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Late Breaker - EULAR 2023 update on imaging of large vessel vasculitis. Ultrasound is now recommended as first line imaging test in all patients with suspected GCA, and axillary arteries should be in the standard examination, Dejaco C et al, Abst#LB0009, #EULAR2023 @RheumNow
2023 @eular_org recommendations for LVV imaging interestingly, the key changes vs 2018 are about PET/CT: - can consider PET/CT for cranial GCA diagnosis - PET/CT (alt MRI) can be used for monitoring - more for when you lose ESR/CRP because of IL-6i #EULAR2023 @RheumNow
2023 update @EULAR recommendations imaging in GCA What's new: 1. US = first line imaging test 2. Axillary arteries should be included in standard examination 3. Alternative imaging FDG-PET or MRI 4. Takayasu: MRI preferred CT or FDG-PET alternatives @Rheumnow #EULAR23 LB0008
#EULAR2023 Clinical Highlights. Vasculitis: OP0061 - new US imaging showing vessel inflammation differentiating patients with Behcet’s vs No-BD. OP0304: cohort study showed Benralizumab (IL5 RA) given for eosinophilic asthma also improved BVAS. RCT for EGPA is ongoing @RheumNow
#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
The steroid dosing in SAPHYR (sarilumab in PMR): Bottom two trajectories: sarilumab protocol & actual Top two trajectories: placebo protocol & actual Fascinating that with sarilumab, more PNL only really in play at PNL <3mg/d. Def takes the heat out POS0715 #EULAR2023 @RheumNow
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
I mean, if proteomics is more your jive for GCA, we’ve got that too here at #EULAR2023. Definite potential for phenotyping a disease with diverse outcomes POS0694 @RheumNow
Very early days, but it’s cool to see transcriptomics in GCA ➡️ in situ spatial profiling ➡️ drug-gene interactions ➡️ new therapeutic targets identified. Only time will tell if they will work, but very cool nevertheless. POS0091 (Mayo, La Jolla, & INSERM) #EULAR2023 @RheumNow
Do we use too much PNL in GCA (when not using TCZ)? Could we wean quicker? Salvarini group n=22 26w PNL weaning protocol from GiACTA, but no TCZ 10/26 in relapse free remission at 1y Much less PNL, still some steroid AEs Way of the future for some? POS0728 #EULAR2023 @RheumNow
#EULAR2023 #OP0007 What are the recent trends of autoimmune disease (AID)? A database study (22m) in UK showed: - 1 in 10 people had AID in the last 20yrs - socioeconomic, seasonal & regional disparities cd influence pathogenesis - CTD (SLE,pSS,SSc) tended to co-occur @RheumNow
Autoimmune disease diagnoses slowly on the rise, despite reduced smoking - but that’s now 10% of the population, & many patients have more than one. Most are lifelong. Surely this needs more investment?? CPRD data from the UK #EULAR2023 OP0007 @RheumNow

How Age of Onset Affects Giant Cell Arteritis

MedPage Today
May 23, 2023

Giant cell arteritis (GCA) has a different phenotype when diagnosed late in life compared with earlier onset, a large Italian cohort study indicated.

Features of what might be called "senior GCA" include increased rates of cranial symptoms, a markedly higher risk for aortic aneurysm

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International Consensus on ANCA-Associated Vasculitis with Glomerulonephritis

May 22, 2023

Nephrology Dialysis Transplantation has published an overview of the management of anti-neutrophil cytoplasmic antibody associated vasculitis with glomerulonephritis based on several international guidelines, including those frorm the ACR 2021, EULAR 2022 and KDIGO 2021 (Kidney Disease:

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"Ideally, you should get your TA biopsies within 2 weeks, but that's not always possible. Don't delay tx." @anisha_dua reminds us that bx can still be positive up to 8 weeks after steroid initiation. Just be aware of lesional changes with time. #RNL2023
Dr. Anisha Dua on Imaging in PMR: - US of shoulders to eval for bursitis can increase specificity - MRI better for pelvic girdle, but expensive - Consider PET if lack of response to steroids, r/o malignancy #RNL2023 @RheumNow
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
How to long for maintenance of GPA? Continue for 24 months, then consider: Relapse history? Organ damage? Toxicity? Patient wishes? Compliance? Family planning? Dr. Langford @RheumNow #RNL2023
Carol Langford #RNL2023 @RheumNow Rx options for GPA showed by targeted to patient's disease characteristics of severe vs non-severe disease CYC not for non-severe due to toxicity MTX, MMF not for severe disease
"Highest pre-test probability for GCA is actually: 1) Limb claudication 2) Jaw claudication #RNL2023 @RheumNow"
GCA biopsy: When and How Early is best, rec'd in first 2 weeks. Findings can be present at 8 weeks but be less prominent @anisha_dua rec's unilateral imaging in most pts, especially w scalp tenderness on one side &gt;1 cm length #RNL2023 @RheumNow

Allergic Drug-Induced Arthritis (5.19.2023)

May 19, 2023

Dr. Jack Cush reviews the news and journal reports from this past week on  This week we delve into some odd associations, repeat drug warnings and the consequences of antirheumatic therapies.

  1. Subanalysis of the tofacitinib ORAL Surveillance study shows the JAK

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Dr. Spiera's approach to PMR treatment - prefers methylprednisolone - rapid taper over 16 weeks - consider GC sparing therapy (MTX, IL-6i) @Rheumnow #RNL2023
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