Vasculitis

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 https://t.co/ya41nJG6qK
Dr. Antoni Chan @synovialjoints( View Tweet )
Jun 03, 2023
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 https://t.co/2DC37CM6gA
David Liew @drdavidliew( View Tweet )
Jun 03, 2023
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 https://t.co/rGPfOPX1gI
Aurelie Najm @AurelieRheumo( View Tweet )
Jun 03, 2023
#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 https://t.co/7uohfjGk49
Md Yuzaiful Md Yusof @Yuz6Yusof( 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
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 https://t.co/aEC8cQaR7O
David Liew @drdavidliew( 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
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 https://t.co/tSWpZlUPoE
David Liew @drdavidliew( View Tweet )
Jun 01, 2023
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 https://t.co/n7raIENVOT
David Liew @drdavidliew( View Tweet )
Jun 01, 2023
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 https://t.co/qeZHeCi9vq
David Liew @drdavidliew( View Tweet )
Jun 01, 2023
#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 https://t.co/3DDPR2K5NC
Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
May 31, 2023
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 https://t.co/7NGF5YaE9z https://t.co/m6SaibqmEq

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David Liew @drdavidliew( View Tweet )
May 31, 2023
Watch: GPA Treatment Choices https://t.co/9v6C5nOLqu https://t.co/1E347ulsvR

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Dr. John Cush @RheumNow( View Tweet )
May 28, 2023
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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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ANCA, vasculitis, test

International Consensus on ANCA-Associated Vasculitis with Glomerulonephritis

Jack Cush, MD
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 https://t.co/uYBNrGzdQm https://t.co/Rvs0ewHzwb

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Dr. John Cush @RheumNow( View Tweet )
May 22, 2023
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 https://t.co/tjhGlJPDWZ https://t.co/9h1FwfM0CP

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Dr. John Cush @RheumNow( View Tweet )
May 20, 2023
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

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Dr. John Cush @RheumNow( View Tweet )
May 19, 2023
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 https://t.co/tFn2p5DfJV https://t.co/Uu4Fmans40

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Dr. John Cush @RheumNow( View Tweet )
May 19, 2023
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 https://t.co/jw3wq2k7gb https://t.co/y3ck6KuCDj

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Dr. John Cush @RheumNow( View Tweet )
May 19, 2023
"Highest pre-test probability for GCA is actually: 1) Limb claudication 2) Jaw claudication #RNL2023 @RheumNow https://t.co/Ed52fIcVaI" https://t.co/dA1FlCEU3i

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Dr. John Cush @RheumNow( View Tweet )
May 19, 2023
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 https://t.co/Pn25Qt0WL4 https://t.co/5qROaTbD2w

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Dr. John Cush @RheumNow( View Tweet )
May 19, 2023
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Allergic Drug-Induced Arthritis (5.19.2023)

Jack Cush, MD
May 19, 2023

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.  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 https://t.co/LR9e0aXkeN https://t.co/qXUBkz5vfe

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Dr. John Cush @RheumNow( View Tweet )
May 18, 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

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Dr. John Cush @RheumNow( View Tweet )
May 18, 2023

Recent Blogs

ACR20 Pearls Part 3: Pragmatic Applications for Managing Vasculitis

Kathryn H. Dao, M.D.
Feb 11, 2020
Giant-Cell_Vasculitis.jpg
While the ACR prepares to publish its new guidelines for the diagnosis and management of vasculitis in the Spring of 2020, Dr. John Stone presented his own perspectives on the practical management of vasculitis during the 2019 ACR meeting in Atlanta.  He acknowledged that what may be pearls one day, may be disproven with data in the future.  Read Post

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