Rheum Chapter Notes (4.26.2024)
Dr. Jack Cush reviews this past week’s news and journal articles from RheumNow.com.
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AbbVie announced preliminary positive results from phase 3 SELECT-GCA study showing remission in 46% of #GCA pts Rx w/ upadacitinib for 52wks (vs 29% PBO); RCT included a 26-wk steroid taper regimen https://t.co/DIstJ4hazo https://t.co/VXc7rj0REJ
Dr. John Cush @RheumNow( View Tweet )
GPA Management in 2024
https://t.co/qTwI7oVMBI https://t.co/Tr0eVmcgNN
Dr. John Cush @RheumNow( View Tweet )
Pregnancy in vasculitis checklist:
- goals and timeline
- disease activity in 12 mos
- is there end organ damage?
- Review Rx
- h/o clots/miscarriages, APLS?
- Check Ro/La
- Role for ASA?
- Refer to MFM
Catherine Sims #RNL2024 @RheumNow
Dr. John Cush @RheumNow( View Tweet )
#RNL2024 @RheumNow
@philseo: I now give Tociliizumab for nearly all patients with GCA
GiACTA shows we weren't doing well enough with steroid monotherapy
GiACTA shows dosing frequency does not make a big difference in new diagnosis, but makes a difference in relapsing disease
Dr. John Cush @RheumNow( View Tweet )
#RNL2024 @anisha_dua
Throwing the kitchen sink in severe GPA
CYC + RTX combo - sick population (median GFR 9, 47% on HD, 52% DAH, all received PLEX too)
- 85% survival, 69% not ESKD, low rates of relapse (13% at 36 mos)
But, prolonged B cell depletion, aggressive Rx
Dr. John Cush @RheumNow( View Tweet )
Canary in a Coal Mine (4.19.2024)
Dr. Jack Cush reviews regulatory reports, news and novel journal articles - this week focusing on Sjogren's, ILD, Gout and Uveitis.
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PJP PPx in AAV
@anisha_dua #RNL2024 @RheumNow
919 GPA pts on RTX - only 31% on TMP/SMX
13 pts devel PJP, not on PPx
Overall decreased serious infections (HR 0.5), outpt infections HR 0.7
Adverse effects on TMP/SMX 29.6 vs 13.4
For every serious ifn avoided, 2-3 pts will have AE
Dr. John Cush @RheumNow( View Tweet )
ICYMI: Vasculitis Pearls
https://t.co/7z6b0Wj37X https://t.co/PHlOvFG9qQ
Dr. John Cush @RheumNow( View Tweet )
ICYMI: Vasculitis Pearls
Once again RheumNow Live 2024 really delivered with high impact learning packed into short sessions. As someone with an interest in vasculitis it was fantastic to see four of my favorite speakers in the Vasculitis Mavens and STEP talks. They gave us what we really want from these talks –
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Join us 4/16 for Tuesday Night Rheumatology at 6:30pm ET. This week we'll be focusing on Vasculitis Mavens with:
Vasculitis & Pregnancy - Catherine Sims, MD
GPA Management in 2024 - Anisha Dua, MD, MPH
Treat to Target in Vasculitis - Philip Seo, MD
https://t.co/6IaCdCodGf https://t.co/HlZ8OiZWc4
Links:
Dr. John Cush @RheumNow( View Tweet )
Best Imaging in Giant Cell Arteritis - US, PET, MRI?
Imaging is often instrumental in diagnosing and staging patients diagnosed with giant cell arteritis (GCA).
https://t.co/LXVB6cHDfO https://t.co/ArLNdEPuVx
Dr. John Cush @RheumNow( View Tweet )
Best Imaging in Giant Cell Arteritis - US, PET, MRI?
Imaging is often instrumental in diagnosing and staging patients diagnosed with giant cell arteritis (GCA). A new study compared the diagnostic performance of Colour Duplex Ultrasound (CDUS), Fluor-18-deoxyglucose Positron Emission Tomography Computed Tomography (FDG-PET/CT) and
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Serious Infections in Takayasu arteritis
The large vessel vasculitis, Takayasu arteritis (TAK), carries a significant morbid risk and a cohort analysis shows these patients are also at high risk of serious infection with resultant higher risk of death.
https://t.co/qqtpCMYnZf https://t.co/ZlxATKVQIA
Dr. John Cush @RheumNow( View Tweet )
TAPIR study shows that GPA patients treated with rituximab can be safely weaned off low dose prednisone. But. 20% risk of relapse in those treated with non-RTX regimens @VasculitisBCN24 #vasculitis https://t.co/jDy0lOQQIP
Catherine Hill @CatherineL_Hill( View Tweet )
Seasonal Pathogens and Henoch-Schönlein Purpura
Epidemiologic studies of Henoch-Schönlein purpura (HSP) have suggested seasonal variation in occurrence rates (higher from September-April, lower in June-August), suggesting a role for infectious triggers. The importance of infection was recently shown with nonpharmaceutical interventions (
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337 PMR pts studied by FDG PET, followed 6 mos - 9% (31) had subclinical vasculitis (GCA)
- 21 had isolated LG vessel
- 3 isolated cranial vasculitis
- 7 both cranial & LG vessel vasculitis.
Steroid use higher w/ subclinical vasculitis, but not relapse https://t.co/uwXf4ucVnQ https://t.co/AOacTnQZaS
Dr. John Cush @RheumNow( View Tweet )
1/600 Falls May Die (4.5.2024)
Dr. Jack Cush reviews the news and Journal reports from this past week on RheumNow.com - including problems w/ falls, pain and treatment of Dupuytren’s contractures.
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Serious Infections in Takayasu arteritis
The large vessel vasculitis, Takayasu arteritis (TAK), carries a significant morbid risk and a cohort analysis shows these patients are also at high risk of serious infection with resultant higher risk of death.
337 PMR pts studied by FDG PET, followed 6 mos - 9% (31) had subclinical vasculitis (GCA)
- 21 had isolated LG vessel
- 3 isolated cranial vasculitis
- 7 both cranial & LG vessel vasculitis.
Steroid use higher w/ subclinical vasculitis, but not relapse https://t.co/QyRFwY45eU https://t.co/rg1WSBeMFl
Dr. John Cush @RheumNow( View Tweet )
Should all patients with #polymyalgia rheumatics be screened for #giantcellarteriitis with vascular #ultrasound? A recent viewpoint summarizes the evidence:
📊prevalence of subclinical GCA may be as high as 25%
https://t.co/UL6gWRdE5R https://t.co/EAlRyNNWYt
Links:
Annals of the Rheumatic Diseases @ARD_BMJ( View Tweet )
Autoimmune dz pts have higher risk of macular degeneration. Cleveland Clinic study of 200K AMD vs controls, finds:
- SLE (RR 1.73)
- Scleroderma (1.65)
- Psoriasis (1.48)
- Vasculitis (1.48)
- RA (1.4)
- UC &CD (~1.42)
- Sarcoid (1.42) https://t.co/RrXaaqz3Aw https://t.co/9dGoGRCBYu
Dr. John Cush @RheumNow( View Tweet )
Predicting Vasculitis Relapse
Scores on a patient-reported sino-nasal symptom questionnaire were associated with subsequent flares of one type of ANCA-associated vasculitis (AAV), researchers said.
https://t.co/2IjrXiGbIA https://t.co/4uTsa6mc77
Dr. John Cush @RheumNow( View Tweet )
post hoc of the PEXIVAS study 704 participants w/ severe ANCA vasculitis: 92% achieved remission & 23% had relapses (rate 10.3/100PYs)-- Neither plasma exchange nor glucocorticoid tapering regimen impacted relapse risk. https://t.co/LKaqptWbxZ https://t.co/nOvE6BqYOl
Dr. John Cush @RheumNow( View Tweet )
Naysayers & Disrupters (3.22.2024)
Dr. Jack Cush reviews the news and journal reports from the past week - including a few contrary reports on infection, seropositivity and plasmapheresis.
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