Skip to main content

Vasculitis

Hypoxia seems to exacerbate neutrophil activation by ANCA - enhanced F-Actin polymerization - enhanced NET formation Could hypoxia predilection in certain tissues (kidney, lung) lead to the AAV phenotypic disease patterns? @RheumNow #ACR24 https://t.co/KxaeMvkd2t
Brian Jaros, MD @Dr_Brian_MD( View Tweet )
Hydralazine - known culprit of drug-induced AAV How does hydral (H) AAV differ from primary (1) AAV? 💥 High dual positivity MPO/PR3 💥 DAH / pleuritis more common in H-AAV 💥 ENT, constitutional, nervous, ILD in 1-AAV 💥 More 6mo remission in H-AAV @rheumnow #ACR24 Abst 2496

Brian Jaros, MD @Dr_Brian_MD( View Tweet )

SELECT-GCA suggests JAKis may be the new kid on the block Clinicians treating giant cell arteritis (GCA) have long had to contend with a disappointingly limited selection of drugs from which to select. https://t.co/vtJzwFZMBq https://t.co/dikMRwjIZY
Dr. John Cush @RheumNow( View Tweet )

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. This approach is not well individualized to the patient as we do

Read Article
Risk stratification of GCA pts: who might lose vision? Cranial MRI with vessel wall enhancement used to calculate additive score... # of vessels affected Higher scores a/w ocular GCA > non-ocular GCA > no GCA and decreased w/ tx @RheumNow #ACRbest #ACR24 https://t.co/knDVrl84Qs
Brian Jaros, MD @Dr_Brian_MD( 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

Read Article
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
Dr. John Cush @RheumNow( View Tweet )
Yang et al. Cranial vessel wall MRI in GCA. Quantitated with PEG score. PEG score ocular GCA>non-ocular GCA>non-GCA. Decreases with treatment. @RheumNow #ACR24 Abstr#2650 https://t.co/e26urOpb7V https://t.co/eekQbzmKYm
Richard Conway @RichardPAConway( View Tweet )
A#2651 Vasculitis w VEXAS 81 men, median age 67 - 27% had evid of vasculitis, variable size vessel 22% SVV- 17/18 cutaneous, one peritubular capillaritis on renal bx 2.5% MVV (2 cutan), LVV (2 carotid thickening, 1 had +TA bx), ANCA+ @RheumNow #ACR24 https://t.co/puablIBLCP
Eric Dein @ericdeinmd( View Tweet )
Sullivan et al. Vasculitis in VEXAS. 81 patients. 27% vasculitis. Cutaneous SVV 20%, AAV 2.5%, cutaneous MVV 2.5%, LVV 2.5%. @RheumNow #ACR24 Abstr#2651 https://t.co/AV3RcuSKpV https://t.co/xrax025TzP
Richard Conway @RichardPAConway( View Tweet )
A#2648 PET for GCA Delayed imaging at 180 min improve dx performance for pts on GCs Optimal PET w/in 3 days of GC, most patients unable to do w/in that window Delay has sensitivity 92% even on prednisone - may be good tool for pts unable to get early PET/CT #ACR24 @RheumNow https://t.co/kxpNfRqkGN
Eric Dein @ericdeinmd( View Tweet )
A#2650 MRI can show extent of vessel wall inflamm to guide severity of GCA Brain & orbital MRI performed Assessed 7 arteries bilaterally -> CAMRIS-GCA MRI score (0-10) 33 GCA (17 ocular), 41 not GCA CAMRIS-GCA ass w/ ocular GCA, higher severity. Improved w Rx @RheumNow #ACR24 https://t.co/19XCuZJXqF
Eric Dein @ericdeinmd( View Tweet )
Disseminated acanthamoeba : pt with modular painful skin lesions on his palms and scalp— initially dx’d with a cutaneous vasculitis- he got worse with immunosuppression. Imaging and histology shown #ThievesMarket #ACR24 @RheumNow https://t.co/FjJ0Sk0Kxt
TheDaoIndex @KDAO2011( View Tweet )
A systematic review & meta-analysis by Dr. JBCorrea et al show that the ff immune-mediated dses are assocd w/⬆️ ocurrence risk after covid19 infection 👇 Behcets SpA SS SLE PMR Pso RA Sjogrens T1DM Vasculitis IBD Ask prior covid infexn in pts history @RheumNow #ACR24 abs2614 https://t.co/TIEglPrmvL
RIP to Glucocorticoids in GPA For many years glucocorticoids were the mainstay of our treatment of granulomatosis with polyangiitis (GPA). https://t.co/WqpO6ACqtu https://t.co/vb8qx3uHA0
Dr. John Cush @RheumNow( View Tweet )
Xia et al. Upadacitinib in refractory Behcets. Open label, 8 patients. Follow-up 4-14 months. Lower disease activity 2.5 vs 1.5. Lower pred, 11.9 vs 8.1. @RheumNow #ACR24 Abstr#2515 https://t.co/ZXsJkNRlTm https://t.co/S8LhpqZ8X3
Richard Conway @RichardPAConway( View Tweet )
Does vasculitis flare with checkpoint inhibitors? @MDAndersonNews experience: 17 stable pts 4 pts flared - all able to be controlled (i.e. 13 didn't flare) Encouragement that stable vasculitis pts that need ICI should get them! #ACR24 ABST1986 @RheumNow https://t.co/jO4w3HWBMd
David Liew @drdavidliew( View Tweet )
Will be covering some TAK pearls and pitfalls from today’s session! Renal dz stratified by location of vessel inflammation: - TAK = proximal (off aorta) - FMD = mid-section, beading - PAN = distal arterial branches @RheumNow #ACR24 https://t.co/zu6qJ6DXcF
Brian Jaros, MD @Dr_Brian_MD( View Tweet )
Imaging in TAK Diagnosis @KQuinnRheum @RheumNow ⭐ Take homes ⭐ 👉location of renal artery stenosis (RAS) key to making Dx with proximal RAS in TAK 👉FDG PET -focal uptake in TAK vs diffuse in GCA 👉MRI good surrogate for disease activity where PET unavailable #ACR24 https://t.co/UWxTAZScIt
Patricia Harkins @DrTrishHarkins( View Tweet )
Systemic polyarteritis nodosa looks creepily/scarily beautiful on PET/CT. Look at that Christmas tree! but sensitivity can be affected by pred, & isn't great even without (48%). By itself, a good rule in test, but not a good rule out test. #ACR24 ABST1962 @MayoClinic @RheumNow https://t.co/y28J6VKja4
David Liew @drdavidliew( View Tweet )
The TAPIR study presented at #ACR24 may not be as attention grabbing as others like SELECT-GCA, but in my opinion it is arguablyone of the most important ANCA-vasculitis studies ever. I've shared some further thoughs in an article on @RheumNow https://t.co/mImAE8ezSQ

Richard Conway @RichardPAConway( View Tweet )

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

Read Article
de Boysson et al. RCT anakinra in GCA. 30 patients. Week 52 relapse 53% in anakinra vs 46% in placebo. @RheumNow #ACR24 Abstr#1699 https://t.co/sqDWUlkXAX
Richard Conway @RichardPAConway( View Tweet )
Safer and less relapses in #Takayasu’s #arteritis In #MTX + #MMF Vs #Cyclo ➡️ #azathioprine @RheumNow #ACRBest @ACRheum abst#1696 WOW 😮 Amazing! https://t.co/y3BDjdAa6P

Janet Pope @Janetbirdope( View Tweet )

#Upadacitinib rises ‘ Up’ in all subgroups of #GCA Subset of overall #RCT of #rinvoq w more reduction of #steroids vs placebo+ slower #prednisone taper Consistent results best in UPA 15 mg >UPA 7.5mg/d > #placebo #ACR24 #ACRBest @RheumNow @ACRheum abst#1695 https://t.co/dA7RkNmWFd

Janet Pope @Janetbirdope( View Tweet )