Off-Label Use of JAK Inhibitors in Orphan Diseases and Other Conditions?
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
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
Links:
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 )
A new score to quantify GCA inflammation?
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
Links:
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
Links:
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
Links:
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
Links:
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
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
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
Janet Pope @Janetbirdope( View Tweet )
Difficult to Manage Axial Spondyloarthritis
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
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
Dr. John Cush @RheumNow( View Tweet )
Risk of Uveitis with Spondyloarthritis
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
Dr. Akhil 🇮🇳 @DrAkhilX( View Tweet )
Linger on the Fingers (9.6.2024)
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
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
Dr. John Cush @RheumNow( View Tweet )
Running with Data (8.30.2024)
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
Dr. John Cush @RheumNow( View Tweet )
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 axial spondyloarthritis (axSpA).
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JAK Inhibitors Reduce Macular Degeneration
Insurance claims data showed that patients with autoimmune disorders who took JAK inhibitors had lower rates of AMD, hinting that the drugs might treat the common eye disease.
https://t.co/MuJpbGPqe8 https://t.co/hcp4W3wP8a
Dr. John Cush @RheumNow( View Tweet )
JAK Inhibitors Reduce Macular Degeneration
Insurance claims data showed that patients with autoimmune disorders who took JAK inhibitors had lower rates of AMD, hinting that the drugs might treat the common eye disease.
https://t.co/bx0UCp0o3r https://t.co/FXSlcFHYXI
Dr. John Cush @RheumNow( View Tweet )
Recent Blogs
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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