BACHELOR Trial - Baricitinib in Early Polymyalgia Rheumatica
Lancet reports a French study demonstrating the efficacy of baricitinib in patients with polymyalgia rheumatica (PMR).
Effectiveness of Interleukin-6 Receptor Inhibitors versus Conventional Synthetic Immunomodulatory Therapy for Treatment of Frail Patients with Polymyalgia Rheumatica
Sponsored by Sanofi
https://t.co/ipt1OcddOn https://t.co/RRda88qV2j
Dr. John Cush @RheumNow( View Tweet )
Effectiveness of IL-6 Receptor Inhibitors versus Methotrexate or any Conventional Immunomodulators in Patients with Steroid Refractory Polymyalgia Rheumatica
Sponsored by Sanofi
https://t.co/bYVVBH49uF https://t.co/3BqhhHrvyi
Dr. John Cush @RheumNow( View Tweet )
TheDaoIndex @KDAO2011
@UnaMakris wants us to shift our approach to #GeriRheum. #RNL2025– remember the 5 M’s Multimorbidity Mind Medications Mobility what Matters most
https://t.co/MIVnpw87rW https://t.co/D4AmrYhyWH
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Dr. John Cush @RheumNow( View Tweet )
Adela Castro @AdelaCastro222
Are your patients aging with RA, or are they diagnosed with Late Onset RA (LORA)? -LORA pts tend to present acutely -High inflammatory markers~PMR Like -Seronegative/Decreased titers of RF/CCP @UnaMakris #RNL2025 https://t.co/tLrGBV6P1i https://t.co/53HVvUmrG4
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Dr. John Cush @RheumNow( View Tweet )
TheDaoIndex @KDAO2011
Late onset RA (LORA) aka RA diagnosed at an older age — pts have higher inflammatory markers, presents like PMR; they also have polypharmacy, comorbidities, frailty, etc that can complicate management @UnaMakris #RNL2025 @RheumNow #GeriRheum… https://t.co/E2WFwfCsWD https://t.co/tKF0OnUFQH
Dr. John Cush @RheumNow( View Tweet )
@RichardPAConway on PMR
#RNL2025 @RheumNow
PMR mimics: look for mimics in unusual/refractory cases
- Suspect the mimics to avoid undertreatment or over-treatment
Conway: PMR is NOT easy. Easy to misdiagnosis, easy to mistreat. "One of our most challenging cases" https://t.co/WqPWwCuutF
Eric Dein @ericdeinmd( View Tweet )
Late onset RA (LORA) aka RA diagnosed at an older age — pts have higher inflammatory markers, presents like PMR; they also have polypharmacy, comorbidities, frailty, etc that can complicate management
@UnaMakris #RNL2025 @RheumNow #GeriRheum https://t.co/zqEcyg2ejw
TheDaoIndex @KDAO2011( View Tweet )
@UnaMakris #RNL25 @RheumNow
Older patients w RA
1/3 of pts onset >60-65
- More acute onset, more systemic, more PMR-like, larger jts
- Higher IL-6, lower TNF-a, less RF, higher ESR
-Co-morbidities, polypharmacy, cognition, depression
Age does not equal frailty, but does correlate https://t.co/5qb60WyKkP
Eric Dein @ericdeinmd( View Tweet )
Are your patients aging with RA, or are they diagnosed with Late Onset RA (LORA)?
-LORA pts tend to present acutely
-High inflammatory markers~PMR Like
-Seronegative/Decreased titers of RF/CCP
@UnaMakris
#RNL2025 @RheumNow https://t.co/aOCwb3lHef
Adela Castro @AdelaCastro222( View Tweet )
BACHELOR Trial - Baricitinib in Early Polymyalgia Rheumatica
Lancet reports a French study demonstrating the efficacy of baricitinib in patients with polymyalgia rheumatica (PMR).
Glucocorticoids are the mainstay of therapy in PMR patients and may be problematic in older… https://t.co/svLmE6OBWm https://t.co/K8sdROswxV
Dr. John Cush @RheumNow( View Tweet )
Great table re:side effects of even low dose steroids in RA
Likely generalizes to other diseases ie PMR, SLE
P in prednisone stands for poison!
#ACR24 @RheumNow https://t.co/2bFy6dwl96 https://t.co/YDtjSX054I
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Dr. John Cush @RheumNow( View Tweet )
54K Peptic Ulcers Annually (12.13.2024)
Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com
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ICYMI: Say Goodbye to Methotrexate in PMR?
For decades, glucocorticoids (GCs) have formed the backbone of polymyalgia rheumatica (PMR) management. Whilst previously there was a sense that a “low” GC dose with limited duration was used, we now appreciate just how heterogenous the disease course of PMR can be, with many
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ACR24: Rheumatology Roundup
Join Drs. Jack Cush and Artie Kavanaugh as they review 15+ presentations and abstracts from the 2024 ACR Convergence meeting in Washington, DC.
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The Case for JAKi in PMR
Dr. David Liew abstract 0858, Baricitinib in Early Polymyalgia Rheumatica (BACHELOR Study), presented at #ACR24.
https://t.co/NLF75PuMOb https://t.co/FpUUdbtrwf
Dr. John Cush @RheumNow( View Tweet )
Say Goodbye to Methotrexate in PMR?
Despite mixed results on its clinical efficacy in three previous randomised controlled trials (RCTs)1-3, methotrexate is considered the most widely used GC sparing agent. #ACR24
https://t.co/Q5Sw9dvYqJ https://t.co/jvEmg6aPcq
Dr. John Cush @RheumNow( View Tweet )
@drceowen @TheLancetRheum @RheumNow Efficacy in newly diagnosed & established PMR is not necessarily interchangeable
different treatment paradigm
?different immunologically
Many other diseases have different Rx for induction vs maintenance, early dx vs established.
Having said that: doesn't look great for MTX. https://t.co/89lByaYdYq
David Liew @drdavidliew( View Tweet )
Lot said about #ACR24 ABST1697:
MTX in newly diagnosed PMR, neg RCT
Many have said no hope for MTX in PMR now
Agree doesn't bode well
However, MTX may still have role in established PMR
@drceowen & I have made that call a priori @TheLancetRheum https://t.co/ywCJc0zHzC
@RheumNow https://t.co/JUXk2tDNyR
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David Liew @drdavidliew( View Tweet )
JAKs and Other Drugs in PMR
This has been an interesting ACR meeting in terms of PMR updates. I would argue that we are still far too wedded to glucocorticoids only in the management of PMR. Yes, some patients will do fine with just glucocorticoids but we persist far too long with a glucocorticoid only strategy in others
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I've shared some thoughts on @RheumNow on methotrexate, tocilizumab, and baricitinib in PMR based on #ACR24 https://t.co/WXiW1nLN4k
Richard Conway @RichardPAConway( View Tweet )
Harkins @DrTrishHarkins et al. Impact of AC joint OA in PMR. 67% of PMR have AC joint OA. Those who do have worse pain and fatigue scores. @RheumNow #ACR24 Abstr#1974 https://t.co/vAqVuQ5Jzm https://t.co/zx5MMtWdBE
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Richard Conway @RichardPAConway( View Tweet )
Does adding a Clofutriben (HSD-1 inhibitor) w/ prednisone minimize the risks of steroid toxicities in #PMR patients?
VS placebo, PMR patients who received Clofutriben + Prednisone had substantial reductions in bone, lipid, and glycemic control parameters
@RheumNow #ACR24
Akhil Sood MD @AkhilSoodMD( View Tweet )
Would be helpful for us (and pts) to better understand rimmunotherapy agent specific risk on subsequent GCA/PMR
AFTRER propensity matching of >7k pt on combo nivolumab/ipilimumab compared to pembrolizumab:
- PMR RR 3.8x N/I vs. P
- no diff in GCA risk
@RheumNow #ACR24 https://t.co/IF4Gh7Cumd
Brian Jaros, MD @Dr_Brian_MD( View Tweet )
Say Goodbye to Methotrexate in PMR?
For decades, glucocorticoids (GCs) have formed the backbone of polymyalgia rheumatica (PMR) management. Whilst previously there was a sense that a “low” GC dose with limited duration was used, we now appreciate just how heterogenous the disease course of PMR can be, with many
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