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Steroids

Reconsidering Steroids Not one of us in rheumatology hasn’t prescribed steroids, but we need to reconsider how much/how often we use them. In almost every disease state we treat, we are seeing progression towards lesser and shorter courses . https://t.co/VRlCeNXyKR https://t.co/k5Uy7IHr3h

When should we be starting therapy in GCA and PMR?

Nov 28, 2023

The problem with having therapies that work is that you then have to figure out what to do with them. You cannot hide behind a shrug of the shoulders, or the ambiguity of therapeutic inadequacy. The question that follows the presence of a therapy is the question as to how to best use it.

GCA

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Reconsidering Steroids

Nov 24, 2023

There is not a single one of us in rheumatology who hasn’t prescribed steroids, but we really need to reconsider how much and how often we use them.

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IgG4 disease- the WInS withdrawal study results

IgG4-related disease describes a group of fibroinflammatory diseases whose features may include autoimmune pancreatitis, swelling of or within an organ system, salivary gland disease, swollen lymph nodes, skin manifestations, and symptoms consistent with allergies or asthma. While remission

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Early aggressive treatment in SLE: are we there yet?

Early treatment with DMARDs has revolutionised the outcomes of patients with rheumatic arthritis. However, this concept has not been fully extrapolated to other autoimmune rheumatic diseases such as systemic lupus erythematosus.

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Do We Stop or Continue Treatment?

Nov 20, 2023

Remission had been a dream, an elusive concept. But then, with the introduction of biologics, conventional synthetic and targeted synthetic DMARDS, patients are able to live longer and with a better quality of life. While these therapeutics have been helpful, they are expensive and carry

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Less (Glucocorticoids) is More in Lupus Nephritis Dr. Yuz Yusof talks with Dr. Amir Saxena about abstract 0781 at the 2023 ACR Convergence meeting in San Diego, CA. https://t.co/EriaJvBPj9 https://t.co/x5hNIAgBz2
L16 @ #ACR23 ⭐️Can you discontinue glucocorticoids (GC) & immunosuppressive agent (IM) in stable IgG4-RD (clinically quiescent for at least 12 mo)? ➡️146 pts followed for 18 mo: 👉Group 1: withdraw GC+IM vs 👉Group 2: withdraw GC… https://t.co/j77xYm9qSN https://t.co/72IwBeEwv9
Peng et al. 146 IgG4-RD in remission on immunomodulators+GC. 18 month follow-up. Withdraw IM+GC - 52% flare. Withdraw GC + continue IM 14.2% flare. Continue both 12.2% flare. Clear message that ongoing IM is the way Abstr#L16 #ACR23 #ACRbest @RheumNow https://t.co/3CAQhyTYqq https://t.co/qr1GOSvJYg
Nov 15, 2023
L16 #ACR23 @RheumNow W/d of Immunosuppr and Low-dose steroid in IgG4RD Gr1: W/d GC+IM, G2: IM alone, G3: Maintain Relapse rate: G1 52%, G2 14%, G3 12% https://t.co/xe6NLVxUov
Nov 15, 2023
Withdrawing immunosuppression and steroids in IgG4-RD Maintaining immunosuppression with or without steroids associated with low relapse rate 52% of pts who withdrew steroids +immunosuppression relapsed @RheumNow #ACR23 Abs#L16 https://t.co/xJyDiCkMVD
Nov 15, 2023
Withdrawal of Immunosuppressant and Low-dose Steroids in IgG4-RD Patients with Stable Disease 146 pts - 3 Grps 1: withdraw GC+IM 2:withdraw GC but maintain IM; 3: maintain GC+IM The maintenance of IMs, with or without low-dose GC, superior to withdraw #ACR23 @rheumnow #abstL16
#ACR23 Late-Breaking Abstr#L19 IA steroid can help osteoarthritis knee pain but effect & duration are variable. Phase 3 RCT: improvement in ADP & WOMAC pain favouring TLC5999 (liposomal modification of DEX) vs PBO at all timepoints inc. after repeated injection @RheumNow #ACRBest https://t.co/xUhoFHPExr
Would intraarticular steroids for knee OA be better with a sustained release formulation? ph3, TLL599 (liposomal delivery dexamethasone) vs normal dex vs placebo some gains over normal dex well tolerated New options always welcome in OA! @ProfDavidHunter #ACR23 L19 @RheumNow https://t.co/TUrhppHMiD
What happens when you stop #steroids and/ immunosuppressive Rx in Pts in remission for at least 1 yr in #IgG4 disease? You are likely guessing correctly Pts flare! Don’t stop Rx ?taper 🤷‍♀️ Like RA Rx - if stop Rx = flares Large RCT from China L16 #ACR23 @RheumNow @RheumNow
Nov 15, 2023

ACR23 – Day 3 Report

Nov 15, 2023

These year’s annual ACR Convergence has been a success with the return of an insanely active Poster Hall! F2F learning amidst miles of research and many young talented aside wizened establish presenters is such a welcome return to ACR, the way it should be.



Highlights from today

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Clinical Year in Review at #ACR23 By @philseo (@jhrheumatology) Review some of the most impactful scientific studies in #Rheumatology in the past year! 🍕 https://t.co/ystEjzrU8u
ARTIC REWIND RCT 3 yrs csDMARD withdrawal 38% 3yrs csDMARDs free remission vs. 80% stable dose gpe 75% recovery after restart Rx progression 19% in half dose gpe More use bioDMARDs (18%) & GCs (50%) withdraw gpe Trends towards lower infections @RheumNow #ACR23 #ACRBest https://t.co/jhOINV7LLS
Nov 14, 2023
Low dose #prednisone has (bad) brain effects. An argument to use steroid sparing drugs in #PMR ⁦@philseo⁩ ⁦@ACRheum⁩ ⁦@RheumNow⁩ #ACR23 THINK about steroid sparing Rx in ?all pts with #PMR #Great #debate https://t.co/usQJRNUN8B
Nov 14, 2023
Rx of #inflammatory #arthritis with #glucocorticoids doesn’t seem to affect outcomes in #malignancy treated with #checkpoint #inhibitors. Good news as new or flaring inflammatory arthritis as an irAE can be severe. #ACR23 @RheumNow @ACRheum #1055 @CanRIO_Tweets https://t.co/tFIPcQq2X6
Nov 14, 2023
There is a dose, duration and recency-dependent relationship between previous GC use and MACE. GC doses 5mg/day, durations of 30 days, and use one year prior to MACE were all associated with an increased risk of MACE, Wallace B Abst#2430 #ACR23 #ACRBest https://t.co/2ExboBvo2W https://t.co/FuqXdFFwqP
Nov 14, 2023
Nepal et al. No increased risk of GI perforation for tocilizumab in GCA HR 1.05 . Diverticulitis (RR 3.51), IV methylprednisolone (RR 5.41) risk factors. This fits with my priors, steroids are a bigger risk than tocilizumab. Abstr#2560 #ACR23 @RheumNow https://t.co/BAmBQA0kEP https://t.co/zRjmDIkOHp
Nov 14, 2023
After attaining #remission or #LLDAS after a flare - HALF flare over f/u esp if tapering pred to <7.5 or 5 mg. #HCQ was protective. 65% got LLDAs and 45% rem in 1/2 yr - longer time to get #remission #2553 #ACR23 @RheumNow @ACRheum #ACRbest Asian cohort of #SLE largest@in world https://t.co/yBBqYJZVOe
Nov 14, 2023
Fantastic presentation by Desh Nepal from MCW on risk of GI perforation in patients with #GCA Low incidence , no association with TCZ, but increased risk with IV methylprednisolone and h/o diverticulitis. @EBRheum #ACR23 https://t.co/bgvmjAXBEY
GCs on MACE in RA in VA A#2430 #ACR23 @RheumNow Not just ongoing steroid usage, also prior usage 1 year ago 5 mg use for 30 days one year ago - increases MACE events by 3% 5 mg use for 90 days one year ago - increases MACE events by 9%
Nov 14, 2023
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