ACR20 - Day 3 Report Save

Here are my highlights from day three, Sunday, of the ACR 2020 Convergence. 

Guidelines for Treatment of Polyarticular JIA

ACR/AF guidelines for the management of juvenile idiopathic arthritis (JIA) were presented on Sunday. The previous 2019 recommendations focused on polyarticular JIA, enthesitis, uveitis and sacroiliitis. The current guideline specifically addresses systemic JIA, oligoarticular JIA and TMJ involvement.

• Oligoarthritis: intraarticular (but not chronic oral) steroids, NSAIDS; then DMARDs, then biologics
• TMJ Arthritis (may be isolated) – Same as oligoarthritis above.
• Systemic JIA: NSAIDs followed by IL-1 or IL-6 inhibitors; Oral steroids, nor DMARDs, should not be initial monotherapy.
  • With MAS: Steroids followed by IL-6 or IL-1 (neither preferred) before calcineurin inhibitors; DMARD or other biologic agents may be necessary for residual disease.

Lupus and Thrombotic Risk

Dr. Michelle Petri had a series of abstracts on Sunday addressing the risk of venous and arterial thromboses (n=88) among the 821patients in Hopkins lupus clinic. They found that the presence of LAC in lupus was associated with an increased risk of arterial (OR 3.1) or venous (OR 4.9) thromboses (Abstract 1261).  Finding an IgA Beta-glycoprotein-1 Ab was also associated with a 2 fold risk of thromboses.  Contrary to common lore, LAC outperformed double or triple positivity (Abstract 1262).  Lastly Abstract 1266, she examined the risk of CVA and MI in her lupus cohort and showed CVA occurred early and were correlated with LAC and lupus activity (C3); but there was no correlation with myocardial infarction (appears to be multifactorial in pathogenesis).