL-6 Inhibitors in PMR: Give early or late?

It's exciting to be able to have this conversation because it's only in the past year that we have an approved non-corticosteroid therapy for PMR that's been shown to be effective in a well done clinical trial.

Steroid Tapering in PMR: What's the Gold Standard?

Today I will be talking about the gold standard tapering of glucocorticoids and polymyalgia rheumatica or PMR. Now, whenever we talk about a gold standard, it gets tricky because in practice, so many factors influence the way that we approach glucocorticoids and tapering in PMR.

Comorbidities in RA: Focus on Difficult-to-Treat Disease

The presence of comorbidities naturally complicates treatment choice, patient adherence to medication and patient outcomes, increasing also the risk of making RA ‘difficult-to-treat’.

Infections Rheums Should Worry About

With the increasing development and use of new biologics and oral targeted therapies to treat RA and other immune mediated inflammatory diseases, an awareness of infection risk and prevention has become of increasing interest as well. While our patients may be susceptible to many different types of infections depending on immunosuppressive regimen, age and co-morbidities, I’ll highlight a few of the “usual suspects”.

Hard Conversations: DMARDs and Malignancy

Cancer is the most difficult DMARD risk to discuss with patients. Few warnings could scare people away from a drug faster than the words “may increase risk of cancer,” yet the risks (even when substantiated) have all been low and may be counterbalanced by the benefits of disease control.

Should You De-escalate DMARDs in RA?

I'm here to talk about de-escalation of DMARDs in patients who are in remission. Should you do it? Here's what I think.