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Vasculitis

IL-6i in Behcets? Lit Review finds 25 articles papers, 74 pts (31 TNFi naive, 45 TNFi prior Rx). Pts Rx w/ tocilizumab IV. TCZ given for vascular, CNS , ocular & mucocutaneous. TCZ was effective in 87% TNF naive & 80% in TNFi Experienced pts. https://t.co/u1jnR9gb1L https://t.co/Rkqch4MVWi
Worldwide, IL-6 inhibitors are approved for RA, poly JIA, systemic JIA, AOSD, GCA, Takayasu arteritis, Castleman’s dz, CAR-T-cell-induced cytokine release syndrome, neuromyelitis optica spectrum disorder and severe COVID-19 https://t.co/SRPjerXnGS
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Heavy Metal Rheumatology (9.23.2022)

Sep 23, 2022

Below are this week’s highlights from RheumNow, as discussed by Dr. Jack Cush. Thanks to all of you for your kind comments and great reviews of our weekly podcast. Please let us know how we can improve by emailing me or recording your suggestion using the "Ask Cush Anything" link on our website

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Is PMR the Next Indication for Tocilizumab? About half of patients with steroid-dependent PMR were able to get off steroids altogether when they were started on tocilizumab (Actemra) infusions, a randomized phase III trial showed. https://t.co/LUMG4NnZzs https://t.co/zdFacyYyud
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Is PMR the Next Indication for Tocilizumab?

Sep 21, 2022

About half of patients with steroid-dependent polymyalgia rheumatica (PMR) were able to get off steroids altogether when they were started on tocilizumab (Actemra) infusions, which also improved disease control in most cases, a randomized phase III trial showed.



In a 24-week study, 49

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A longitudinal study of 506 ANCA-associated vasculitis (AAV) pts showed pts w/ negative ANCA serologies within 180 days of induction had signif lower risk of relapse (HR 0.55; 0.38 to 0.81) but not for ESRD or death within 5 years. https://t.co/qFb2Usov8L https://t.co/faogbabc2W
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CD19 CAR T Cell Therapy in SLE (9.16.2022)

Sep 16, 2022

The big news this week: the approval of deucravacitinib (a new class of drug?) for psoriasis; the 2022 ACR guidance on glucocorticoid-induced osteoporosis; a national poll of older adults over the age of 50 who claimed self-reported or doctor-diagnosed arthritis; and much more. Let's review

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Mayo study of 3817 temporal artery biopsies performed on 2539 pts (1994-2004) - 681 (27%) +Bx on one side. Biopsy length HAD NO significant effect BX positivity. If 1-side initially Bx-, then Bx of the contralateral side yielded an added 7% Bx positivity https://t.co/Lr8hYHIlG7 https://t.co/alIpklPtsw
A longitudinal study of 506 ANCA-associated vasculitis (AAV) pts showed pts w/ negative ANCA serologies within 180 days of induction had signif lower risk of relapse (HR 0.55; 0.38 to 0.81) but not for ESRD or death within 5 years. https://t.co/Dn8GGXnSDi https://t.co/C73hG9T7Au
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STING/IFN Activation Promotes ANCA-Associated Vasculitis Progression

Aug 29, 2022

Research presented in the Journal of Experimental Medicine shows that ANCA-associated vasculitis (AAV) may be propagated by pathogenic mechanisms triggering cGAS/STING/IRF3-dependent IFN-I release.

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Cluster analysis of 649 #GPA patients (age 60 yrs) finds 3 clusters: 1)Limited dz w/ ENT + cough(n=426) - many evovle to gen dz @ yr 1 2) Generalised non-renal Dz (176) ) 3) Renal dominant Dz(47) Mortality in #1, signif lower than mortality in #2 & #3 https://t.co/XgZVt9b73n
Should you do sural nerve biopsy (SNB) to Dx vasculitis? Study of 91 pts undergoing SNB suggests the SNB must be off sufficient length to improve Dx yield. 40/91 (44%) showed vasculitis. +SNB assoc w/ longer SNB sample, other organ Sxs & +ANCA https://t.co/6S00ySj0fL https://t.co/WbY400YsWX
CMV Increases Thromboembolism Risk in ANCA-associated Vasculitis Infection may play an important role in the genesis of vasculitis and ANCA seropositivity; this report suggests that past CMV infection may be a risk.https://t.co/K8HzolqLJ9 https://t.co/2VUasoinnL
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Hit Parade Review (8.12.2022)

Aug 12, 2022

We've got a lot to discuss this week: psoriasis; fatigue; sleep; sural nerve biopsies; uveitis and SpA; diet and RA; tofacitinib and the ORAL surveillance study; what not to take with mycophenolate - and more. In what order should these items be discussed? This week the run down is based on

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Cytomegalovirus Increases Thromboembolism Risk in ANCA-associated Vasculitis

Aug 11, 2022

Infection may play an important role in the genesis of vasculitis and ANCA seropositivity; this report suggests that past cytomegalovirus infection may be a risk in the occurrence of venous thromboembolism (VTE) in patients with anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis. 

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Increased Mortality in Giant Cell Arteritis

Aug 09, 2022

A population-based study from Ontario, Canada suggests an increased mortality risk in patients with giant cell arteritis (GCA), according to a recent report in Arthritis Care & Research.



A health administrative data study looked at 22,677 GCA patients (≥50 years of age)

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Do not take antacids or PPI with mycophenolate. Magnesium & aluminium hydroxide antacids (Maalox) will lower MMF Cmax 33% & AUC 17% if given simultaneously. PPI also lowers AUC by ~33% https://t.co/IoWISgL3SY https://t.co/JV1Yv5Pg9d https://t.co/b8UoQ4zMUV https://t.co/VwNgVQ5End
RTX Induction and Maintenance in Older ANCA–Associated Vasculitis Patients A cohort study suggests that RTX use among patients 75 years and older with ANCA–associated vasculitis (AAV) is efficacious but also has a high risk of serious adverse events.https://t.co/HF9hyQcHZV https://t.co/xpDSohFcRK
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Rituximab Induction and Maintenance in Older ANCA–Associated Vasculitis Patients

Jul 13, 2022

A cohort study suggests that rituximab (RTX) use among patients 75 years and older with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) is efficacious but also has a high risk of serious adverse events, likely related to associated steroid use and the advanced age of

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#Bestinclass Recurrent #PMR RCT of #sarilumab v placebo. Nearly doubles sustained remission but maybe attenuating effect - flare difference over time? N=118. 🤷‍♀️ Dunno who I would use it in yet. LB0006 @RheumNow @eular_org #EULAR2022 @Janetbirdope
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ICYMI: 2021 Rheumatology Year in Review

Jul 08, 2022

For 2022, let's look our top 10 list of advances, game-changers, worries and those better medical practices that evolved during 2021.

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Getting Real on PMR Dr. David Liew talks polymyalgia rheumatica and how our understanding has evolved over the years. #EULAR2022 https://t.co/DyVCxDVPE7 https://t.co/PF7zqxX7yk
FDG-PET/CTscans were used in 58 for FUO evaluations. Dx was Rheumatic (44.5%), malignancy (34.5%), or infectious (10.3%). Most prevalent Rheum dx was vasculitis (17%), especially LG vessel vasculitis. FDG PET/CT is a useful FUO pts https://t.co/NEZDB20OXN https://t.co/4123Gh2v2Y
Polymyalgia rheumatica immunological puzzle further illustrated Infiltrating macrophages expressing IL-6 and GM-CSF may drive the subacromial bursitis often seen in polymyalgia rheumatica, according to new research presented at #EULAR2022.https://t.co/oa619uNgnB https://t.co/gyNnsMDXGo
Environmental articulate matter (PM2.5) levels can increase the odds of a systemic autoimmune rheumatic disease onset (OR 1.12; 1.08–1.15), , w/ no effect of ozone. Results not changed by controlling for smoking. https://t.co/7BGBh9h0lf https://t.co/LcUo4Lxzgx
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