Articles By Richard Conway, MBBChBAO, PhD
ICYMI: EGPA in 2025
Formerly classified as an ANCA-associated vasculitis, EGPA is both most commonly ANCA negative and clinically different to the other two ANCA-associated vasculitis conditions, GPA and MPA. The management of EGPA has frequently fallen into the trap of being copied from its more common and well-known cousins. Now, however, we are seeing a discordance and following GPA/MPA management will potentially lead to both over-treatment and suboptimal treatment for EGPA. In this context, the Sunday morning session at RNL 2025 on “EGPA management in 2025 and beyond” by Dr. Michael Wechsler was both timely and clinically relevant.
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EGPA in 2025
Formerly classified as an ANCA-associated vasculitis, EGPA is both most commonly ANCA negative and clinically different to the other two ANCA-associated vasculitis conditions, GPA and MPA. The management of EGPA has frequently fallen into the trap of being copied from its more common and well-known cousins. Now, however, we are seeing a discordance and following GPA/MPA management will potentially lead to both over-treatment and suboptimal treatment for EGPA. In this context, the Sunday morning session at RNL 2025 on “EGPA management in 2025 and beyond” by Dr. Michael Wechsler was both timely and clinically relevant.
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“Preventing” Arthritis in Psoriasis
The always compelling Dr. Alexis Ogdie explored whether aggressive treatment of psoriasis can prevent psoriatic arthritis in an excellent Saturday morning session at RheumNow Live 2025.
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Best of 2024: Vasculitis Pearls
Once again RheumNow Live 2024 really delivered with high impact learning packed into short sessions. As someone with an interest in vasculitis it was fantastic to see four of my favorite speakers in the Vasculitis Mavens and STEP talks. They gave us what we really want from these talks – personal opinions and approaches that go beyond the guidelines. They really dropped a selection of pearls on us and I wanted to share a few of these with you.
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Methotrexate to Prevent RA, Clear as Mud
Intervention in individuals predisposed to develop RA, with a holy grail of prevention of RA, has long been a hot topic. The 4-year results of the TREAT EARLIER study, presented at Tuesday’s oral abstract session, show that methotrexate appears to prevent the development of RA in high risk ACPA- patients.
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Up-front Secukinumab in PsA?
We now have an absolute plethora of agents available for use in psoriatic arthritis (PsA). In contrast we have an almost complete lack of understanding of how best to optimise use of these agents – what is the right agent at the right time for the right patient. A study presented this week has given us some further information on the topic.
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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 who clearly need an alternative as glucocorticoid adverse events multiply.
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RIP to Glucocorticoids in GPA
For many years glucocorticoids were the mainstay of our treatment of granulomatosis with polyangiitis (GPA). The paradigm shifted with cyclophosphamide and then again with rituximab, and we used less steroids, but we still used lots. Avacopan teased the demise of steroids, but in the trial they, and now we, still use them. Glucocorticoids are our old trusty friend, our comfort blanket. But no more! Good riddance to the medication with the highest long-term adverse event burden that we use. Long-term glucocorticoids in GPA should now be a rarity. The reason for such exuberance is the TAPIR study presented by Dr. Peter Merkel at Saturday’s opening plenary session.
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ICYMI: Vasculitis Pearls
Once again RheumNow Live 2024 really delivered with high impact learning packed into short sessions. As someone with an interest in vasculitis it was fantastic to see four of my favorite speakers in the Vasculitis Mavens and STEP talks. They gave us what we really want from these talks – personal opinions and approaches that go beyond the guidelines. They really dropped a selection of pearls on us and I wanted to share a few of these with you.
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ICYMI: Co-management of Psoriatic Disease
It is a common clinical scenario to see someone with both severe psoriatic arthritis and skin psoriasis. In an ideal world this would involve a combined clinic with our local friendly dermatologist. For many of us, however, this is not practical for many reasons. The excellent Saturday morning session on choosing systemic therapies in psoriatic disease at RheumNow Live 2024 from dermatologist extraordinaire Dr. April Armstrong was therefore hugely insightful.
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