Advanced Clinical Practice for IgG4-related dacryoadenitis/sialadenitis and autoimmune pancreatitis
IgG4-related illness is a new systemic disorder affecting multiple organs. In IgG4-RD, the lacrimal, salivary, and pancreatic glands are affected. Lip and core needle biopsies are useful for IgG4-DS diagnosis. Early treatment is required to protect gland function. The use of glucocorticoids and steroid-sparing medicines may help manage IgG4-DS.
JAK Inhibitors in Rheumatoid Arthritis
JAK inhibitors have changed the way RA is managed. This is because the JAK pathway is linked to numerous cytokines that are linked to RA pathogenesis. JAK inhibitors offer quick action, role in reducing central pain processing, effect on structural damage and radiographic progression, and safety.
Autoinflammatory Vasculitis Syndromes: An Emerging Diseases
AIDs should be considered in children with inflammatory episodes that recur or persist over months or years in the absence of other causes. Vasculitis is most common in FMF. Try to identify clinical pattern consistent with one of the known AIDs but may need to thing outside those boxes. Genetic testing remains the mainstay of diagnosis & functional analysis assists with precision medicine.
Juvenile Idiopathic Arthritis (JIA) treatment recommendations and guidelines
Individuals with JIA whose biologic dose was increased from standard to high dose displayed an improvement in disease activity scores, similar to the improvement observed in patients whose biologic dose was increased from standard to high dose. For individuals who do not respond well to standard dose therapy, raising the biologic dose to a high level may be a realistic option to consider.
Sjogren's Update APLAR 2021
Sjogren's syndrome is a rhematic, autoimmune illness that affects middle-aged women. Currently, Patients have a sex bias due to the X chromosome dosage effect (IL 17). Sjögren's has no effective disease-modifying drugs. Several failed clinical trials approved Metformin as a new agent. Recent COVID-19 pandemic has shown that a COVID-19 infection is a trigger for anti-Ro.
Prevention of infective complications in SLE
Infection in patients with SLE was associated with a five-fold increase in standardized mortality ratio. Factors related to increased risk of infection include immunosuppressive medications, disease activity, impaired immune response, and renal impairment. Clinical outcomes reports of LN patients primarily focused on the efficacy and toxicities of different therapeutic interventions.
APLAR Consensus Statement on SLE Management
There are 34 consensus statements released by the APLAR SLE Special Interest Group. More discussion needed on: role of belimumab in lupus nephritis; role of COVID-19 immunisation; role of thrombopoietin receptor agonists in renal protection; Pregnancy, assisted reproduction, and obstetric APS require another Delphi.
Updates on Immune Mediated Necrotising Myopathy
Idiopathic inflammatory myopathies (IIM) are systemic conditions with dominant manifestations on skeletal muscle. There is a raised serum level of muscle enzymes. Immune Mediated Necrotising Myopathy (IMNM) is more frequently associated with sarcolemmal MHC1 expression, complement deposition in muscle capillaries, more lymphatic infiltrates, & more regenerative fibres.
ACR response in Psoriatic Arthritis
Classification of Criteria for Psoriatic arthritis (CASPAR) states that a patient must have inflammatory articular disease (joint, spine or entheseal) with ≥3 joints. As per SELECT PsA 1 and PsA 2 studies, it was found that there is significant greater ACR20 response rate vs placebo at week 12 in non-bDMARD IR and bDMARD-IR patients.
Understanding the Predictors of Long-Term Organ Damage
SLE is a chronic and debilitating disease characterized by flares, progressive end organ damage as well as increased mortality. Several factors linked to organ damage that can categorized as fixed factors (age, pre-existing organ damage, race, sex), increased modifiable factors (steroids use, hypertension, higher disease activity, active renal involvement), & decreased modifiable factors.
Relapsing Polychondritis (RP) in 2021
Relapsing is characterised by recurrent inflammation of cartilaginous tissues and proteoglycan-rich structures. This condition can be fatal. PET-CT can help determine disease severity and therapy options. Mild joint, ear, and nose inflammation is treated with NSAIDs, Dapsone and Colchicine. Acute exacerbations require systemic corticosteroids. Biological medicines are modestly effective in RP.
Recent Progress in Targeted Therapy for SLE
The number of patients with SLE is increasing and there are substantial unmet medical needs for this disease. The heterogeneous nature of SLE manifestations remains a substantial burden for many patients. New evidence is guiding towards an understanding of the molecular and cellular pathways that are involved in the disease.
Axial psoriatic arthritis - Is it different from Axial Spondyloarthritis?
Ax PSA is heterogeneous and a proportion of patients appear to have axial disease distinct from axSpA. In addition to genetic, clinical, and imaging differences, axPsA may respond differently to treatment than axSpA. Right sacroiliac arthritis was statistically more severe than left sacroililiac arthritis. Secukinimab reduced total berlin MRI score for the entire spine and SI joints.
Update on Future Therapeutics in Osteoarthritis Treatment
Canakinumab is a monoclonal Ab to IL-1B that treats inflammation underpinning atherothrombosis. It reduced the chances of joint replacement significantly as compared to placebo in the CANTOS trial. In PROMOTE trial which compared Methotrexate and placebo, WOMAC pain, stiffness, & function improved significantly with MTX. Many new promising therapies have come up about inflammation.
Living Recommendations Paradigm in OA Treatment Guidelines
Living guidelines provide updated recommendations & need to understand why recommendations diverge. The final arbiter comes through shared clinical decisions between healthcare provider and patient. Common recommendations for osteoarthritis:Self-managementWeight lossCane overshoe wedge and other forms of bracesTopical NSAIDsOral non-selective or selective NSAIDs with caution
RA special interest group Symposium - Early RA criteria
Very early rheumatoid arthritis (VERA) was defined as a disease with symptoms of less than 12 weeks. By the early 1990s, it has decreased to 24 months with greater emphasis on the first 12 months. Detection of ERA and VERA is important for improving outcomes. MRI/USG are adjunctive tools in the detection of ERA and VERA. New ERA criteria are validated and need to be used in routine practice.
RA special interest group Symposium - Clinical Deep Remission
Remission is the main target of RA and DAS28 criteria is inadequate. Clinical deep remission includes no swollen joints, no tender joints, normal ESR, and normal CRP. Longitudinal RA cohort from Peking University People's hospital included patients with 3 or more than 3 visits per year. It was found in this study that CliDR has better practicality.
Cardiovascular Comorbidity in Axial Spondyloarthritis- What's new?
Axial Spondyloarthritis (AS) patients have an increased risk of death, stroke, & CVD. The author shows that Canakinumab 150 mg every 3 mnths reduced recurrent CV events compared to placebo, regardless of lipid lowering. Inflammation control & therapy of CV risk factors may slow progression of subclinical atherosclerosis and events.
Co-morbidities in Psoriatic arthritis (PsA)
Anxiety showed an impact on DAPSA, PsAID, and HAQ-DI in a study that highlights the impact of co-morbidities on disease activity, patient global assessment, and function in psoriatic arthritis. FM PsA patients had higher mean BMI than non-FM ones. In PsA, fibromyalgia reduces the effectiveness of biologic drugs. Patients with PsA have higher levels of FeNO & SLE comorbidity.
A Single course Rituximab - What does it achieve?
From 2014 to 2020, all RA patients who received a single course of rituximab with a minimum of 1 yr post-injection follow-up were included in the study. The baseline DMARDS, steroid & lab investigations available were compared . A single course of low dose rituximab leads to better disease control which decreased steroids and stable dmards dosage even after one year.
