Eye

Systematic review of 208 pts w/ IgG4–related disease & pachymeningitis - mean age 52 yrs; 2/3 male. HA & cranial nerve dysfunctions were most common Sxs. nearly half had systemic Dz. Abnl imaging of cavernous sinus and middle fossa. Incr. IgG4 in 65% w/ CSF pleocytosis in 52%… https://t.co/0TberfIXsH https://t.co/6k5QgGTnkw
Dr. John Cush @RheumNow( View Tweet )
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Anti-Zoster Drug Prevents Shingles in Lupus Patients on Anifrolumab

MedPage Today

The antiviral drug valaciclovir (Valtrex), given prophylactically, kept patients with systemic lupus erythematosus (SLE) under treatment with anifrolumab (Saphnelo) from having herpes zoster attacks, researchers said, offering a potential alternative to zoster vaccination.

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Overview of Uveitis management of adult & pediatric rheumatology. - Uveitis accounts for 10% of visual impairment globally - TNF inhib are effective; w/ IL-6 inhib as 2nd line options https://t.co/fwhTxEpVG0 https://t.co/cKGdcDbz3d

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Dr. John Cush @RheumNow( View Tweet )
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Off-Label Use of JAK Inhibitors in Orphan Diseases and Other Conditions?

Janet Pope, MD, MPH, FRCPC

When should you consider off-label use of JAKi?

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ANCA Vasculitis "Eye": Can rituximab help? Dr. Janet Pope discusses abstract 0726 at #ACR24 https://t.co/KzYcmjon8D https://t.co/KDIi1vJE4P

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Dr. John Cush @RheumNow( View Tweet )
PsA Potpourri Dr. Arthur Kavanaugh reviewed highlights on adult and pediatric sessions on uveitis, as well as interesting abstracts, at #ACR24 https://t.co/jsCMKHBFMk https://t.co/roZOZT3Mqd

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Dr. John Cush @RheumNow( View Tweet )
Biggest absence award at #ACR24 @ACRheum @RheumNow 🥇 Absence of discussion on 👇 #Oral #Surveillance Except for maybe Monitoring for mouth ulcers and cancers issues are not resolved but we are comfortable with ambiguity!

Janet Pope @Janetbirdope( View Tweet )

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A new score to quantify GCA inflammation?

Eric Dein, MD

The treatment paradigm for Giant Cell Arteritis (GCA) has been a binary approach to the presence or absence of vasculitis. When GCA is present, we institute high doses of glucocorticoids for treatment of the inflammatory process. This approach is not well individualized to the patient as we do

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Risk stratification of GCA pts: who might lose vision? Cranial MRI with vessel wall enhancement used to calculate additive score... # of vessels affected Higher scores a/w ocular GCA > non-ocular GCA > no GCA and decreased w/ tx @RheumNow #ACRbest #ACR24 https://t.co/knDVrl84Qs

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Brian Jaros, MD @Dr_Brian_MD( View Tweet )
Yang et al. Cranial vessel wall MRI in GCA. Quantitated with PEG score. PEG score ocular GCA>non-ocular GCA>non-GCA. Decreases with treatment. @RheumNow #ACR24 Abstr#2650 https://t.co/e26urOpb7V https://t.co/eekQbzmKYm

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Richard Conway @RichardPAConway( View Tweet )
A#2650 MRI can show extent of vessel wall inflamm to guide severity of GCA Brain & orbital MRI performed Assessed 7 arteries bilaterally -> CAMRIS-GCA MRI score (0-10) 33 GCA (17 ocular), 41 not GCA CAMRIS-GCA ass w/ ocular GCA, higher severity. Improved w Rx @RheumNow #ACR24 https://t.co/19XCuZJXqF

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Eric Dein @ericdeinmd( View Tweet )
Low uveitis rates in patients with axial spondyloarthritis and psoriatic arthritis treated with bimekizumab (BKZ) over the long term. Key findings: - AxSpA: 3.7% incidence (1.3/100 PY) with BKZ. - PsA: Only 0.2% incidence (0.1/100 PY). - All events were mild/moderate, with no… https://t.co/jkUwHJk3FJ https://t.co/gTcCzeC88e

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Antoni Chan MD (Prof) @synovialjoints( View Tweet )
Single cell TCR sequence study explores the limitations of TRBV9-depleting therapies in axial spondyloarthritis. Key findings: - Identified a clonally expanded TRBV5-5+ TCR in HLA-B27+ acute anterior uveitis. - Alternative TRBVs may retain pathogenicity and evade anti-TRBV9… https://t.co/Aj8oslsTNX

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Antoni Chan MD (Prof) @synovialjoints( View Tweet )

Which subsets of GCA pt might benefit most from upadacitinib? Sub-analysis from SELECT-GCA presented today: 💥Both relapsing and refractory disease 💥Pt w hx of PMR 💥Non-smokers 💥No hx ischemic eye dz In general, most subgroups still favor UPA @RheumNow #ACR24 Abst 1695 https://t.co/pX5hcX4TmR

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Brian Jaros, MD @Dr_Brian_MD( View Tweet )
#Blinded by results? 😊 #Ocular #involvement in #GPA 👇 Helped by #rituximab 👁️ #GPA Difficult Proptosis Pseudotumour Conjunctivitis Scleritis Vasculitis Ocular muscles - diplopia Small case series ‘author defined’ remission in 80% 👍 #RTX #abst0726 @rheumnow #ACR24 https://t.co/GHptelOTyv

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Janet Pope @Janetbirdope( View Tweet )
back, LBP, spine, AS

Difficult to Manage Axial Spondyloarthritis

Adela Castro, MD

Studies show that patients with difficult-to-manage axSpA have a higher disease activity; however, the lack of a consensus definition led researchers and clinicians to utilize their own proposed definition, resulting in variability of the characteristics of non-responders.

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Systematic review suggests (although not provn) that audiovestibular dysfunction may be from APS. Anti-phospholipid & HSP-70 Abs found 25-33% w/idiopathic sudden sensorineural hearing loss,. ACL Abs seen in up to 27% w/ sensorineural hearing loss https://t.co/GTcLoM0SCZ https://t.co/afFntYnPPG

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Dr. John Cush @RheumNow( View Tweet )
Overview of Uveitis management of adult & pediatric rheumatology. - Uveitis accounts for 10% of visual impairment globally - TNF inhib are effective; w/ IL-6 inhib as 2nd line options https://t.co/CmGuA7W4Ag https://t.co/p5aEQlV7p6

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Dr. John Cush @RheumNow( View Tweet )
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Risk of Uveitis with Spondyloarthritis

Jack Cush, MD

A retrospective registry study shows that uveitis may be seen in 10% with the diagnosis of axial spondyloarthritis (axSpA) but becomes more common (47%) over the next 30 years of disease. The good news is that biologic therapy can significantly lower the risk of uveitis in (SpA).

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🌟 ACUTE OPTIC NEURITIS - Differentials https://t.co/eE1Kbnmqc1

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Dr. Akhil 🇮🇳 @DrAkhilX( View Tweet )
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Linger on the Fingers (9.6.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. This week with a focus on fingers and better prescriptive follow through.

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Immunomodulatory Prevention of Uveitis Relapse in Behçet's The results of a randomised, open-label, head-to-head trial shows that adalimumab was superior to ciclosporin in preventing uveitis relapses in patients with severe Behçet's disease. https://t.co/12fpuIZFmA https://t.co/iDJJq29JMA

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Dr. John Cush @RheumNow( View Tweet )
Pooled data from BE MOBILE 1 & 2 RCTs shows Bimekizumab (dual-IL-17A/F inhib) may protect against uveitis in axSpA pts. N=349 pts - 0.6% BKZ vs 4.6% placebo developed uveitis (1.8 vs 15.4/100 PYs); even in pts w/ Hx of uveitis (6.2 vs 70/100 PYs; p=0.004) https://t.co/f8Uk0rEg86 https://t.co/mY1ikcGCNP

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Dr. John Cush @RheumNow( View Tweet )
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Running with Data (8.30.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com - including tips on steroids, MAS, and myositis testing.

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Finding Spondylitis Among Psoriasis, Uveitis and Colitis Patients Maksymowych and colleagues have shown that screening patients with either psoriasis, iritis, or colitis may yield a surprising percentage meeting ASAS criterial for axSpA. https://t.co/lVCdGnMVaT https://t.co/jFILeHrQXj

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Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

My Take on New Ocular Screening Guidelines for Plaquenil

Sergio Schwartzman, MD
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A recent article published by the American Academy of Ophthalmology presented new recommendations for screening of patients being managed with hydroxychloroquine that changed the previous monitoring paradigm. More importantly, it has repositioned hydroxychloroquine from one of the safest medications that rheumatologists use to a drug that can have potentially significant ocular morbidity (if used in doses greater than 5 mg per kilogram and or for prolonged periods of time). Read Post

The Role of Hydroxychloroquine Blood Levels in SLE

Michelle Petri, MD, MPH , Laura Durcan, MD

We review the available literature, with a particular focus on the recent findings in the Hopkins Lupus Cohort, regarding the clinical utility of hydroxychloroquine blood levels in helping to clarify some of the issues regarding retinopathy, how best to dose this medication, and medication adherence. 

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