Steroids

alveolar hemorrhage acute

PEXIVAS: Diffuse Alveolar Hemorrhage in ANCA-Associated Vasculitis Patients

Jack Cush, MD

A secondary analysis of the PEXIVAS study showed antineutrophil cytoplasmic antibody–associated vasculitis (AAV) patients complicated by diffuse alveolar hemorrhage (DAH) may have improved with plasma exchange and glucocorticoids, the results did not achieve significance. 

Diffuse

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192 RA pts on MTX: GI Sxs studied w/ MISS (MTX intolerance severity score). GI intolerance seen in 56%, Nausea & pain post-MTX most common. More in afro-descendants, w/ FM, Steroids, or JAKi. MISS results unrelated to Route, Gi Dz, age, MTX dose https://t.co/EROmZQo1Zs https://t.co/SOMzzXXj0b

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Dr. John Cush @RheumNow( View Tweet )
RT @yuz6yusof #EULAR2024 OP0180 Can we safely taper GC in #lupus patients who are in remission? Single study in Italy showed in pts with SLEDAI=0 + pred =<5mg/d + stable IS/HCQ, GC discontinuation after proper tapering appeared safe and was associated with a low risk of flare

Dr. John Cush @RheumNow( View Tweet )

RT @drminidey OP0165- incidence & risk factors of D2T RA in an early RA cohort Factors assoc with D2T RA: 🩸 Seropositivity 🦴 Erosions 📈 Disease activity 📊 D2T pts have higher steroid doses & more commonly develop iatrogenic-related #comorbidities, e.g. osteoporosis

Dr. John Cush @RheumNow( View Tweet )

GCA,woman

JAK Inhibitors in Giant Cell Arteritis

Jack Cush, MD

Trials are underway evaluating the potential benefits of JAK inhibitors (JAKi) in giant cell arteritis (GCA) patients who are refractory to standards of care. An observational real-

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EULAR24,Roundup

EULAR 2024 Rheumatology Roundup (6.21.2024)

Jack Cush, MD

Drs. Artie Kavanaugh and Jack Cush discuss highlights from the EULAR 2024 meeting in Vienna

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Update on low-dose glucocorticoids in SLE GC have been the mainstay of treatment in SLE for nearly 75 yrs. GC induce anti-inflammatory effects, quickly relieve symptoms, and reduce mortality in life-threatening flares through various actions. https://t.co/uEtWftvwEz https://t.co/nJlpELMj5W

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Dr. John Cush @RheumNow( View Tweet )
Voclosporin and Steroids in Lupus Nephritis Dr. Jack Cush reports on abstract OP0059 presented at Eular 2024 in Vienna, Austria. https://t.co/y9QPieV0py https://t.co/GzwntEJLve

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Dr. John Cush @RheumNow( View Tweet )
Convention1.jpg

EULAR 2024 – Day 4 Report

Jack Cush, MD

The final day of EULAR 2024 was rich in posters, Late-breaking oral presentations and EULAR updates and recommendations.  Below is a synopsis of the half-day's action.

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steroids.prednisone.pills_.jpg

Update on low-dose glucocorticoids in SLE

Md Yuzaiful Md Yusof, MRCP(UK), PhD

Glucocorticoids (GC) have been the mainstay of treatment in SLE for nearly three quarters of a century. GC induce a range of anti-inflammatory effects, quickly relieve some symptoms and lower mortality in some life-threatening flares. However, they also have multiple side effects that limit the

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PMR patients get too much steroid. Data across 27 million people in England, n=39,438 with PMR. The blue are getting more pred than guidelines. Like everything in rheum: we need to be giving less pred, not more. Lumping PMR in with GCA won’t help. #EULAR2024 POS0411 @RheumNow https://t.co/bsi3lrAafm

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David Liew @drdavidliew( View Tweet )
Steroids are often started before pts see a rheumatologist This associates with long-term low-dose steroid use Need better collaboration between referrers and rheum to reduce this avoidable steroid burden POS0137 @RheumNow #EULAR2024

Mrinalini Dey @DrMiniDey( View Tweet )

« Glucocorticoids are such old drugs and we still use them so much » says Josef Smolen Summary slide from « 75th anniversary of GCd, what have we learnt? » @RheumNow #EULAR2024 https://t.co/XSRt44zupw

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Aurelie Najm @AurelieRheumo( View Tweet )
EULAR guidelines for screening for TB in rheumatic disease patients #EULAR2024 https://t.co/jaixl8lGkY

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Jilaine Bolek Berquist @BolekBerqui( View Tweet )
POS0277: proof of concept: Prophlx with canakinumab x 1 dose rather than steroids/colch/NSAIDS when starting pegloticase with MTX in pts with active, refractory gout: 11 pts: #gout flares 0 (compared 54% in MIRROR-C), infusion rxn 0, no safety signal @rheumnow https://t.co/4qFnQTOuq0

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TheDaoIndex @KDAO2011( View Tweet )
The fracture risk with glucocorticoids is dose dependent. Lems W #EULAR2024 @RheumNow https://t.co/TGjKu1vfXx

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Dr. Antoni Chan @synovialjoints( View Tweet )
I was allocated to bring down the warning, & I did apologise up front to both the EMA and Janet #EULAR2024. It's a tough gig regulating impactful medicines with risk-benefit, especially when our world is full of other medicines with risk-benefit trade-offs (like prednisolone). 2/ https://t.co/6YPhYHbhg8

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David Liew @drdavidliew( View Tweet )
#EULAR2024 OP0124 EULAR recommended target oral Pred =<5mg/d. Should the threshold of LLDAS be changed to LLDAS5? Multicentre study showed the protection gained from mortality, irreversible organ damage accrual and flare was no different btw the two targets @RheumNow #EULARBEST https://t.co/GbP25tTmX8

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Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
#EULAR2024 OP0180 Can we safely taper GC in #lupus patients who are in remission? Single study in Italy showed in pts with SLEDAI=0 + pred =<5mg/d + stable IS/HCQ, GC discontinuation after proper tapering appeared safe and was associated with a low risk of flare @RheumNow https://t.co/8IIgPuZUrF

Links:

Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
OP0165- incidence & risk factors of D2T RA in an early RA cohort Factors assoc with D2T RA: 🩸 Seropositivity 🦴 Erosions 📈 Disease activity 📊 D2T pts have higher steroid doses & more commonly develop iatrogenic-related #comorbidities, e.g. osteoporosis #EULAR24 @RheumNow

Mrinalini Dey @DrMiniDey( View Tweet )

Can you ⬇️ #Glucocorticoids or #immunesuppressive in #SLE & change am’t of damage From Asia Pacific #lupus collab (Biologics not included) Compared 7.5 mg #prednisone or less Or DMARD 1/2 flared after LLDAS ⬇️dose didn’t prevent damage #EULAR2024 @eular_org @RheumNow https://t.co/QmjEz87Cvw

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Janet Pope @Janetbirdope( View Tweet )

GC treatment duration for <90 and 90 to 360 days is associated with a higher risk of cumulative SI compared to nonexposed, especially the first year but also up to two years since first visit in RA patients. Maximum RR for <90 days is observed at 8 months since first visit (RR:… https://t.co/ecK2ylqrRk https://t.co/IQ5QQjExYQ

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Dr. Antoni Chan @synovialjoints( View Tweet )
🌎 Global disparities in steroid prescribing in #SLE 💊 HCQ assoc with decreased steroid use 📈 Other contributing factors may be prevalence, severity & phenotype of disease, plus access to DMARDs & biologics 📍SLE poster tour 15:30 TODAY #EULAR2024 Abs #POS0013 @RheumNow https://t.co/7pL8kpeqOs

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Mrinalini Dey @DrMiniDey( View Tweet )
Medicare & Optum claims data study of 2851 #RA pts w/ breast cancer (BC). In 3 mos before BC 27028% received bDMARDs. W/in 1st 3 yrs post-BC Dx 24-26% were receiving bDMARDs. 70% of RA pts on steroids without change w/ time https://t.co/51NcXv0xyc https://t.co/461NZiFvDO

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Dr. John Cush @RheumNow( View Tweet )
lupus,nephritis,GN

Upside/Downside of Steroids in Lupus Nephritis

Jack Cush, MD

A systematic review of randomized clinical trials of patients with biopsy-proven lupus nephritis (LN) demonstrates both the benefits and harms to early glucocorticoid (GC) regimens on lupus outcomes. 

This meta-analysis of the control arms of 50 RCTs

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Recent Blogs

Best of 2023: PMR: glad or bad tidings?

Sarah Mackie, MRCP, PhD
Smile feedback opinion yes no good back opinion
Please don’t tell your patient that PMR “typically” lasts two years. According to real-world data from the UK, one in four patients with PMR is prescribed steroids by their primary care physician for over four years. But nobody tells them this at the start, and that causes big problems later on. Read Post

Advancing PMR

Eric L. Matteson, MD, MPH
Dr. Eric Matteson
Even though polymyalgia rheumatica is not perceived by many physicians as a severe diagnosis, its diagnosis and management actually propose significant challenges. I'd like to talk about those challenges, and what directions our path forward can include to advance our understanding and improve the treatment of patients who have PMR. Read Post

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