Bah Humbug Vitamin D (12.20.2024)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.
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Best of 2024: Determinants of Gout Flares
Approximately 12 million US adults in the US have gout. Two recent literature reports in JAMA and Arthritis Care & Research highlight contributors to gout flares.
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Review of IgA Vasculitis (Henoch–Schönlein Purpura) - the freq of glomerulonephritis is higher in adults than children and tends to present more severely. Rx w/ 1st line steroids, Other agents: Colchicine, dapsone, MTX (Minor dz), CsA, tacrolimus, MMF (steroid sparing)… https://t.co/tB5fll3RfN https://t.co/knc7KesyRj
Dr. John Cush @RheumNow( View Tweet )
ICYMI: Are Emulation Trials a Fantasy?
Are emulation ‘trials’ helpful, despite the biases that occur with observational data, or do they truly mimic the results of randomized controlled trials (RCTs)?
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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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Drug-Free Remission in Giant Cell Arteritis is Uncommon
A Spanish retrospective registry study of patients with giant cell arteritis (GCA) found that 3-4 years after diagnosis, only 21% of patients with GCA successfully reached the sustained drug-free remission (SDFR). But if SDFR was achieved, the likelihood of experiencing recurrence was
Primary Hypophosphatemia (HYPOPH) - Japan study 50,136 adults w/ 424,434 alk phosphatase (ALP) tests. Persistent HYPOPH seen in 0.54% (273) due to cancer(30%), steroids(21%), DMARDs (16%). Unexplained HYPOPH had pain, muscle weakness, fatigue & could have primary HYPOPH… https://t.co/kGPSXSYEZI https://t.co/RtwSRnzeU0
Dr. John Cush @RheumNow( View Tweet )
Primary Hypophosphatemia (HYPOPH) - Japan study 50,136 adults w/ 424,434 alk phosphatase (ALP) tests. Persistent HYPOPH seen in 0.54% (273) due to cancer(30%), steroids(21%), DMARDs (16%). Unexplained HYPOPH had pain, muscle weakness, fatigue & could have primary HYPOPH… https://t.co/8RbSnhS3vl https://t.co/NdRIA4oREr
Dr. John Cush @RheumNow( View Tweet )
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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Worried about CV Risk and JAKi? What about the Steroids?
Dr. David Liew discusses abstracts 1981 and 2673, presented at #ACR24
https://t.co/OkMgIqxl2A https://t.co/1DVapGcWUn
Dr. John Cush @RheumNow( View Tweet )
Maximizing DMARDs to Strive for Steroid-Free Remission in RA
In 1950, three scientists won the Nobel Prize for discovering steroids, initially hailed as a "miracle cure" for RA. However, within a year, unrelated side effects like pain and fatigue emerged. Despite these issues,… https://t.co/dQEjXzxU0U https://t.co/NqyZHfBiId
Dr. John Cush @RheumNow( View Tweet )
Maximizing DMARDs to Strive for Steroid-Free Remission in RA
In 1950, three scientists were awarded the Nobel Prize for their groundbreaking discovery of steroids, heralded at the time as a "miracle cure" for rheumatoid arthritis (RA). However, just a year after their introduction, evidence began to surface regarding the harmful side effects
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A new score to quantify GCA inflammation?
The treatment paradigm for Giant Cell Arteritis (GCA) has been a binary approach to the presence or absence of vasculitis. When GCA is present, we institute high doses of glucocorticoids for treatment of the inflammatory process. #ACR24… https://t.co/b5H7KOtZPC https://t.co/AvrwHcXI7r
Dr. John Cush @RheumNow( View Tweet )
Is Your Practice Up to Date? New Guidelines for SLE Nephritis
Randomized controlled trials (RCTs) drive guidelines; guidelines drive clinical practice. Because updated guidelines lag trials by many years and dissemination of guidelines takes additional time, rheumatologists often practice “behind the data.” The 2024 ACR Guidelines for the Management of SLE
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Methotrexate to Prevent RA, Clear as Mud
Intervention in individuals predisposed to develop RA, with a holy grail of prevention of RA, has long been a hot topic. The 4-year results of the TREAT EARLIER study, presented at Tuesday’s oral abstract session, show that methotrexate appears to prevent the development of RA in high risk
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Prof Petri reports the ff predictors of fracture in SLE:
-older age
-Caucasian race
-female sex
⚠️ Prednisone (but not recent IM triamcinolone or IV methylpred) is a MAJOR risk factor.
When possible, avoid prednisone!
@RheumNow #ACR24 #ACRbest abs2679
@rheumarhyme https://t.co/q2NMRaYsAF
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sheila @RHEUMarampa( View Tweet )
All-caps abstract text throw-down by Michelle Petri re:fractures in SLE 😆
I keep saying this; our obsesssion with vitamin d is not commensurate w/reality
It's. The. Prednisone.
#ACR24 @RheumNow Abstr#2679 #ACRBest https://t.co/13luByNvYT
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Mike Putman @EBRheum( View Tweet )
What are the predictors of fracture in #SLE?
🦴Prednisone! Even at low doses ≤5mg
🦴Stroke
🦴Caucasian race
🦴Female
🦴Low BMD
Try to avoid steroid use. If they are needed, IM triamcinolone or IVMP preferable to oral GC.
Ab2679 #ACR24 @RheumNow
Mrinalini Dey @DrMiniDey( View Tweet )
Increased risk of mortality related to negative effects of GC use persists long after stopping and never return to pre-GC levels. #GCStewardship
#ACR24 @RheumNow ABST#2673 https://t.co/5AwHDmvQGf
Jiha Lee @JihaRheum( View Tweet )
Up-front Secukinumab in PsA?
We now have an absolute plethora of agents available for use in psoriatic arthritis (PsA). In contrast we have an almost complete lack of understanding of how best to optimise use of these agents – what is the right agent at the right time for the right patient. A study presented this week has
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How long is a long acting #intra-articular #steroid #injection in #knee #osteoarthritis?
#IA steroids can be q3monthly
#RCT of IA #fluticasone #propionate
Was superior to #placebo
Seemed to last approx 24 weeks
➡️ sub analysis in moderate pain, BMI<30
#ACR24 @RheumNow #2106 https://t.co/QBFCqXd1Q8
Janet Pope @Janetbirdope( 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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Continuing or Stopping Low Dose Glucocorticoids in GPA
Dr. Mike Putman reports about plenary session abstract 0774 (the TAPIR study) about how and when patients can stop steroids in GPA. #ACR24
https://t.co/OWqN0jmkc1 https://t.co/foOaVRtGiV
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Dr. John Cush @RheumNow( View Tweet )
A#2652
NEWTON study 🇫🇷 Retrosp cohort
51% relapse. Median @8.7 mos, dose 9mg pred
Rf: limb art involv- HR 1.9
Pred taper speed not risk for relapse
Most relapse -> incr GCs
Toci 1/3 at dx, 50% stopped
-61% d/c due to remission, 39% SEs
-1/3 relapse after d/c
@RheumNow #ACR24 https://t.co/NP0wieDmvo
Eric Dein @ericdeinmd( View Tweet )
Peyrac et al. 211 GCA. Relapse in 52% at median 261 days (so 1st year). 83% on GCs at relapse, median dose 6.5mg pred. 36% relapse post-toc discontinuation, at median 133 days. 64% no relapse when toc stopped, at median 511 days @RheumNow #ACR24 Abstr#2652 https://t.co/NqtdDNGGoc https://t.co/mXD8x7O6Ww
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Richard Conway @RichardPAConway( View Tweet )
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