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Big Time Vasculitis (3.10.2023)

Dr. Jack Cush Reviews the News and Journal articles from the past week on RheumNow. This weeks highlights includes insights on scleroderma, myositis, vasculitis and answers the question - does aggressive biologic treatment of psoriasis prevent future psoriatic arthritis?

  1. Massachusetts Medical Society workforce survey (600 MDs) shows that >half have cut back patient time, 55% admitted to burnout (more in women), & 1 in 4 physicians plan to leave medicine in the next two years.

  2. GCA patients with AORTITIS proven by CTA or FDG-PET/CT have higher rates of relapse. Among 82 GCA pts, 78% positive on both CTA & PET. Relapse was seen in 70% in the CTA+/PET+ group & 29% in the CTA-/PET+ (p = 0.019).

  3. BRIDGE-PMR a proof-of-concept trial studied 1 dose of IV RTX in 47 PMR pts - at 1 yr, 52% RTX were in GC-free remission (compared to 21% given PBO). Eight (33%) patients in the placebo group and six (26%) in the rituximab group had adverse events

  4. ENT involvement studied in 320 ANCA associated vasculitis pts: 65% had ENT involvement w/ median age =52 yrs, & median BVAS3 = 12. Relapse seen in 29% despite immunosupp Rx. No diff in outcomes betw pts Rx w/ oral or IV CTX or RTX

  5. Study of 197 AAV pts in RAVE trial (RTX vs CTX; followed by AZA) showed most serious infections (82%) occurred in 6 mos (68% Resp infx) & assoc w/ lower#s CD19+ cells. TMP/SMX prophylaxis against P. jirovecii decreased SIE rates

  6. Review of Systemic sclerosis current therapy:

    • early dcSSc: MMF, CTX, RTX, TCZ

    • rapidly progressive dcSSc - ?Stem cell transpl?

    • SSc-ILD: MMF>CTX, possibly nintedanib, perfinidone

    • Raynauds w/ digital ulcers: CA channel block, PDE5 inhib, iloprost, Bosentan

  7. Metanalysis of 3 RCTs & 19 observational studies, showed hematopoietic stem cell transplantation . (HSCT) significantly improved skin thickness and lung function. While HSCT had more deaths than IV CTX, HSCT had higher 2 yr survival rate

  8. Serum beta-2 microglobulin (B2M) in 100 #SLE pts - strong correlations betw B2M & 24 hr urinary protein, BUN, creatinine, disease activity, & damage score (p < 0.001), & negatively correlated with GFR, C3, C4 (p < 0.001). B2M predicted lupus LN

  9. 2017 Prevalence of Psoriatic arthritis (PsA) in Sweden estimated to be 0.34% (range 0.32-0.50% across all sensitivity analyses); lower in males & w/ higher level of education. 0.24% have seen rheumatology care- 32% on b/ts-DMARDs, 41% csDMARDs

  10. ARTIS Swedish study of Cancer in RA or PSA pts (~15k pts) starting JAKi vs TNFi. With ~2 yrs F/U, the risk of Cancer (excluding NMSC) was similar betw JAKi and TNFi (HR 0.94; 0.65 to 1.38), but more incident NMSC w/ JAKi (HR 2.12; 1.15 to 3.89) at 2 yrs

  11. Bullous pemphigoid is an autoimmune blistering Dz that may be seen with other hematologic dz - hemophilia A, hypereosinophilic syndrome, autoimmune thrombocytopenia, aplastic anemia, Heme malignancy (MDS, CLL, etc)

  12. Long-Term Survival of Idiopathic Inflammatory Myopathies

  13. Does Biologic Treatment in Psoriasis Reduce the Risk of Psoriatic Arthritis? 


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