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Important from @cappelliMD @jhrheumatology irAE cohort on predictors of DMARD requirement in ICI-inflammatory arthritis, and persistent ICI-IA post-ICI cessation. The better we can predict these patients, the more we can get the right therapy early POS0951 #EULAR2023 @RheumNow
New 2023 @eular_org SLE recommendations Key changes, in response to evidence: - more caution re: steroids - biologics earlier - combo therapy (BEL or CNI/VCS) considered for lupus nephritis #EULAR2023 @RheumNow
#SLE #EULAR recommendations What is new - use LESS #glucocorticoids, aim for none or 5 mg/d or less, use #biologics early if needed to prevent damage, #lupus #nephritis consider less pulse dose if using, voclosporin vs Belimumab ? it depends @RheumNow #EULAR2023
Meds in #lupus at #EULAR2023 recs - HCQ first line therapy. Target dose remains the same. Some discussion on monitoring levels if possible - MAIN CHANGE - Glucocorticoids to be minimized (only use for bridging). Nephrologists more so in favor of steroid free remission @RheumNow
We would think that targeted therapies would have reduced GC use in RA. Well, this is not really the case. Comaprison of GC use in 1999-2008 vs. 2009-2018 52% of patients remain on GC for>3Mo after initiation & 1/3 still continues after 2 years! @RheumNow #EULAR23 POS0309
#EULAR2023 #POS0222 Post-hoc Analyses of Phase 3 RCT in Rituximab-treated ANCA vasculitis patients only (65% of total) showed more patients met Remission rate & with lower GC Toxicity vs Pred Taper + RTX at 52 weeks, consistent with Trial Main Results @RheumNow
Initial use of glucocorticoids GC as bridging treatment in RA resulted in increase use of GC later, fewer DMARD changes later, van Ouwerkek L, Abst#OP220 #EULAR2023 @RheumNow

EULAR 2023 – Day 2 Report

Jun 01, 2023

Day 2 at the international EULAR Congress meeting is always bigger and busier. There were sessions on JIA therapies, crystal arthritis, novel drugs for SLE and Sjogren's, early RA and preclinical RA interventions, IgG4 disease, osteoporosis and the growth and application of artificial

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Treatment of IIM, MTX or AZA or IVIG are 1st line (with steroids). #EULAR2023
What do we do with PMR patients with subclinical GCA seen on ultrasound? Well, in these non-blinded cohorts the subclinical GCA pts got more pred. Was it warranted? Hard to say. If we’re going to look for it, let’s try and figure out what it means POS0712 #EULAR2023 @RheumNow
Rx of #lupus #SLE The most challenging seems to be longstanding & residual disease activity - damage accumulates over time - esp if #glucocorticoids are used. Consider only as bridging. How to treat #lupus #EULAR2023 Boumpas ⁦@RheumNow⁩ #ClinicalPearl ⁦@eular_org⁩
Tapering pred in RA - this just rings true from everyday clinic life. Some patients just seem to hit a wall at PNL 2.5. Sometimes it’s GC withdrawal arthralgias/tertiary adrenal insufficiency, but often it’s genuine inflammation. I still wonder why? POS0050 #EULAR2023 @RheumNow
CareRA trial: 3 months addition of LEF vs. ETA in pts resistant to COBRA-Slim regimen (MTX 15 mg/w + step-down prednisone): After 2 years, no difference in dis control but those who received ETA early were treated more frequently w/ csDMARD monotherapy #EULAR23 @RheumNow OP0129
#EULAR2023 #OP0046 With more effective therapies in #lupus, we should aim for bare minimum/cessation of steroid. A study using French database showed: >12% were on =>5mg Pred/d, this associated with comorbidities & increased costs 14% on high dose Pred weren’t on HCQ @RheumNow
I swear it is muscle, Doctor! GLORIA trial substudy Pred 5 mg/day 2 years in RA pts >65yo: Weight gain 1kg vs. PBO, no increase or redistribution of fat mass but augmentation in lean mass 💪 Probably explained by better disease control (although NS in study, small sample size)
#EULAR2023 Abstr #OP0048 What happened if we taper steroid in #lupus patients who are Serologically Active Clinically Quiescent? A cohort study in Asia showed: - Tapering was NOT associated with subsequent flare - Tapering reduced damage in those on =>5mg/day @RheumNow

Belimumab in Lupus Nephritis

May 29, 2023

Belimumab is a B-lymphocyte stimulator (BLyS)-specific inhibitor that is FDA approved for the treatment of active lupus and lupus nephritis, based on a few pivotal trials; and now a metanalysis supports its use in active lupus nephritis.

A meta-analysis and systematic review of six

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Avacopan in GPA - non-inferior to prednisone for induction remission - received FDA approval for treatment of severe active GPA in combo with standard therapy and steroids - should be used in newly diagnosed active or relapsing disease @rheumnow #RNL2023
SAPHYR, presented at #ACR22, unpublished Robert Spiera at #RNL2023 Phase 3 study for refractory PMR Sustained remission of disease, less steroids usage, steroid toxicity, and improved PROs @RheumNow
Chinese study of 4091 SLE pts, 3% (106) dx w/ osteonecrosis (AVN). AVN risk factors included: - SLE onset age ≤ 30 (HR 1.6) - Arthritis (HR 1.6) - Organ damage (HR 2.6) - RNP+ (HR 1.7) - High steroid doses (HR 1.7)

2022 EULAR Recommendations on Screening and Prophylaxis for Opportunistic Infections

May 11, 2023

Opportunistic and chronic infections may be rare and are often difficult to diagnose, especially in patients with autoimmune inflammatory rheumatic diseases (AIIRD), that may be immunocompromised. A EULAR task force has established recommendations for screening and prophylaxis against OI. 

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715 women w/ infertility from recurrent implantation failure were randomized to either placebo or prednisone 10 mg/d. Live birth rates were unaffected by pred (37.8% 38.8% w/ PBO; NS), but pred did increase rate of preterm deliveries (11.8% vs 5.5%; P=.04)

Prevalence and Mortality of IgG4-related disease in the USA

May 04, 2023

A current review of the epidemiology of IgG4-related disease (IgG4-RD) in the USA shows a low prevalence with possibly increasing numbers, owing to increasing awareness of this unique immune-mediated condition.

Epidemiologic data and outcomes were gleaned from analysis of commercial

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PJP Prophylaxis Needed with Steroids and RTX The 2023 EULAR Vasculitis guidelines recommends primary prophylaxis with antibiotics, especially in rheumatic disease patients receiving RTX.

Treatment and Management of Neuropsychiatric Lupus

May 02, 2023

On the first day of ACR State of the Art conference in Orlando, Florida, Dr. Michelle Petri reviewed the treatment and management of neuropsychiatric lupus. Dr. Petri, a lupus expert from Johns Hopkins Rheumatology, reviewed the latest clinical and animal model studies that offer hope in

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