Peter’s Pearls in vasculitis - Dr Merkel noted: 1. Do NOT follow ANCA titers 2. Anti-PR3 ANCA more likely to relapse 3. ANCA+ EGPA behaves like GPA/MPA 4. Don’t delay is there is Pulm hemorrhage/ RPGN 5. Steroids save lives in the short term #CCRwest

Thank you for inviting me to lecture #LSUrheum on Practical Applications of the @acr-journals.bsky.social #LupusNephritis guidelines. #Shreveport

May is #LupusAwareness month! @rheumnow is running a campaign: Lupus Unlocked: Keys to Mastery First blog by Dr Sammaritano rheumnow.com/news/contracep… @Lupusreference @LupusOrg @EricFMorand @edvital @alhkim @alvinwellsmd @Janetbirdope

“TNFi are on the whole cardioprotective for IMIDs”- Prod McInnes #CCRE25

Hypogammaglobulinemia is prevalent in our pts exposed to B cell depleting therapy, BiTEs, CAR-T, alkylators. Worse with age and if they have underlying low Ig’s before Rx. Severe hypoIgG is <200 mg%. High risk patients=AAV & SLE Dr @LCalabreseDO #CCRE25

Besides alkylators, other meds can cause hypo-IgG @LCalabreseDO #CCRE25

Dr M Kahlenberg shares what she does for #SLE patients 1. HCQ for every patient and check HCQ blood levels once a year 2. Sun protection using zinc/ titanium based sunblock 3. Add HCQ for people with incomplete lupus (when you suspect but not enough evidence) 4. Less steroids! #CCREast25

This is pretty cool- I tried out Open Evidence (ChatGPT for HCPs). It can generate mock board questions, write discharge planning, help with medical decision making. The last photo is a fictional case to see how it would care for a 78 yo w/RA, recurrent infx & HCV @EvidenceOpen

CDC guidance: who should & should’t get MMR (#measles mumps rubella) vaccine. Interestingly, there is data showing if someone get vaccinated within 72 hours of exposure to measles, they may get some protection and have a milder course. www.cdc.gov/vaccines/vpd...

Treat to target goals are near impossible to achieve. Read my conversation with Dr Dzhus on how the war has affected patients and rheumatologic care in #Ukraine. @ashira-md.bsky.social @kristenyoung.bsky.social @ukrainematters.bsky.social @rheumcat.bsky.social @rheumnow.bsky.social

Thanks Alabama Society for the Rheumatic Disease for having me come review the 2024 ACR Lupus Nephritis Guidelines. Lively discussions and great company! #SLE #LupusNephritis

Who’s liable for an incorrect #AI diagnosis or medical advice? Is this a reason why physicians are slow to adapt AI in their practice? Interesting law review article on this www.acsh.org/news/2024/03... @rheumnow.bsky.social

80% #hydradenitis suppurativa pts are smokers or former smokers, smoking can predate #HS by 4-5 years. Other associations: DM-2, Spa, obesity, SAPHO, PCOS eval for SCC (squ. cell CA) #RNL2025 @rheumnow.bsky.social

"Tombstone comedones" (2 comodones together) are pathognomonic of #Hydradenitis - Dr. J Cather #RNL2025 @rheumnow.bsky.social

"Vinegar water or 1 tbs bleach to 1 gallon water can help with the odor from #Hidadrenitis" - Dr. J Cather reviewed goals of therapies and Rx's (while laser hair removal can help, it also can cause problems; intralesional steroids can cause atrophy) @rheumnow.bsky.social #RNL2025

Dr. C Bakewell's PEARLs on imaging in #ankspond & #PsA: - PsA may have +HLA-B08 and B28 (esp if it looks like candle drip--not just B27) - for PsA, up to 30% of pts will have spinal lesions without Si joint changes - for AS, MRI SI joints, xray the spine #RNL2025 @rheumnow.bsky.social

Can NSAIDS reduce the risk for progression in #ankylosingspondylitis? - Dr. Van Der Heidje #RNL2025 @rheumnow.bsky.social

What are RA flare risks? @rheumnow.bsky.social #RNL2025

The consequences of #RA flares - @rheumnow.bsky.social #RNL2025

WWJCD-- what would Jack Cush do? for RA flares #RNL2025 @rheumnow.bsky.social

"NO guidelines address RA flares!" - @rheumnow.bsky.social on how flares are perceived as bad and important, but yet, no standard definition, guidance on this #RNL2025

#RNL2025. RA flare definition differs w/ clinical trial. Pt's flare definition is even more different. Recent study defined flare as sDAI >=4.7 or CDAI > =4.5. a longer flare is worse than a shorter flare. Can't rely on DAS28 & low correl w/VECTRA or biomarkers. @rheumnow.bsky.social

#RNL2025 @rheumnow.bsky.social on SGLT2/GLP-1 helpful for PsA, PsO... likely Rheums will be more comfortable writing these Rx's given the benefits seen for the inflammatory disease. Make sure you know side effects and how to titrate them.

My new blog: This unique career lifestyle has been embraced by several of our colleagues and is growing… it has filled the void in areas that are rheumatology deserts. @RheumNow @ACRheum @AWIRGROUP @uptoTate @vksandhumd rheumnow.com/blog/rheum-t...

BTW, abstracts are due today for #EULAR25 congress.eular.org/abstractsgen...

I registered to attend RheumNowLive in person … this will make it even more interesting. #ACR25 will need to step up its game @vksandhumd.bsky.social @rheumepi.bsky.social @rheumcat.bsky.social

"If you want a planned pregnancy, you need to first prevent an unplanned pregnancy ." - @kidneydoc101.bsky.social on pregnancy challenges for patients with #LupusNephritis @kdigo.org

Prof TM Chan highlights key management objectives in #LupusNephritis @goKDIGO

Anyone who has interest in Glonerular diseases (eg #LupusNephritis #AAV #IgAN) — @KDIGO.org is having its inaugural guidelines educational meeting happening today and tomorrow … note time zone (LN session at 12:30 CST today) kdigo.org/kdigo-direct...

Attention Rheum Fellows and recent graduates —this is a professional development conference teaching you things about clinical and academic practice you don’t learn during your training csro.info/fellows/fell...

ICYMI: Dr. M Dall'Era & @BradRovin discussed her paper & ACR 2024 #LupusNephritis guidelines: start triple Rx early "MMF+steroids alone is substandard" rapid⬇️proteinuria➡️better for renal outcomes use⬇️steroid dosing protect the podocytes @LupusForum youtu.be/mak240dn8Yg

My dear friend Dr Eugene Fung is retiring after decades of providing rheumatologic care for the people of Central Texas. Even at his retirement party, he continues to teach us. @rheumnow.bsky.social

“On average male doctors earn 29% more than female doctors in 2023” www.medscape.com/slideshow/20...

Need a cause for end-of-year donations? The Lonestar LFA @LupusOrg is hosting their 3rd annual camp in North Texas for children living with #SLE Donations can be made by texting LUPUS to 707070 or visiting their website: secure3.convio.net/lfach/site/Don… Registration for the camp is opened, too

Weekly recap in ACR journals Lupus nephritis kidney biopsy features to guide BI655064 add-on therapy doi.org/10.1002/art.... Four-year pain course in hand osteoarthritis doi.org/10.1002/acr.... Heart failure incidence in patients with and without rheumatoid arthritis doi.org/10.1002/acr....

Scope of Infections Associated with b/ts DMARDs

Congratulations to Drs. Mohamad Bittar and Atul Deodhar for this *outstanding* review of axial spondyloarthritis. Bookmark this for a read!

I love it when the fellows teach me— the arrows on the bottom of the iphone camera is for when you take a selfie to tighten or expand the frame (designed so that it doesn’t look like your arms are in the way! Despite the lesson, my photo with the #USC #RheumFellows did not come out as hoped!

One thing I didn’t expect in the wake of the CEO shooting is the sudden attention on health insurance policy. I have seen this video and the BCBS policy itself go viral on almost every platform. People are waking up. Real lasting change in healthcare is coming. youtube.com/shorts/vWA2a...

Disease course and outcomes in pediatric-onset AAV affecting the kidneys. At 1 year, 42% had evidence of permanent renal damage. Renal function at diagnosis is a strong predictor of renal function at 1 year In Arthritis & Rheumatology doi.org/10.1002/art.... #Medsky #Nephsky

Disease modification in #SLE means 1. preventing flares 2. Reducing steroids and 3. Reducing organ damage over time. Steroids temporarily reduce disease activity, but they do not prevent future flares and contribute to damage. Compare to biologic therapies that protect patients over the life course.

It’s not just physicians but APPs are also getting #BurnedOut. I have been volunteering at a charity rheum clinic, and the joy of practicing medicine is back… I am able to spend more time with the patients, not have to rush or worry about billing/documentation, and can control my schedule.

Off-Label Use of JAK Inhibitors in Orphan Diseases and Other Conditions? The issues surrounding publication bias are real.

Care pathways among patients with SLE in the Lupus Midwest Network registry: • ~1/4 initially seen by nephrology or dermatology • 1/4 had delays in SLE-spec. care, which were assoc. with damage • Hematologic or aPL antibodies domains, and fewer SLE manifestations assoc. with delay in SLE-spec. care🩺

🆕 #ACR24 | Updated Guidelines for Lupus Nephritis Treatment & Management 🫘 Highlights 🔶 • Critical role of renal biopsy • Differences for treatment by LN Class • Adjunctive Rx w/ HCQ & RAASi • GC pulse ⇢ *moderate/low* dose PDN #Lupus #NephSky #RheumSky #Rheumatology #MedSky

jamanetwork.com/journals/jam... Long-Term Risk of Autoimmune and Autoinflammatory Connective Tissue Disorders Following COVID-19 | Rheumatology | JAMA Dermatology | JAMA Network

#Inebilizumab-- anti-CD19 shown efficacious to reduce #IgG4RD flare rates in MITIGATE study. #ACR24 #YearInReview

"Targeting CD40/CD40L may be an effective approach to treating #Sjogrens." - Dr. M Pillinger #ACR24 #ACRReview

#ACR24 #YearInReview MANDARA Trial Benralizumab (IL-5Ri) vs Mepolizumab (IL5i) noninferiority study lead to 2024 FDA approval for benralizumab in #EGPA. Secondary outcomes: eosinophils fell more dramatically and more pts able to get off of GCs with #Benralizumab.

Is it worthwhile to use MTX in knee OA? #ACR24 #YearInReview @rheumcat.bsky.social