Steroids

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 https://t.co/YGTRl71505

David Liew @drdavidliew( View Tweet )

Jun 03, 2023

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 https://t.co/J3Lp8owRyT

David Liew @drdavidliew( View Tweet )

Jun 03, 2023

#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 https://t.co/Ylnnl3pHOK

Janet Pope @Janetbirdope( View Tweet )

Jun 03, 2023

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 https://t.co/d8WnUOgrwq

Bella Mehta @bella_mehta( View Tweet )

Jun 03, 2023

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 https://t.co/dDkUJFlmEm

Aurelie Najm @AurelieRheumo( View Tweet )

Jun 03, 2023

#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 https://t.co/BmiujbhQI9

Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )

Jun 02, 2023

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 https://t.co/IjxgQTZ8SE

Dr. Antoni Chan @synovialjoints( View Tweet )

Jun 02, 2023

EULAR 2023 – Day 2 Report

Save

Jack Cush, MD

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

Read Article

Treatment of IIM, MTX or AZA or IVIG are 1st line (with steroids). #EULAR2023 https://t.co/TDKWxgrST0

Dr. John Cush @RheumNow( View Tweet )

Jun 01, 2023

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 https://t.co/KmCcE0Nsu9

David Liew @drdavidliew( View Tweet )

Jun 01, 2023

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 https://t.co/heBbcRAjxO

Janet Pope @Janetbirdope( View Tweet )

Jun 01, 2023

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 https://t.co/JBh26VqPuM

David Liew @drdavidliew( View Tweet )

Jun 01, 2023

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 https://t.co/YwSoZWi375

Aurelie Najm @AurelieRheumo( View Tweet )

Jun 01, 2023

#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 https://t.co/x99Jt9yf1g

Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )

May 31, 2023

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)

Aurelie Najm @AurelieRheumo( View Tweet )

May 31, 2023

#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 https://t.co/Q6GiaSCgV6

Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )

May 31, 2023

DPGN, lupus, nephritis, GN, glomerulonephritis, biopsy, kidney

Belimumab in Lupus Nephritis

Save

Jack Cush, MD

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

Read Article

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 https://t.co/My6M5MGBl1 https://t.co/0aPFUeE55Q

Links:

https://bit.ly/3BAxm0L

Dr. John Cush @RheumNow( View Tweet )

May 19, 2023

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 https://t.co/oQJV7gUV3W https://t.co/S1LRBT55Qn

Links:

https://bit.ly/3Mhfkp5

Dr. John Cush @RheumNow( View Tweet )

May 18, 2023

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) https://t.co/DnqhEIWztY https://t.co/aP0uh0oh1x

Links:

https://bit.ly/41A7hJD

Dr. John Cush @RheumNow( View Tweet )

May 15, 2023

2022 EULAR Recommendations on Screening and Prophylaxis for Opportunistic Infections

Save

Jack Cush, MD

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.

Read Article

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) https://t.co/ey5JDk2Xi5 https://t.co/Rcgphj147r

Links:

https://bit.ly/44xn4fb

Dr. John Cush @RheumNow( View Tweet )

May 08, 2023

Prevalence and Mortality of IgG4-related disease in the USA

Save

Jack Cush, MD

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

Read Article

PJP Prophylaxis Needed with Steroids and RTX The 2023 EULAR Vasculitis guidelines recommends primary prophylaxis with antibiotics, especially in rheumatic disease patients receiving RTX. https://t.co/eq42bK7MB1 https://t.co/Wk1hOpXanv

Links:

https://bit.ly/3AMku7k

Dr. John Cush @RheumNow( View Tweet )

May 04, 2023

Treatment and Management of Neuropsychiatric Lupus

Save

Eric Dein, MD

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

Read Article

Recent Blogs

AOSD: complicated disease or a disease with complications?

Save

Bella Mehta, MBBS, MS

Jul 18, 2022

Many clinicians may not have seen a case of AOSD during training, which overall leads to several delays in referrals and appropriate diagnosis for AOSD patients. AOSD is an autoinflammatory disease where innate immunity plays a primary role and is characterized by seemingly unprovoked inflammation, but without the high-titer autoantibodies or antigen specific T cells seen in autoimmune diseases. Read Post