Vasculitis

Is MTX Safe in the Elderly? (12.1.2023)

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Jack Cush, MD

Dec 01, 2023

Dr. Jack Cush reviews this past week's news and journal reports from RheumNow.com. Good news is that nearly 99% of adult rheumatology positions matched! But the challenge is that 45% of pediatric fellowship programs and 39% of pediatric rheum slots were unfilled in the 2024 NRMP match.

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WATCH: TMP SMX Prophylaxis in GPA https://t.co/JtIjgxwrCf https://t.co/Tmzdu00oyH

Dr. John Cush @RheumNow( View Tweet )

Nov 28, 2023

When should we be starting therapy in GCA and PMR?

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David Liew, FRACP

Nov 28, 2023

The problem with having therapies that work is that you then have to figure out what to do with them. You cannot hide behind a shrug of the shoulders, or the ambiguity of therapeutic inadequacy. The question that follows the presence of a therapy is the question as to how to best use it.

GCA

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UK study 336 GCA pts shows after 12 mos of tocilizumab, TCZ stopped (w mean pred 2mg/d) & GCA flares at 6, 12 & 24 mos was 21%, 35% & 49% respectively; requiring prednisolone dose increase to 20 (10-40) mg/day (34% were major relapses) https://t.co/EZ78ciNK0R https://t.co/R1qFsvnhoF

Dr. John Cush @RheumNow( View Tweet )

Nov 27, 2023

Substudy of the ADVOCATE trial looked at 214 ANCA assoc vasculitis pts treated with #RTX; avacopan Rx showed improved recovery of renal function, faster reduction in albuminuria and lower glucocorticoid toxicity compared to a prednisone taper. https://t.co/91PtvQfoIr https://t.co/ZjYCVP5lqG

Dr. John Cush @RheumNow( View Tweet )

Nov 25, 2023

Infections During Treatment of GPA with Rituximab Dr. Richard Conway (Dublin, Ireland) discusses abstract 1584 presented at the 2023 ACR Convergence meeting in San Diego, CA. https://t.co/eKi3KExEnk https://t.co/b9G9w5e9tc

Dr. John Cush @RheumNow( View Tweet )

Nov 25, 2023

Identifying GCA diagnosis and disease activity through proteomics from plasma: diagnosis looks good disease activity looks harder (Much like a lot of things in GCA, really) Exciting work @MayoClinic @MdWarrington @jsung0906 #ACR23 ABST2601 @RheumNow https://t.co/SwxN58LieB

David Liew @drdavidliew( View Tweet )

Nov 15, 2023

Greigert et al. IL17 in GCA. Increases vascular inflammation. Synergistic effect on myofibroblasts with IFN-γ - increases IL-1B, IL-6, GM-CSF, CCL20 (recruits T cells), CCL2 (recruits monocytes), VEGF (neoangiogenic). Abstr#2599 #ACR23 @RheumNow https://t.co/p4GumZStAZ https://t.co/zZv0TF4fmn

Richard Conway ( View Tweet )

Nov 15, 2023

⭐️Further Assessment of a patient with rash c/w leukocytoclastic vasculitis: 👉History: ⏺️Timing, onset, progression? ⏺️Recent infectious for infectious symptoms? ⏺️Recent/new meds? ⏺️Hx of cancer? 👉Laboratory assessment for ALL: ⏺️CBC w/ diff ⏺️CMP (w/ interest in Cr,… https://t.co/tVqz6XDXt2 https://t.co/LqZpx5j0Bp

Meral K. El Ramahi, MD @MeralElRamahiMD( View Tweet )

Nov 15, 2023

#ACRbest Peter Merkel as Distinguished Investigator said Data are good. Need data to develop questions, understand #vasculitis Hx of #vasculitis - great minds & drugs - now challenged by funding and comparators Session 15W127 #ACR23 @RheumNow @ACRheum https://t.co/5leIeLWZ6O

Janet Pope ( View Tweet )

Nov 15, 2023

#vasculitis clinical trials are accelerating. Need the right time - early studies have lessons learned re feasibility and design/endpoints #ACR23 @RheumNow @ACRheum Great lecture - P Merkel 15W127 great graphs of vasculitis developments https://t.co/YRdPiaflxY

Janet Pope ( View Tweet )

Nov 15, 2023

ACR23 – Day 3 Report

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Jack Cush, MD

Nov 15, 2023

These year’s annual ACR Convergence has been a success with the return of an insanely active Poster Hall! F2F learning amidst miles of research and many young talented aside wizened establish presenters is such a welcome return to ACR, the way it should be.

Highlights from today

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👨‍⚖️ The Great Debate: should we use advanced therapies / biologics at disease onset in PMR & GCA? #ACR23 By Dr. Robert Spiera & Dr. Phil Seo @philseo #Vasculitis #PMR #GCA https://t.co/rkcUeEBLeZ

Mithu Maheswaranathan, MD ( View Tweet )

Nov 14, 2023

#ACRbest Abstracts – Day 3

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Jack Cush, MD

Nov 14, 2023

Today was a big day for the Plenaries, Curbside Consults, ACR Business meeting (and induction of our new ACR President Dr. Deborah Desir) and Late-Breaking Posters. Our hot-button reporters have compiled these #ACRbest abstracts for you! (November 14, 2023 at #ACR23)

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Plenary Abs #2425: Pregnancies among vasculitis pts - higher frequency of spontaneous abortion and preterm delivery. Risk of maternal complications associated with vasculitis were observed to vary by vessel size and parity. #ACR23 https://t.co/qLcpNapcjg @rheumnow https://t.co/sk3dhySVfP

Dr. Rachel Tate ( View Tweet )

Nov 14, 2023

Rector et al. Pregnancy outcomes in vasculitis. More spontaneous abortion, elective termination, ectopic & molar pregnancy, x2 preterm delivery. Preeclampsia in 12%. Worse again in small vessel vasculitis Abstr#2425 #ACR23 @RheumNow https://t.co/cotncE16ma https://t.co/QoJpJIHJfJ

Richard Conway ( View Tweet )

Nov 14, 2023

Intriguing data on #GCA treated with tocilizumab #aneurysm still occurs #vasculitis https://t.co/6cPlFRReLJ

KenWarringtonMD @MdWarrington( View Tweet )

Nov 14, 2023

Nepal et al. No increased risk of GI perforation for tocilizumab in GCA HR 1.05 . Diverticulitis (RR 3.51), IV methylprednisolone (RR 5.41) risk factors. This fits with my priors, steroids are a bigger risk than tocilizumab. Abstr#2560 #ACR23 @RheumNow https://t.co/BAmBQA0kEP https://t.co/zRjmDIkOHp

Richard Conway ( View Tweet )

Nov 14, 2023

Great work @HoromanskiMd on a vasculitis in pregnancy plenary session! #ACR23 https://t.co/WSmqJjfBes

Mike Putman @EBRheum( View Tweet )

Nov 14, 2023

Fantastic presentation by Desh Nepal from MCW on risk of GI perforation in patients with #GCA Low incidence , no association with TCZ, but increased risk with IV methylprednisolone and h/o diverticulitis. @EBRheum #ACR23 https://t.co/bgvmjAXBEY

Sebastian E. Sattui MD, MS @SattuiSEMD( View Tweet )

Nov 14, 2023

Kaymakci et al. 49 GCA patients in clinical remission undergoing thoracic aortic surgery. Active aortitis in 82%. Abstr#2557 #ACR23 @RheumNow https://t.co/WQh47LThGD https://t.co/DeORKmjYP7

Richard Conway ( View Tweet )

Nov 14, 2023

Pregnancies outcomes in vasculitis: - Higher frequency of spontaneous abortion and preterm delivery - 12% had pre-eclampsia - Risk higher in multiparous > nalliparous - Risk highest in small vessel vasculitis Rector A, Abst#2425 #ACR23 #ACRBest @RheumNow https://t.co/TgbRWw9il5

Dr. Antoni Chan ( View Tweet )

Nov 14, 2023

MANDARA -52wk,ph3 non-inferiority study comparing efficacy & safety of benralizumab & mepolizumab in EGPA receiving SOC 👉Benralizumab was non-inferior to mepolizumab in achieving remission at wks 36 & 48 (2.71%; 95% CI –12.54, 17.96; p=0.7278) #ACR ABSTL14 @RheumNow #ACRbest https://t.co/S3aa3g5mnN

sheila ( View Tweet )

Nov 14, 2023

Vasculitis patients associated with increased pregnancy risks Large study of >600 pregnancies in >500 pts Vasculitis pts higher frequency of spontaneous abortion, elective termination, ectopic and molar pregnancy, preterm delivery 12% pre-eclampsia @RheumNow #ACR23 Abs#2425 https://t.co/Nqa77nxSFu

Robert B Chao, MD ( View Tweet )

Nov 14, 2023

Pregnancy outcome in Vasculitis - Claim database study A#2425 #ACR23 @RheumNow 665 vasculitis pts, LVV 60, MV 160, SVV 217, variable 250 Incr risk of preterm delivery, particularly medically-ind deliv, esp Small vessel vasc (5x risk med-induced) Higer risk pre-eclampsia/eclampsia https://t.co/bWMyY5oqNK

Eric Dein ( View Tweet )

Nov 14, 2023