Steroids

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ICYMI: Should Lupus Nephritis Receive PJP Prophylaxis?

Jack Cush, MD

A current review article suggests that the need for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in patients with systemic lupus erythematosus (SLE) and lupus nephritis will need to be individualized based on therapies and risk factors.

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Hepatitis B (Keep)

ICYMI: AGA Guideline: Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals

Jack Cush, MD

The American Gastroenterology Association has published its revised clinical practice guidelines for the prevention and treatment of hepatitis B virus (HBV) reactivation in at-risk patients, particularly those with immune-mediated disease, receiving immunomodulatory therapy and steroids.

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Glucocorticoid Tapering in SLE Dr. Yuz Yusof discusses abstract POS1224 presented at the 2025 EULAR meeting in Barcelona, Spain. https://t.co/oI992YLvnB https://t.co/mPmMxcpMey

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Dr. John Cush @RheumNow( View Tweet )
JAMA Clinical Challenge - 34-yoF with Forearm Pain and Stiffness. 1 yr of progressive skin tightening over forearms, tibia, LOM of fingers & elbows. Denied DM, Raynauds. Worse after tennis, better w/ steroids. Increased ANA, eosinophils, CRP, aldolase - your Dx? https://t.co/5VrE4OpZ4N
Dr. John Cush @RheumNow( View Tweet )
JAMA Clinical Challenge - 34-yoF with Forearm Pain and Stiffness. 1 yr of progressive skin tightening over forearms, tibia, LOM of fingers & elbows. Denied DM, Raynauds. Worse after tennis, better w/ steroids. Increased ANA, eosinophils, CRP, aldolase - your Dx? https://t.co/ppuzIB4iRf
Dr. John Cush @RheumNow( View Tweet )
epilepsy,brain,seizure,CVA

A Review of Intracranial GCA

Jack Cush, MD

A comprehensive review in Rheumatology on intracranial giant cell arteritis (icGCA) stresses that GCA is both an intracranial and extracranial large vessel vasculitis, with the former having unique presentations, and outcomes.

A systematic review included 102

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UK study of 17472 newly Dx #RA pts (10997 MTX, 4,540 csDMARDs; 13680 steroids-CS) w/ 1307 Serious Infx (SI) (3/100PY) & 311 SI deaths. MTX signif decr. SI (adj HR 0.72) & CS no effect HR 0.99. SI assoc w/ age, smoker, comorbidity, seropositive, high DAS28. 1 DAS unit incr SI https://t.co/Zmsuaf7Rw3
Dr. John Cush @RheumNow( View Tweet )
How to properly use steroids in early RA Guidelines differ on the early treatment of RA – ACR suggests not to use glucocorticoids (GC) and EULAR updated recommendations for RA treatment presented at #EULAR2025 continued to suggest early treatment with MTX and glucocorticoids. https://t.co/FakKxRot0p
Dr. John Cush @RheumNow( View Tweet )
Steroids, Not JAKi, Are the Real Infection Risk Dr. David Liew reporting at EULAR 2025 in Barcelona, Spain. https://t.co/rLpyo1UNjd https://t.co/bDfdLTEM1N

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Dr. John Cush @RheumNow( View Tweet )
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How to properly use steroids in early RA

Janet Pope, MD, MPH, FRCPC

Guidelines differ on the early treatment of RA – ACR suggests not to use glucocorticoids (GC) and EULAR updated recommendations for RA treatment presented at #EULAR2025 continued to suggest early treatment with MTX and glucocorticoids. We do know that it is not easy to get a significant minority

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lupus,nephritis,GN

2025 update of EULAR recommendations on lupus nephritis

Md Yuzaiful Md Yusof, MRCP(UK), PhD

At the 2025 EULAR congress in Barcelona, Prof Dimitrios Boumpas presented a summary of the updated EULAR recommendations on the management of lupus nephritis (LN). The most significant change in the treatment paradigm of LN is that the historic standard of care (SOC) (i.e.

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Sometimes you hear: “PMR dose steroids don’t really matter” Errrrr… (You wouldn’t accept this steroid exposure in any other disease. Never) #EULAR2025 POS0139 @RheumNow https://t.co/o6w2RpaGBj

Links:

David Liew @drdavidliew( View Tweet )
#EULAR vs #ACR #RA #recommendations Do you agree that #ERA pts should receive #glucocorticoids @RheumNow #EULAR2025 @eular_org

Janet Pope @Janetbirdope( View Tweet )

Management of AAV: 1.High dose GC f/b reduced dose taper ‼️caution in pts w/severe renal dz and RTX induction. 2. RTX effective for induction and maintenance, best for relapses. 3.PLEX: in RPGN pts if accesible ⚠️ risk for infection. 4.Avacopan: for faster GC weaning. No https://t.co/kfZ4gM38KG

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Adela Castro @AdelaCastro222( View Tweet )
Pearls on EGPA: 1. GC are mainstay for mild dz 2. Organ threatening/relapsing➡️CYP (RTX alternative) 3. W/o organ threatening➡️ anti-IL-5/IL-5R. 4. IL5i are less effective for ENT 5. Consider sx for nasal polyps. #EULAR2025 @RheumNow https://t.co/zoJEWxafsN

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Adela Castro @AdelaCastro222( View Tweet )
“That is why this task force continues to say: nothing is better than methotrexate and glucocorticoids to start” - Josef Smolen, on RA treatment #EULAR2025 @RheumNow https://t.co/AbkgWS8tvH

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David Liew @drdavidliew( View Tweet )
#EULAR new #RA #recommendations J Smolen presents justification for #MTX +#glucocorticoids at onset do you agree? Diff from #ACR #EULAR #Recommendations II #EULAR2025 @RheumNow https://t.co/wqCX5HA87q

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Janet Pope @Janetbirdope( View Tweet )
Recommendations for RA management at #EULAR2025 - MTX [or other csDMARDs] and steroids still remain the first line- nothing beats that! - ofcourse minimize steroids! - rather than stopping meds at remission, reducing doses may be a better solution. Not much changed. @RheumNow https://t.co/NK5ejsgjWV

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Bella Mehta @bella_mehta( View Tweet )
#EULAR2025 Abstr#OP0324 Cohort study of #lupus nephritis in Greece showed Earlier GC Discontinuation (D/C) & flare protection post-D/C is associated with renal response, low disease activity & HCQ use at GC D/C. Membranous LN & recent diagnosis were assoc w early GC D/C @RheumNow https://t.co/agFgyG5eaS

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Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
What kills in GCA? Greek national prospective cohort, small numbers and no doubt some channeling bias, but: Steroids (absence of DMARD use) is more of a factor than CV disease in GCA mortality. With new options, all GCA pts should be on something #EULAR2025 POS0960 @RheumNow https://t.co/Wmvf6tEvaF

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David Liew @drdavidliew( View Tweet )
Stabilize the pts with HLH with steroids when still trying to figure out the diagnosis of #HLH/ #MAS Many drugs can be used...but important to balance infection risk with immunosuppression These are critical pts. Be vigilant.. #EULAR2025 @RheumNow https://t.co/id4ae3SWtj

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Bella Mehta @bella_mehta( View Tweet )
Treatment strategies for steroid free management of #relapsingpolychondritis 56 patients from a single center #POS0149 #EULAR2025 @RheumNow https://t.co/d4I56opS02

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Bella Mehta @bella_mehta( View Tweet )
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EULAR 2025 - Day 1 Report

Jack Cush, MD

Wednesday was Day One at EULAR 2025 in Barcelona. Thousands from around the world gathered, eager to reunite at this international educational forum. Below are a few of my favorites from Day 1.

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#MTX in new #PMR?! RCT of #MTX was negative in early #PMR - no effect on #steroid #tapering ACR24 #1697 At #EULAR2025 👇 +RCT of #methotrexate in PMR <8wks #steroids #Rx MTX 25 mg/wk v #placebo N=64 ⬆️GC remission ✅80% v 46% ⬇️relapse w MTX 🤔 Abst0064 @RheumNow #EULAR2025

Janet Pope @Janetbirdope( View Tweet )

Single center study of 1538 #SLE pts found 2.2% w/ lupus mesenteric vasculitis (LMV) - 39 LMV episodes in 31 pts - 2/3 had Nausea, vomiting, diarrhea & abdominal pain (~15% peritoneal irritation) & had active Dz (renal, Skin, Heme). LMV responded to steroids & https://t.co/vXCpbiC60P
Dr. John Cush @RheumNow( View Tweet )
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